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Form in my presence and I agree to provide all information and assistance as may be needed by the Board in relation to this nomination form. Name (as in NRIC / Passport) 1. 2. NRIC / Passport No. Mailing Address Tel / HP No. Relationship to CPF Member Signature Revised in August 2014 Page 1 of 2 4. DECLARATION i) I do not wish to distribute my CPF moneys according to the Intestacy laws/Inheritance Certificate, whichever is applicable. I wish to distribute my CPF moneys and any share.

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