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Notice of Revocation of Nominations Central Provident Fund Board


									                                            Central Provident Fund Board                                            For Official Use Only
                                  79 Robinson Road, CPF Building, Singapore 068897                                  Serial No.
                                Website: CPF Call Centre: 1800-227 1188
                                                       FORM 3B
                                         CentRal PROvident Fund BOaRd
                                    nOtiCe OF RevOCatiOn OF nOMinatiOnS

                                       This form may take about 5 minutes to complete
                         (To be completed by member. Please read the instructions carefully before completing the form.)
   NAME OF CPF MEMBER AS IN NRIC / Passport (IN BLOCK LETTERS)                                         SINGAPORE NRIC NO./CPF A/C NO.


   I hereby revoke the previous nomination made by me.

   *Signed by the abovenamed member/The right thumbprint                       )
     of the abovenamed member was affixed                                      )       __________________________________________
                                                                               )       Signature/right thumbprint of member
   *(a) in the presence of the 2 witnesses below;                              )
        OR                                                                     )       DATE _____________________________________
   *(b) after the contents have been read over and explained                   )

        to *him / her in the _________________*language / dialect              )       Telephone No.: (H) __________________________

        by ______________________________________ (Name)                       )                      (O) __________________________

        __________________________ (*NRIC/Passport No.) in the                                        (Hp) _________________________

        presence of 2 witnesses below.                                         )       Email Address: _____________________________

   Note: the 2 witnesses must be at least 21 years old (unless they are employees of the Board)
         and must not be the member.

   1)   Name of Witness (in BLOCK letters) ________________               2)       Name of Witness (in BLOCK letters) ________________

        ______________________________________________                             ______________________________________________
        *NRIC (for Singaporeans and Permanent Residents of                         *NRIC (for Singaporeans and Permanent Residents of

        Singapore) / ___________________________________                           Singapore) / ___________________________________

        Passport No. (for foreigners) ______________________                       Passport No. (for foreigners) _____________________

        Address ______________________________________                             Address _____________________________________

         _____________________________________________                             _____________________________________________

        Email Address __________________________________                           Email Address _________________________________

        Signature of Witness ____________________________                          Signature of Witness ___________________________

        Telephone No. _________________________________                            Telephone No. ________________________________

*Delete as appropriate

                                                                                                                            Revised in April 2009

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