APPLICATION FORM

Here you can apply directly to the O.P.F., or download the application in pdf and send the completed form via fax at 0030 2109480995.

Fund Register Number (to be filled in by the Fund)

Surname (as indicated on the identity card)

Name

Date of birth (dd/mm/yyyy)

Gender

Father’s name

ID No./Passport no.

Passport’s expiry date

Nationality

Taxpayer Identification No.

TIN Country

Tax Office to which tax return is filed

Social security no.

Mailing address street & no.

Postcode

City & Prefecture

Mobile no.

Residence no.

Business no.

E-mail

Current Social Security Agency

Year of first-time classification under Social Security Agency of Main Insurance

Employer’s corporate name

Payroll code

Date of employment

Service of employment

The fields “Employer’s corporate name” & “Kind of cooperation with the Group” will be filled in by the applicant while the remaining fields of this category will be filled in by the Fund.

Office Employee

C.E.O. or member of Board of Directors

Personnel (on the basis of employment contract or independent service relationship or works contract, as well as lawyers with mandate relationship or contract)

External associate

Seafarer

Pursuant to article 19 of the Articles of Association. the amount of ordinary contribution of a person insured for the
business of lump-sum) indemnity (optional) is established as follows (USD equivalent, per month):

€30,00 Minimum contribution

€5,000.00 Max. contribution

* Amount of monthly contribution

Fill in the monthly amount (in €/USD) of contributions you wish for the Lump-sum indemnity business

In words per month

In figures per month

* In case no mandatory ordinary employer's contribution arises from the applicant's relationship with the employer or the provisions of the Fund's Articles of Association, then an ordinary monthly contribution of insured employee must be necessarily paid, which will be equal to the minimum amount of contribution unless otherwise specified above.

Surname

Relationship | WITH INSURED

Name

TIN or Social Security No.

More Beneficiaries

** In case the insured person does not fill in the particulars of one or more beneficiaries, the total amount from the insured person's personal
account will be allocated to his legal heirs.

The undersigned solemnly state that the above particulars are complete and accurate and that I took cognizance of the statutory provisions of the OCCUPATIONAL PENSION FUND OF TSAKOS MARITIME ENTERPRISES AND ASSOCIATES (LEGAL PERSON OF PRIVATE LAW) (YO.D.D./ Φ51020/27566/682/24.05.2018/Government Gazette Issue B/889), as well as of any amendments which I unreservedly accept.

By this application I apply for my registration with the Occupational Pension Fund of TSAKOS Maritime and Associates.

Should the above details change, I shall promptly notify the Fund thereof in writing at my own responsibility.

I accept that the monthly ordinary contribution of insured person (if any) and/or any extraordinary contribution of insured person I state in writing to the Fund that I wish to pay will be withheld from my monthly earnings through my payroll (it concerns only those persons who are directly paid by the Group.

I hereby accept the terms and conditions of registration form.

Terms & conditions

APPLICATION FORM

Personal details of Member

Contact details

Supplementary details

Employer’s details

Kind of cooperation with the Group

Contribution amounts

Beneficiary’s Particulars**

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APPLICATION FORM

Personal details of Member

Contact details

Supplementary details

Employer’s details

Kind of cooperation with the Group

Contribution amounts

Beneficiary’s Particulars**