BAHAMAS HOTEL INDUSTRY MANAGEMENT PENSION FUND

SOUTHERN ENTRANCE; SG HAMBROS BUILDING, WEST BAY STREET; PO BOX N7799; NASSAU NP, THE BAHAMAS; (242) 322-8381-4 (242) 502-4243; FAX: (242) 502-4221

The Following information is needed from all pensioners to complete our records.

NAME: _____________________________________________________

STREET ADDRESS: _________________________________________

_________________________________________________________________

POSTAL ADDRESS: _________________________________________

TELEPHONE CONTACT: _________________________________________

BAHAMAS HOTEL INDUSTRY MANAGEMENT PENSION FUND

SOUTHERN ENTRANCE; SG HAMBROS BUILDING, WEST BAY STEET; PO BOX N7799; NASSAU NP, THE BAHAMAS; (242) 322-8381-4(242) 502-4343 FAX: (242) 502-4221

BENEFICIARY DESIGNATION

EMPLOYEE NAME _________________ ADDRESS _______________

_______________________________________________

I hereby designate as my Primary Beneficiary to receive the pension benefits, if any, payable at my death under the Rules and Regulations of the Pension Plan:

Name of Primary Beneficiary Address Relationship

In the event that my Primary Beneficiary named above predeceases me, I hereby designate as my Secondary Beneficiary to receive the pension benefits, if any, payable at my death under the Rules and Regulations of the Pension Plan it being understood that if any Primary Beneficiary survives me, no benefit will be paid to a Secondary Beneficiary:

Name of Secondary Beneficiary Address Relationship

__________________________________ _______________

Employee’s Signature Date

__________________________________ _______________

Witnessed by: (Not a named Beneficiary) Date