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    NPS Application Form

    Uploaded by

    데이브자바이
    This document is an application form for a lump-sum refund or lump-sum death payment from the National Pension Service in Korea. The front of the form collects information about the insured deceased person and beneficiary. It requests details like names, resident registration numbers, relationship, financial account. The back provides instructions on required documents, how the application will be processed, and special notes for different beneficiary circumstances and agent applications.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    NPS Application Form

    Uploaded by

    데이브자바이
    515 views2 pages
    This document is an application form for a lump-sum refund or lump-sum death payment from the National Pension Service in Korea. The front of the form collects information about the insured deceased person and beneficiary. It requests details like names, resident registration numbers, relationship, financial account. The back provides instructions on required documents, how the application will be processed, and special notes for different beneficiary circumstances and agent applications.

    Original Description:

    NPS Application Form for all OFWs

    Copyright

    © Attribution Non-Commercial (BY-NC)

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    This document is an application form for a lump-sum refund or lump-sum death payment from the National Pension Service in Korea. The front of the form collects information about the insured deceased person and beneficiary. It requests details like names, resident registration numbers, relationship, financial account. The back provides instructions on required documents, how the application will be processed, and special notes for different beneficiary circumstances and agent applications.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    515 views2 pages

    NPS Application Form

    Uploaded by

    데이브자바이
    This document is an application form for a lump-sum refund or lump-sum death payment from the National Pension Service in Korea. The front of the form collects information about the insured deceased person and beneficiary. It requests details like names, resident registration numbers, relationship, financial account. The back provides instructions on required documents, how the application will be processed, and special notes for different beneficiary circumstances and agent applications.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    [Form 23] (Front)

    (Please refer to the back side. Spaces marked ※are Official Use only.) Period for Handling
    Immediately
    □Lump-sum Refund or
    Application for {
    □Lump-sum Death Payment

    Name Resident － Tel.


    Registration No.
    Beneficiary
    (Representative Mailing Postal Code□□□－□□□
    beneficiary of Address
    equal standing)
    Relationship Number of □One □ designated
    to Beneficiary Beneficiaries of Representative
    (Deceased) equal standing □More than One ( Persons) □ undesignated
    Insured Name
    Registration - Date of
    (Deceased) No. death
    Financial Institution to which the Account No.
    benefit shall be transferred

    ※ Entitlement ※ Date of Eligibility ※ □Yes ※ □Yes


    Code ※Ending date of calculation Disabled □No Unpaid □No
    benefit
    for Additional payment
    ☞ Please write below only if there are equal beneficiaries and a designated representative.
    Name Resident Registration No.
    Designation of a representative ※Degree of
    No.
    Date Signature Disability
    Beneficiaries
    of equal ① －

    standing ② －

    ③ －
    ☞ “Choice of Benefit” is only for a person who is eligible for two or more benefits.
    ※ Choice of Eligible Benefit
    Benefit Benefits (① D M Y)
    ②
    ( D M Y)
    ③
    ( D M Y) chosen ( D M Y)
    (Date) (Date)
    ☞ Fill in below only in the case of an application by an Agent.

    Reason □ Staying abroad □ Military Service Beneficiary (Seal)


    Application by □ Imprisonment □Other
    Agent Date of (Verified by a
    application relevant Chief (Stamp)
    (Verification) official)
    Name Registration No. - Tel.
    Applicant Relationship to
    Mailing Postal Code □□□－□□□ Beneficiary
    Address

    I hereby apply for a Lump-sum Refund or a Lump-sum Death Payment under Free of
    Article 34 of the Enforcement Regulation in the National Pension Act. Charge
    Receipt
    Date of Application: D. M. Y.
    Applicant: (Signature or seal)

    To. President of National Pension Service

    1
    (Back)
    The Application shall be processed as follows.

    Applicant Through National Pension Service

    Regional Office
    Fills in the Application receives application & confirms
    the entitlement

    Financial Institution Head Office


    Receipt notifies of
    deposits into the account requests payment payment

    Regional Office
    determines the payment, sends the
    notification to applicant

    《 Required Documents 》
    1. The Applicant's Resident Registration Card or other Identification Card.
    2. A copy of Certificate of Resident Registration (in the case of the application caused by death of the contributor )
    3. If applied by an agent, a copy of beneficiary's Registered Seal Certificate. (인감증명, Ingam
    Jeungmyeong, it is available at Gu Offices.)
    4. If applying by way of a loss of Korean nationality or emigration from Korea, a copy of your Passport or
    other relevant certificates which can prove the cause of application.
    《 Tips 》
    1. Spaces marked ※ are for Official Use only.
    2. Please fill in all appropriate items concerning the beneficiary; name, resident registration and telephone number.
    Mailing address and postal code should be written according to the Certificate of Resident Registration.
    3. Account number at a financial institution should belong to the applicant and be confirmed that it is open.
    4. If beneficiaries of equal standing designate a representative, the designated person shall stamp or sign on the
    "Designation of a representative" space.
    a. If there is no representative, each beneficiary of equal standing shall apply individually.
    b. If beneficiaries of equal standing are under age 18, his/her legal agent shall stamp or sign on the "Signature"
    space .
    5. Fill eligible benefits and the date in the "Choice of Benefit" space only if you have a choice of benefit under
    Article 28 of the Enforcement Regulation of the National Pension Act.
    6. “Application by an Agent" is available only if a beneficiary is staying abroad, in prison or other reasons.
    7. In case of an application on behalf of a beneficiary, the Seal should be the same as that of the beneficiary's
    Registered Seal Certificate.
    ※ If a beneficiary is confined to a prison or detention center, it should be verified by the chief official of that
    facility.

    ※ I apply for a Lump-sum Refund or a Lump-sum Death Payment despite knowing that I can not
    receive a Special Old-Age, Disability or Survivors Pension if I receive the Lump-sum Refund.

    Beneficiary: (Signature)

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