Membership Application Form for Retired Members

I wish to become a member of the Public Service Friendly Society in accordance with the registered rules.

Surname

First Name(s)

Home Address

Previous Department

Personnel No.

Email Address

Home Telephone Numbers

Mobile Telephone Numbers

untitled element

Authorisation Form

Please deduct from my salary, until further notice, a sum equivalent to twenty-five cent per hundred Euro (equal to 0.25%) of my inclusive yearly salary, such deduction to be made in equal instalments throughout the year, and pay it to the account of the Public Service Friendly Society.

Name

Personnel No.

Previous Department

Signature

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