FORMNSSF/R.A “THE UNITED REPUBLIC OF TANZANIA NATIONAL SOCIAL SECURITY FUND APPLICATION FOR EMPLOYER'S REGISTRATION (The Nationa Social Secuty Fund Act No: 28 OF 1997) ‘Ths form must be submited to the nearby NATIONAL SOCTAL SECURITY FUND Offcarby the employer within ity days of his becoming subject the above mentioned et Phe he fo in CAPITAL LETTERS. ‘Type of Registration: Cleranch Cl veadquartes Cina int Dette (=D | im erento os: TTT T TTT) (ommrnn NSSF Employer Registration No: (Offcal Use) eBranch "Coe Headquarters NSSF Registration Number; [TT TT TIT] Sonne resin ninter TTT ECE TE (comps JOC gto) var! babe oa fea ELEBE BEL Iaie (Listen) reesorennbe: — CCEEEEEE EEE fmm CDEP) ewe: COETEEEE EEE EET rncnostonone CELE TTT eon Location ot Bane mene’ [TITEL TET TT TTT ee sweet [TT Td Tt hte urges CTT TTTTTTTTTTTTT tt) Peres TT Tost abet | bod 1d ee oat TOT wwe COC newt Pete sexo: =CIDITTITITITTITITiIoCriy) 3 taetve (TTT TT TT TITITITITITItTtt) uebsy oe: CCE E EEE oo meen weceotwegeromet CLIT TTTTLLLLLL rootemooees CT TT) we oe] SeeFORDINSSFIRL cone Deets Co vesaton: COOP) ena Cocco Teepe: CODEC wetteninbes COT TT TTT) foe CCEEEEEEREEIIIM seach Betas ranch name | Roof tmployoss | Postal Address | Telephone Number | Fax Mumber | Mode of Wage Payment Tied Eerie _ CO centralized : beste | crac 6 Seweete TG Contratzed cect a sere Dectaraton Tere criy at (0) The information aiven above is corect and tu. {wil complete and submit employee's registration card in respect ofthe employees. Tm obliged to comply withthe NSSF regatons relating to the payment of contribution promptiy and in ful Fal Names Designation: Signatur: Date: EMPLOYER'S OFFICIAL STAMP