MF1401 - Request For Annuity Purchase

Request No

Ministry

Date

CPR No.

Name

Date of Birth

Retirement Date	Retirement Age	unspecified duration	actual length of service	required length of service for retirement benefits	total length of service	salary and social allowance	reason for termination of service	cost of purchasing the assumed service period	paid by the employee

the fiscal year that will bear the cost of the purchase

Prepared by

Tel. No

Date

Authorized by

Job Position

Yes, I give permission to store and process my data