Death in Service Guide
Death in Service Guide
Death in Service Guide
Department of Management
Office of Human Resources Management
Emergency Preparedness and Support Team
List of abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
IX. ANNEXES
I. Action checklists at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
II. Sources of reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
III. Exhibits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
On 19 August 2003, a bomb exploded at the Baghdad headquarters of the United Nations
Assistance Mission for Iraq, killing 22 staff members and wounding more than 100.
On 12 January 2010, an earthquake destroyed several United Nations buildings in
Port-au-Prince, taking the lives of 102 staff members and injuring numerous others.
On 1 April, a protest at the UNAMA office in Mazar-e-Sharif became chaotic and
violent, causing the deaths of 7 staff members.
Just two days later, on 4 April 2011, perilous weather caused a United Nations plane to
crash in Kinshasa, claiming the lives of 32 people including 22 staff members on board.
These incidents are but a few among many that remind us that every single day,
United Nations personnel face grave and often moral perils while serving our
global mission of peace, development and human rights. Mourning the loss of
fallen colleagues is a ritual with which we have become sadly familiar. We have
also become keenly aware of the need to provide better support to survivors and
to the families of those who perish or are injured.
The UN Secretariat’s Emergency Preparedness and Support Team, in close col-
laboration with other United Nations departments and offices, aims to help all of
us in responding to the deaths of friends and colleagues in a sensitive and timely
fashion, and in strengthening organizational resilience in order to serve as best
we can even in the most desperate of circumstances. This Handbook, an initiative
of the Team, is a collaborative effort among many departments and is meant as a
tool for alleviating the confusion and bureaucratic delays that often ensue when
there is a death or, in the case of larger disasters, many deaths as a result of mali-
cious acts, natural disasters or other emergencies.
While intended primarily for offices and departments directly charged with sup-
porting family members, this publication can help each of us to familiarize our-
selves with what must be done in such difficult circumstances so that we may,
together, create a compassionate and empathetic environment for the loved ones
of those who give of themselves in such an honourable way. Although I am sure
we would all wish for there to be no need for such a guide, the Handbook’s exist-
ence fills an important gap and I commend it to all staff so that we can uphold
our responsibility to honour those colleagues who make the ultimate sacrifice in
serving our Organization, and to help those they leave behind.
BAN Ki-moon
Secretary-General of the United Nations
The Handbook for Action in Case of Death in Service is an updated version of the
original version that was first published in 2001.
The Handbook is a compilation of all the actions, duties and responsibilities that
may occur when a staff member dies while on duty. This Handbook offers timely
guidelines to be applied while recognizing the unique circumstances that might
arise in each situation. It is written with an intention to support those — affected
families and staff — who need most support during difficult times.
I enjoin all staff dealing with bereaved families and colleagues to be compassionate,
flexible and sensitive. Colleagues, please be certain that my office and my staff is
at your service should you need individual consultation regarding particular cir-
cumstances. As part of Secretary-General’s commitment to the families who lost
loved ones, the United Nations family is called upon to go above and beyond the
line of duty to assist families and staff during these difficult times.
The Handbook is organized as a reference material. There are eight chapters,
with the first two chapters outlining death of a staff member at the duty station
(Chapter I), and at field missions (Chapter II). Chapter III discusses the role of
the United Nations Security Management System and actions and official proce-
dures to be taken immediately after death. Chapter IV, the newly added chapter,
outlines actions to be taken in mass casualty incidents. Chapter IV offers support
activities for families and affected staff through a cadre of trained staff such as
the Family Support Team and Family Focal Point. Chapter V, the newly revised
chapter, provides information on Appendix D entitlement and Malicious Acts
Insurance Policy (MAIP) as well as other entitlements. Chapter VI and VII provide
information on pension benefits and insurance benefits for eligible dependents.
Chapter VIII provides information on special procedures, ceremonies and memo-
rial services. Lastly, the annexes portion of the handbook provides administrative
instructions and forms along with sources of reference.
Your feedback is welcome and appreciated on this updated version of the Hand-
book, which I hope will help you in coping with these very difficult situations.
Catherine Pollard
Assistant Secretary-General
Human Resources Management
DEATH AT
DUTY STATION
THIS CHAPTER
A. Responsibility of the United Nations AT A GLANCE:
and of particular offices
A. RESPONSIBILITY
OF THE UNITED
1. Responsibility for coordinating the actions required when a staff
NATIONS AND
member dies while in the service of the Organization is set out OF PARTICULAR
in administrative instruction ST/AI/2000/14 of 9 November 2000. OFFICES
2. What if death occurs at the work place? Unless there are specific
arrangements between the United Nations and the host country,
the laws of the host country apply in cases of death of staff mem-
bers. Therefore, when a death occurs at the work place, DSS must
become involved and must be contacted if an autopsy is required.
The local police may also become involved as appropriate.
3. What if death was sudden or under suspicious circum-
stances? When the death has occurred during an emergency at
1 These actions may be carried out in a different order, or at the same time, depending on the
circumstances.
2 If the death cannot immediately be confirmed, e.g., if there is a plane crash, in a remote loca-
tion, notify the family that an emergency is under way (See Chapter III).
ACTION 2 ✓ACTION 2
Notification: Identify and contact the designated emergency IDENTIFY AND
CONTACT THE
contact indicated on the P.2 form. DESIGNATED
EMERGENCY
1. Identify the designated emergency contact. The name of CONTACT AND THE
FAMILY OR NEXT
the person to contact in case of emergency and the names of OF KIN
the beneficiaries of the deceased (which may or may not be the
spouse and the dependant children) should be listed on the form
entitled “Designation, change or revocation of beneficiary”(P.2),
which can be found in the official status file of the staff mem-
ber. The names of the spouse and children can also be found in
the Integrated Management Information System (IMIS). If there
is no designated emergency contact, no spouse and no children,
identify the next of kin.
2. Personally notify the death. A senior official, usually the under-
secretary-general of the department for which the deceased staff
member worked, should inform the family or the next of kin of
the death. This information should be conveyed personally unless
circumstances make it impossible to do so. Offer to go immedi-
ately to the family’s home to assist in making calls and funeral
arrangements and in taking care of other urgent family matters.
The visit should not be made alone (see chapter VIII, section D,
“Notification Visit”).
3. What if there is no family at the duty station? When the
deceased has no family members at the duty station, contact the
✓ACTION 3 ACTION 3
ASSIST IN MAKING Assist in making arrangements for transportation of the remains
ARRANGEMENTS
FOR
TRANSPORTATION 1. Payment of the expenses for transportation of the remains.
OF THE REMAINS Staff Rule 7.18 provides that, upon the death of a staff member
or of his or her spouse or dependant children, the United Nations
shall pay the expenses of transportation of the body from the offi-
cial duty station or, in the event of death having occurred while
in travel status, from the place of death to a place to which the
deceased is entitled to return travel under Staff Rules 7.1 or 7.2.
These expenses shall include reasonable costs for preparation
of the body. In the case of death of a staff member the payment
of the expenses of transportation of the body may be author-
ized under Staff Rule 7.1. For more details, see administrative
instruction ST/AI/2000/14, paragraph 4.1.
2. Payment of particular procedures for disposal of remains.
As provided in Staff Rule 7.18 and in administrative instruction
ST/AI/2000/14, paragraph 4.2, if local interment (cremation or
other procedure for disposal of remains) is selected, reasonable
expenses incurred may be reimbursed.
3. Who determines these costs and how? As set out in admin-
istrative instruction ST/AI/2000/14, paragraph 4.4, the reason-
able costs that may be reimbursed prior to transportation of the
body or for local interment in New York are determined by the
Assistant Secretary-General for Human Resources Manage-
ment. At other duty stations, such costs are determined by the
Chief of Administration or corresponding official. Expenses
relating to religious or funeral services, such as the use of a
ACTION 4 ✓ACTION 4
Notify other United Nations offices NOTIFY OTHER
UNITED NATIONS
OFFICES
5. Offices that should be notified immediately. Upon being
informed of a staff member’s death, the coordinating officers
should ensure that the following offices are notified as quickly
as possible:
Executive Office of the department concerned; OHRM;
Chief of Human Resources Services or Chief of the local
personnel section (depending on which office receives the
information first).
DSS.
Head of department or office.
✓ACTION 5 ACTION 5
OPEN/SEAL THE Open/seal the desk of the deceased
DESK OF THE
DECEASED
1. Seal the desk of the deceased as promptly as possible.
2. Make the request to open/seal the desk to the Security Ser-
vice. The Human Resources Officer will send an electronic
communication to the Chief of the Security Service requesting
that the desk of the deceased staff member be sealed/opened.
ACTION 6 ✓ACTION 6
Send letters of condolence SEND LETTERS OF
CONDOLENCE
1. Who should sign the letter and what is the appropriate for-
mat? A cable or letter of condolence, signed by the Assistant
S
ecretary-General, OHRM, or the head of the office con-
cerned, as appropriate, should be addressed to the family or next
of kin as soon as possible. For an example of a letter of condo-
lence, see exhibits 3 and 4.
2. Translation of letters of condolence. If possible, letters of con-
dolence should be translated into native language of deceased
staff member and his/her relatives.
3. If the deceased was an official at the level of Assistant Secretary-
General or above, either the Under-Secretary-General or the
Secretary-General will sign the letter of condolence.
ACTION 7 ✓ACTION 7
Obtain certified copies of the death certificate OBTAIN CERTIFIED
COPIES OF THE
DEATH CERTIFICATE
1. To whom is it necessary to send copies of the death certifi-
cate? Obtain certified copies of the death certificate or the offi-
cially certified translation of it, and forward a copy to the follow-
ing, as applicable:
• Chief, Payroll Section, Accounts Division, OPPBA.
• Chief, Insurance and Disbursement Service, OPPBA (attach
one copy for the Aetna Life Insurance Company, if required).
✓ACTION 8 ACTION 8
ASCERTAIN Ascertain beneficiaries for the purpose of assessing
BENEFICIARIES
FOR THE PURPOSE entitlements and benefits
OF ASSESSING
ENTITLEMENTS 1. Ascertain identity and address of beneficiaries. Before the enti-
AND BENEFITS
tlements arising out of the death of a staff member can be deter-
mined, it is necessary to ascertain the identity and exact address of
the spouse, the dependant children and the beneficiaries .
2. Who may be the beneficiaries and how to find this out? A
staff member may have the following beneficiaries in connection
with entitlements:
• A beneficiary or beneficiaries designated at the time of
appointment on the form, “Designation, change or revocation
of beneficiary” (P.2), in accordance with Staff Rule 1.6. The
most recent update of this form can be found in the official
status file of the deceased and the information should also
be recorded in IMIS.
• A beneficiary or beneficiaries under the Regulations and
Rules of UNJSPF or in an up-to-date A/2 form. The Chief
Executive Officer of the Fund should be informed of this
designation.
DEATH AT
THE FIELD MISSION
THIS CHAPTER
AT A GLANCE:
A. ACTIONS TO BE
TAKEN AT THE FIELD
MISSION (HEAD OF
ADMINISTRATION AT
THE MISSION)
B. ACTIONS TO BE
TAKEN BY PERSON-
NEL MANAGEMENT
AND SUPPORT
A. Actions to be taken at the field mission
(Head of Administration at the mission).3
3 These actions may be carried out in a different order, depending on the circumstances.
operating procedures.
2. Designation of a family focal point by FPD and EPST. Fol-
lowing notification, the family focal point will handle all sub-
sequent dealings with the family and provide liaison with the
relevant United Nations organization.
3. Hold the release of the information before the family is noti-
fied. Close contact must be maintained by DFS/FPD with both
the Office of the Spokesperson and the DOA/CAO of the mission
to ensure that no information is released to the press before the
family members are notified of the death.
UN Photo/Marco Dormino
At offices and duty stations where IMIS is not available and for
all local staff of field missions who are not in IMIS, the P.35 form
continues to be used.
3. Ensure the beneficiaries provide the necessary documents.
The family focal point designated by DFS in coordination with
EPST must ensure that the beneficiaries ultimately provide, at a
minimum, the following:
a. Payment instructions
b. Copies of birth and marriage certificates
c. In case of minors, proof of guardianship
d. Completed form or letter in lieu for compensation claims in
accordance with Appendix D
e. UNJSPF form on “Instructions for payment of benefits”
f. Insurance claim form.
4. Submission of information to the Compensation Claims and
Claims Board. DFS is in charge of this (see chapter V).
5. Keep the family informed at all stages of the settlement. And,
if the process takes too long, FPD shall arrange for the desig-
nated beneficiary or beneficiaries to receive an advance against
the payments due.
6. Different types of payments.:
a. Payments to the beneficiary or beneficiaries designated on
forms provided by the United Nations:
¤¤ Salaries, allowances and benefits. Salaries, allowances and
benefits standing to the credit of the staff member as of
THIS CHAPTER
A. Role of the United Nations Department of AT A GLANCE:
Safety and Security (UNDSS)
A. ROLE OF THE
UNITED NATIONS
Security management immediately after the death. When a DEPARTMENT
staff member dies under suspicious or unclear circumstances and/ OF SAFETY AND
SECURITY
or in an accident, the senior United Nations official closest to the
scene will take charge and coordinate his or her action with UNDSS. B. ACTIONS REQUIRED
UNDSS will exercise overall authority until the investigation is con- IN CASE OF DEATH
UNDER SUSPICIOUS
cluded, at which point the coordinating department or office will OR UNCLEAR CIR-
assume responsibility. CUMSTANCES AND/
OR ACCIDENTS.
Responsibility for the security of staff members. In each coun-
C. ACTIONS AT THE
try, the primary responsibility for the security and protection of staff
DEATH SCENE
members of the United Nations, their spouse and eligible depend-
ants, rests with the host government. In spite of these responsibili- D. OFFICIAL NOTIFICA-
TION PROCEDURES
ties, there may be instances in which the security and protection fac-
tors will be uncertain. To deal with these situations and to ensure E. DOCUMENTATION
that there is a coordinated approach for the protection of staff, the F. DISPOSITION OF
organizations of the United Nations have put in place a system for REMAINS
planning and managing security issues.
G. CONCLUSION
UN Photo/Marco Dormino
E. Documentation
A number of documents will be required. The following three are
indispensable:
a. Death certificate. The death certificate is the basic docu-
ment that will be required by various authorities in the
country of assignment and the country of origin of the staff
member, as well as by the United Nations and insurance com-
panies. It should be signed by the attending physician and
should include the date and the official stamp of the clinic or
hospital. The cause of death should be described briefly. It is a
good idea to have a large number of original death certificates
(photocopies with original signatures and stamps), as most
authorities insist on original or notarized copies.
b. Police report. In those countries or areas where there are
police authorities, there will be a need for a police report.
This document will be required in numerous copies for
local authorities. Police authorities usually do not agree to
the removal of a body pending investigation. A statement
to the effect that the remains of the deceased are no longer
required by the police authorities will have to be issued prior
to the removal of the body for burial.
MASS CASUALTIES
In crises that result in mass casualties, the primary focus of response THIS CHAPTER
AT A GLANCE:
will be to expedite essential support to injured staff members and
to families of deceased staff. This chapter is written with a view to A. ACTIVATION AND
prioritizing critical functions with limited resources and communi- RESPONSIBILITIES
OF THE FAMILY
cating effectively so that external support, e.g. from UNHQ or nearby SUPPORT TEAM
field offices, is best utilized. Procedural or administrative actions are (FST)
similar to that of Chapters I and II, and should be followed when the
B. ACTIVATION AND
situation has been stabilized. This chapter is written for mass casual- RESPONSIBILITIES
ties at both UNHQ locations and field offices. OF THE FAMILY
FOCAL POINT (FFP)
During emergencies in which there are mass casualties, the Emer- SYSTEM
gency Preparedness and Support Team (EPST) in New York will acti-
C. FST-FFP COOR-
vate the closest trained Family Support Team (FST) and a group of DINATION WITH
trained Family Focal Point (FFPs). The chapter discusses the roles THE DEPARTMENT
OF SAFETY AND
of the FST and the FFPs. These two groups have different functions
SECURITY (DSS)
which can overlap if both groups are co-located as may be the case
in the future when the training of the units has been completed in D. ACTIONS TO BE
TAKEN IN MASS
a number of peacekeeping locations and duty stations. Where the CASUALTY CRISES
FFPs are in a duty station at a distance from the incident, e.g., New
York or Geneva, communication lines will be of utmost importance.
The chapter makes the assumption that this is the case, as it was in
the Haiti earthquake. In such a case, it is also assumed that the initial
Call Centre will be established at the Headquarters location. (Ideally,
it would be preferable to have the FST, FFPs, and the Call Centre all
in the same location.)
ACTION 1
✓ACTION 1
Deploy FST with Appropriate Resources DEPLOY FST WITH
APPROPRIATE
1. The FST should be set up in an appropriate location with at least two RESOURCES
rooms: one for counselling with families and the other to handle
logistical functions.
2. There should be a sufficient number of drivers and cars available
for use for travel coordination.
3. FST team members should also be equipped with appropriate
communications devices4.
4. All FST team members should be given access to the web portal
and other relevant databases for operations.
4 For example,. fully functioning Blackberries, UN-issued laptops with one standard software
application, Mobile Office with Citrix already installed on the laptops. One or two satellite
phones should be issued as well to enable independence of communications in case of cell
phone network breakdowns and emergencies.
✓ACTION 2 ACTION 2
COMMUNICATE Communicate Status of Emergency
STATUS OF
EMERGENCY
1. The USG for Safety and Security should announce the mode
under which operations are occurring.
2. The current status of the emergency should be communicated
via electronic alert and notification systems, if available. A point
person and a time interval should be identified within DSS to
communicate updates.
3. The EPST will coordinate with the Department of Public Infor-
mation (DPI) as needed with regard to the dissemination of offi-
cial information.
4. DSS should ensure that all key players are notified, including DFS
and OHRM (EPST). The Medical Service may require its own sep-
arate notification.
✓ACTION 3 ACTION 3
SET UP EMERGENCY Set Up Emergency Structures: web portal, Call Centre and
STRUCTURES:
WEB PORTAL, Reception Centre
CALL CENTRE AND
RECEPTION CENTRE 1. EPST should activate the Emergency Support web portal and
identify an administrator to be in charge of allowing access to
the site and ensuring that the information is constantly updated.
Links to the site should be sent to all family members of missing,
deceased or injured staff, as well as to FFPs, Call Centre volun-
teers, and senior staff of OHRM, DFS and DSS. The web portal has
a number of rooms to which access is restricted to the appropriate
ACTION 4 ✓ACTION 4
Set up FFP System SET UP FFP SYSTEM
✓ACTION 5 ACTION 5
COORDINATE Coordinate Information Regarding Injured and Deceased Staff
INFORMATION
REGARDING Members
INJURED AND
DECEASED STAFF 1. The EPST should ensure that the web portal and Call Centre is
MEMBERS
kept up-to-date so that all information conveyed is consistent.
2. EPST should put the FST in contact with the forensics firm pro-
cured by the UN, in past cases Kenyon International.
3. The FST should identify an efficient information flow process
between the on-the-ground teams (e.g. search and rescue teams
or professional negotiators, DSS) and families/UN offices.
4. The core functions of death notification as outlined in Chapters
I and II should be followed: identification of next of kin, decision
on who should notify the family, notification of death, etc. If the
emergency occurs in an HQ location, please follow the instruc-
tions in Chapter I; should it occur at a field office, please follow
the instructions in Chapter II.
5. In either case, the priority of actions should be as follows:
• Once the body has been officially identified, FST should
notify the designated official to inform the families in per-
son, if possible.
• The FST will inform the FFP, who will ensure that the staff
member’s Executive Office, the Staff Counsellor’s Office and
the HR Officer are informed following the procedures set out
in Chapters I and II.
6. Closely following the visit or call from the designated high level
official, the FFP should explain to the family the UN policies
related to the death of a staff member. The FFP also explains any
special measures that may have been put in place following the
incident.
ACTION 6 ✓ACTION 6
Coordinate Repatriation of Bodies COORDINATE
REPATRIATION OF
BODIES
(a) Obtaining and Onpassing Information about the
Staff Member
1. If a body needs to be identified, the FST may request the FFP
to obtain “ante mortem” information from the family. This con-
sists primarily of dental records, fingerprints and descriptions of
identifying marks. A detailed disaster victim identification form
may be used5.
2. The FFP should provide this information to the FST via the web
portal private page, or another appropriate means of secure
communication.
3. FST should onpass the information whichever forensic firm is
working with the UN.
4. Once the body has been identified in writing from the forensic firm
and the family has been formally notified, the FFP should obtain
Disposition Instructions from the Legal Next of Kin: is casket or
cremation preferred? If cremation, should it be carried out at the
funeral home on site prior to the flight? If casket, would it be open
or closed? If open casket, the FFP should discuss with the family
which clothing would be most appropriate. What are the contact
details of the consignee, which is normally the funeral home in the
family’s town? FST will provide this information to the forensic
firm.
5. FST staff on site should accompany the family member should
they express to go to the morgue.
6. The FST should ask the Mission to issue the written Noticas (see
exhibit 1).
(c) Record-Keeping
16. The FST should keep records of all repatriations. They should
work with the forensic firm and the funeral home to ensure that
each file contains all the necessary documents. The information
is similar to the information provided to DSS as soon as a death
is confirmed. See Chapter 1 Section D.
ACTION 7 ✓ACTION 7
Assist Visiting Family Members ASSIST VISITING
FAMILY MEMBERS
1. Working with the FFPs, the FST should facilitate the travel of
family members to the crisis site if they wish to come. Up to two
members of each family may be provided with roundtrip tickets
so that they can accompany the remains back home.
UN Photo/Jean-Marc Ferre
ACTION 9 ✓ACTION 9
Track Progress and Needs of Affected Families and Staff TRACK PROGRESS
AND NEEDS OF
AFFECTED FAMILIES
1. The FST should coordinate with EPST, OHRM and DFS at UNHQ AND STAFF
for long term tracking of affected staff members and family
members.
2. EPST, DFS, DSS, and Medical should share an updated master
tracking list of affected staff members and families. The list will
be maintained by DFS for mission mass casualties and by OHRM/
EPST or designated official for other duty stations.
3. FFPs should provide to EPST the contact information for the
families so that they can be reached in the future, e.g., for com-
memoration ceremonies.
4. FFPs should keep their families apprised of the benefits and
entitlements that they are eligible for and refer them to the
web portal for all reference material and forms. FFPs and HR
Officers should guide each family through the forms, easing
their way.
✓ACTION 10 ACTION 10
ARRANGEMENT OF Arrangement of memorial service
MEMORIAL SERVICE
APPENDIX D,
MAIP AND OTHER
ENTITLEMENTS
THIS CHAPTER
AT A GLANCE:
DETERMINATION
When the death of a staff member is attributable to the performance OF APPLICABILITY:
APPENDIX D AND MAIP
of his or her official duties, he or she may be eligible for two different
types of compensation. These compensations may take the form of: APPENDIX D
disability and/or death benefits via:
MAIP
(a) the provisions in Appendix D to the Staff Rules,
DUAL COVERAGE/
(b) the provisions in the Malicious Acts Insurance Policy COMPARISON CHART
(MAIP), or
CHECKLIST OF
(c) both. ALL AVAILABLE
ENTITLEMENTS
Coverage for death or disability under the MAIP is in addition to REFERENCES
compensation that may be payable under Appendix D to the Staff
Rules or comparable compensation schemes. This chapter outlines
how that determination is made and what steps need to be followed
in order to make these claims.
A. Determination of Applicability
Appendix D
1. Compensation shall be awarded in the event of death, injury,
or illness of a staff member which is determined to be attribut-
able to the performance of his or her official duties on behalf
of the United Nations. Staff members should be aware that not
all deaths that occur while at work or on a mission assignment
are automatically considered to be attributable to the perfor-
mance of official duties. The Advisory Board on Compensation
Claims (ABCC) will consider all aspects of a case, including
whether the death occurred as the result of an illness that has
B. Appendix D
B.1 Eligibility
1. All internationally recruited staff members, and upon the Sec-
retary-General’s recommendation, nationally recruited staff as
well.
2. Does not apply to interns or persons under limited contract.
3. Members of commissions, committees or similar bodies may
be covered under “Rules governing compensation to members
of commissions, committees, or similar bodies in the event of
death, injury, or illness attributable to service with the United
Nations” (see ST/SGB/103/Rev.1).
B.2 Beneficiaries
6 Since 2006, permanent disabilities brought about by chronic Post Traumatic Stress Disorder
(PTSD), caused directly or indirectly by War or a Malicious Act, are also covered.
7 Staff members should be aware that the designation of beneficiary form completed in respect
B.3 Benefits
13. There are several different types of benefits that will apply to a
qualifying staff member or family member. These include:
• Lost Income Benefit ( for injured staff members until return
to work)
• Permanent Disability Benefit ( for injured staff member
who is unable to return to work, applies in tandem with
Pension)
• Lower Pay Grade Compensation (2/3 of lost income if injured
staff member is reappointed at the UN)
• Full Medical Coverage ( for injured and deceased staff)
• Medical Accommodations (e.g. personal assistant, etc.)
• Death Benefit (dependent on years of service of staff member)
• Cost of Preparation of Remains and Funeral Expenses
14. The HR Officer, in collaboration with staff from the ABCC, will be
able to provide specific guidance on the benefits that apply.
staff among duty stations. There have been cases in which it was not possible to obtain impor-
tant information, as personnel had separated from service or the mission had closed.
9 Payment of insurance proceeds under MAIP for the UN Secretariat is governed by ST/
C.2 Beneficiaries
C.3 Benefits
10 Staff Rules 109.10 (a) (vi), 209.11 (a) (v), and 309.6 (a).
11 “Net annual salary” means net salary for the level and step in the published salary scale
at the duty station applicable at the time of injury or death. If remuneration is paid on a daily,
weekly or monthly basis, annual salary will be derived on a pro-rata basis.
15. The MAIP also covers medical costs related to the injury or ill-
ness of up to 10% of the determined disability benefits. If any
other benefits programs, such as Appendix D, already fully cov-
ers medical expenses resulting from service incurred injuries,
MAIP monies will be used to offset those costs.
16. The maximum compensation payable per person is $500,000.
Appendix D MAIP
ELIGIBILITY
Staff Status Internationally recruited Profes- All international and national staff,
sional and General Service staff, consultants, etc. Broad coverage.
and consultants if expressed in
the terms of conditions in their
contract.
Applicable Covers death, injury, or illness of Covers death, permanent total disable-
Situations a staff member which is attrib- ment, permanent partial disablement
utable to the performance of his or permanent loss of function caused
or her official duties. directly or indirectly by War or a Mali-
cious Act.
Eligibility of In the event of death, applies In the event of death, applies to the
Beneficiaries to staff with recognized surviving spouse and/or a dependent
dependants. child or children, or anyone designated
as beneficiary by staff If the staff mem-
ber does not have a surviving spouse
and/or a dependent child or children.
Coverage • Death • Death
• Permanent or temporary dis- • Permanent total disablement
ability (partial or total) • Permanent partial disablement
• Illness • Permanent loss of function caused
• Includes PTSD directly or indirectly by War or a Mali-
cious Act.
• Includes PTSD
❑ contract at time of
death.
ances, overtime owed up
to time of death, less any
lated by local
HR office and
monies due to the Organi- paid with final
zation by staff member. settlement.
Annual leave Staff member on 100 Commutation of accrued To be calcu-
❑ ber is attributable to
performance of official
up to $500,000 for profes-
sional staff, and up to ten
for receipt of
claim by local
duties, surviving spouse times the net annual sal- HR office is
and dependants may be ary for national staff, up to 6 weeks, along
entitled to certain com- a maximum of $500,000. with certified
pensation of Appendix D copies of birth,
of the Staff Rules. The benefit is approved marriage certifi-
by the ABCC which meets cate, Personnel
only twice per year. It is Action form;
important to submit the DSS incident
claim without delay. report
❑ cases of service-incurred
death. The death benefit
on number of years of
completed service with
process benefit
❑ conditions of ASHI.
Enrolment of a surviving
spouse ceases upon
remarriage.
Eligibility of a dependent
child ceases upon mar-
riage, full-time employ-
ment or attainment of
25 years of age.
Group Staff member(s) partici- Benefit is equivalent to Health and
Life Insur- pating in this optional three times of the staff Life Insurance
ance life insurance plan at the member’s pensionable Section
❑ time of death.
If applicable, beneficiary
remuneration up to a
maximum of US$300,000 • Certified
copy of death
will be person named certificate;
by staff member and • Official medi-
recorded by GLI. cal certifica-
tion of cause
of death (if
not included
in death
certificate)
❑ Organization’s expense
to the duty station
her dependents to
❑
Repatriation Payable to surviving The calculation is based Payment will be
grant family members of on the number of qualify- initiated by HR
❑ internationally recruited
staff member(s) for
ing years the staff member
has spent outside of his/
officer based
upon evidence
service outside of his/her her country of nationality of permanent
country of nationality or or permanent residence relocation to a
permanent residence, in service to the Organiza- country other
and for whom the tion. Schedule is shown in than that of the
Organization has paid Annex IV of the Staff Rules staff mem-
travel expenses to the ber’s last duty
duty station. For one surviving family station.
member payment is made
at the single rate; if there
are two or more survivors
payment is made at the
rate applicable to staff
member with dependents
(Footnotes)
1 Permanent Disability generally means that disability has lasted for at least twelve (12) cal-
endar months, is without expectation of recovery in the opinion of MAIP insurers and shall
in all probability continue for the remainder of the Insured Person’s life, and results in their
inability, entirely or partially, to perform business or occupation for which the individual is
reasonably suited by training, education or experience.
2 Specifically, for Category of Insured Person 1- Professional Category and Category of Insured
Person 3 (non-staff).
3 Specifically, for Category of Insured Person 2 – General service staff, Field and National Officers
4 “Net annual salary” means net salary for the level and step in the published salary scale at
the duty station applicable at the time of injury or death. If remuneration is paid on a daily,
weekly or monthly basis, annual salary will be derived on a pro-rata basis.
5 Specifically, for Category of Insured Person 1- Professional Category and Category of Insured
Person 3 (non-staff).
6 Specifically, for Category of Insured Person 2 – General service staff, Field and National Officers
7 “Net annual salary” means net salary for the level and step in the published salary scale at
the duty station applicable at the time of injury or death. If remuneration is paid on a daily,
weekly or monthly basis, annual salary will be derived on a pro-rata basis.
8 Specifically, for Category of Insured Person 1- Professional Category and Category of Insured
Person 3 (non-staff).
9 Specifically, for Category of Insured Person 2 – General service staff, Field and National Officers
10
“Net annual salary” means net salary for the level and step in the published salary scale at
the duty station applicable at the time of injury or death. If remuneration is paid on a daily,
weekly or monthly basis, annual salary will be derived on a pro-rata basis.
PENSION BENEFITS
This chapter provides a brief explanation of some of the terminol- THIS CHAPTER
ogy used and the regulations and administrative policies followed AT A GLANCE:
C. DEFINITION OF
TERMS
B. Administrative procedures
and requirements
UN Photo/Antoninho Bernardino
UN Photo/Logan Abassi
General Assembly and the corre-
sponding governing bodies of the
other member organizations, one
third by the Executive Heads and
one third by the participants;
o. United Nations Joint Staff Pen-
sion Fund. This is the name of the multi-employer defined
benefit pension fund that was established by the General
Assembly to provide retirement, death, disability and related
benefits for the eligible staff of the United Nations and of 18
other member organizations of UNJSPF;
p. Widow. In the event a participant dies while in the service
of a member organization of UNJSPF, a widow’s benefit is
payable to the surviving female spouses of that participant.
Article 34 of the Regulations of the Fund enumerates the full
scope of a widow’s entitlement. The Regulations also pro-
vide, under specific conditions, for benefits to be payable to
divorced surviving spouses (article 35 bis);
q. Widower. In the event a participant dies while in the service
of a member organization of UNJSPF, a widower’s benefit is
payable to the surviving male spouses of that participant.
Benefits
Insurance
Chapter 7 provides an overview of insurance benefits, options and
regulations, and offers advice for the processing of cases in which a
staff member has died while in the service of the organization. Health
insurance benefits are available for the spouse and eligible depend-
ant children of a deceased staff member, or for those they designated
for that purpose.
CHAPTER VII
INSURANCE BENEFITS
A. Health insurance
THIS CHAPTER
More detailed information is available through ICCS. AT A GLANCE:
Applying for ASHI. The spouse and eligible dependant children A. HEALTH
INSURANCE
of a staff member who dies in service while participating in a
United Nations contributory health insurance plan may apply for B. LIFE INSURANCE
CEREMONIES, MEMORIAL
SERVICES AND SPECIAL
PROCEDURES
chapter also offers suggestions on how to arrange memorial services C. FLAGS AND
for staff members who die while in the service of the Organization. HONOUR GUARDS
When the circumstances of a staff member’s death or his or her posi-
tion in the Organization is of such public interest as to involve the
Secretariat as a whole, OHRM may assume responsibility for such
arrangements, either at its initiative or at the request of the coordi-
nating department or office (see chapter I).
In planning ceremonies, memorial services and other special proce-
dures, the wishes of the next of kin should be respected and given
priority over the suggestions contained in this chapter.
A. Memorial services
Holding memorial services for staff who have lost their lives in the
line of duty or while in the service of the Organization, while a sad
duty, is an important action by which the Organization upholds
the noble causes of the United Nations, pays its respects to the life
and work of staff who have dedicated their lives to the Organiza-
tion, and helps the bereaved families cope with the loss of their
loved ones. Suggestions for organizing memorial services are given
below. Some of these suggestions may need to be adapted to local
circumstances.
4. Decide the size of the memorial service and the degree of its
formality. The size of the memorial service and the degree of its
formality should be decided upon first. High-level memorial ser-
vices to be attended by more than 200 people will require a large
conference room or similar facility, which will have to be booked
or rented. A list of speakers will also be needed. Some depart-
mental memorial services for 20-50 participants may be held in
departmental conference rooms. Smaller memorials may take
place in the Meditation Room at Headquarters in New York or
in the office of the DOA/CAO at offices away from Headquarters.
5. Regular protocol for memorial services. For memorial ser-
vices, the need for the following may be taken into consideration:
a. Designating the master of ceremonies.
b. Preparing and printing a simple programme of events,
which may include a favourite quote, poem or picture of the
deceased.
ANNEX 1 ANNEX 1:
ACTIONS TO BE TAKEN:
CHECKLISTS AT A
CHECKLISTS AT A GLANCE GLANCE
ANNEX II:
SOURCES OF
REFERENCE
Actions to be taken in all cases of death
ANNEX III:
These actions may be carried out in a different order, or at the EXHIBITS,
same time, depending on the circumstances. SAMPLE FORMS
ACTION 2
IDENTIFY AND CONTACT THE DESIGNATED EMERGENCY
CONTACT AND THE FAMILY OR NEXT OF KIN
ACTION 3
ASSIST IN MAKING ARRANGEMENTS FOR
TRANSPORTATION OF THE REMAINS
ACTION 4
NOTIFY OTHER UNITED NATIONS OFFICES
ACTION 5
OPEN/SEAL THE DESK OF THE DECEASED
ACTION 6
SEND LETTERS OF CONDOLENCE
PHOTOCOPY
ACTION 7 AND USE THIS
OBTAIN CERTIFIED COPIES OF THE DEATH CERTIFICATE CHECKLIST
FOR ACTIONS
ACTION 8 TO BE TAKEN IN
ASCERTAIN BENEFICIARIES FOR THE PURPOSE ALL CASES OF DEATH
OF ASSESSING ENTITLEMENTS AND BENEFITS
ACTION 9
DETERMINE ELIGIBLE BENEFICIARIES AND INITIATE
SETTLEMENTS OF PAYMENTS AND ENTITLEMENTS
ACTION A.1
ASCERTAIN THE NATURE OF DEATH
ACTION A.2
NOTIFY FPDS AND IDENTIFY AND NOTIFY THE EMERGENCY CONTACT OR
NEXT OF KIN
ACTION A.3
COMPLETE THE “NOTIFICATION OF CASUALTY” FORM
ACTION A.4
ARRANGE FOR AN AUTOPSY AND/OR AN INVESTIGATION, AS
APPROPRIATE (APPLICABLE TO ALL CASES OF SUSPECTED WRONGDOING)
ACTION A.5
ARRANGE FOR THE PROPER HANDLING OF THE REMAINS,
PENDING TRANSPORTATION
ACTION A.6
ARRANGE FOR THE TRANSPORTATION OF THE REMAINS
ACTION A.7
OBTAIN CERTIFIED COPIES OF THE DEATH CERTIFICATE
ACTION A.8
SECURE THE OFFICE AND/OR RESIDENCE AND TAKE
PHOTOCOPY AND AN INVENTORY OF PERSONAL EFFECTS
USE THIS CHECKLIST
FOR ACTIONS TO BE
ACTION A.9
RETRIEVE ITEMS BELONGING TO THE UNITED NATIONS
TAKEN AT THE
FIELD MISSION
BY THE HEAD OF
ACTION A.10
ARRANGE FOR COUNSELLING
ADMINISTRATION
AT THE MISSION
ACTION A.11
CONVENE A BOARD OF INQUIRY
ACTION A.12
ARRANGE FOR A CEREMONY TO BE HELD AT THE MISSION
ACTION A.13
ATTEND THE FAMILY AND/OR PRIVATE CEREMONY
AT THE PLACE OF BURIAL
INSURANCE BENEFITS
ANNEXES 126 Handbook for Action, In Case of Death
Actions to be taken at the Field Mission
by Personnel Management and Support Service
These actions may be carried out in a different order, or at the
same time, depending on the circumstances.
ACTION B.1
NOTIFY THE EMERGENCY CONTACT OR NEXT OF KIN
ACTION B.2
NOTIFY OTHER UNITED NATIONS OFFICES
ACTION B.3
PREPARE AND DISPATCH LETTERS OF CONDOLENCE
ACTION B.4
IDENTIFY ALL DEPENDANTS AND BENEFICIARIES
ACTION B.5
DETERMINE AND ESTIMATE ENTITLEMENTS
ACTION B.6
CALCULATE ANY AMOUNTS DUE TO THE ORGANIZATION,
IF APPLICABLE, AND INITIATE FINAL CLEARANCE
ACTION B.7
FILE THE ADVISORY BOARD AND COMPENSATION CLAIM,
AS APPROPRIATE
ACTION B.8
FILE INSURANCE PAPERS PHOTOCOPY
AND USE THIS
ACTION B.9 CHECKLIST
COORDINATE THE PREPARATION OF THE MEMORIAL DISPLAY FOR ACTIONS
WITH THE DEPARTMENT OF PUBLIC INFORMATION TO BE TAKEN
AT THE
FIELD MISSION
BY PERSONNEL
MANAGEMENT AND
SUPPORT SERVICE
ACTION 1
DEPLOY FST WITH APPROPRIATE RESOURCES
ACTION 2
COMMUNICATE STATUS OF EMERGENCY
ACTION 3
SET UP EMERGENCY STRUCTURES: WEB PORTAL, CALL CENTRE AND
RECEPTION CENTRE
ACTION 4
SET UP FFP SYSTEM
ACTION 5
COORDINATE INFORMATION REGARDING INJURED AND DECEASED STAFF
MEMBERS
ACTION 6
COORDINATE REPATRIATION OF BODIES
ACTION 7
ASSIST VISITING FAMILY MEMBERS
ACTION 8
RETURN OF PERSONAL EFFECTS
INSURANCE BENEFITS
ANNEXES 128 Handbook for Action, In Case of Death
ANNEX II
SOURCES OF REFERENCE
7. Insurance
a. Possible life insurance claim
Author: Insurance
Recipients of material: All staff
INSURANCE BENEFITS
ANNEXES 130 Handbook for Action, In Case of Death
c. Sample fax to permanent mission re: death/serious injury of one
of their nationals
12. Checklists
a. List of questions and information needed in event of a death
b. Checklist of benefits in the event of death/disability while per-
forming official functions on behalf of the United Nations
EXHIBITS
1. Noticas form
2. Notification memo to UN Offices
3. Letter of condolence in English
4. Lettre de condoléances en Français
5. Disability/Death Benefit form
6. Separation Payment form
7. Personal Payroll clearance action
8. Fund beneficiary form
9. Life insurance request form 1
10. Application for ASHI and Pension Fund Deduction (2 pages)
11. Authorization to deduct ASHI Premium contribution
from the Pension Benefit
12. Claim for compensation Under Appendix D
13. Pension fund residual settlement form
14. Claim for Loss or Damage to Personal Effects
INSURANCE BENEFITS
ANNEXES 132 Handbook for Action, In Case of Death
Exhibit 1 Sample
Noticas form
T H R O U G H :
S / C D E :
F R O M :
[Name of HR Expert]
D E :
[Title, Division, Department]
4. We will provide the death certificate and any additional relevant information as we
received it from MINUSTAH.
INSURANCE BENEFITS
ANNEXES 134 Handbook for Action, In Case of Death
Exhibit 3 Sample
Letter of condolence in English
[insert date]
It is with great sadness that I learned of the death of your [husband, wife,
son, daughter…], [name of staff member], while serving with the United Nations
Stabilization Mission in Haiti, following the earthquake of 12 January 2010.
I write to convey my sincere condolences for your loss, and to pay tribute to
your [husband, wife, son, daughter…]’s dedication, competence, and valued
performance, worthy of the highest professional standards as a United Nations
staff member. Mr./Ms. [name of staff member] demonstrated devotion to the work
of our Organization in the service of peace and those in need.
At this time of grief, there is little that one can say to bring comfort or
reassurance. It may, nevertheless, be of some solace for you to know that the
United Nations family mourns with you.
Yours sincerely,
BAN Ki-moon
Le 15 janvier 2010
C’est avec une profonde tristesse que j’ai appris le décès de votre époux/épouse
en poste au sein de la Mission des Nations Unies pour la Stabilisation en Haïti, à la suite
du tremblement de terre du 12 janvier dernier.
Je vous adresse mes plus sincères condoléances et voudrais par la présente lui
rendre hommage. Monsieur/Madame (Family name) a démontré tout au long de sa
carrière au sein des Nations Unies un engagement sans faille au service de la Paix et des
plus vulnérables ainsi qu’un travail dévoué et de grande qualité.
Il est difficile de trouver les mots justes pour soulager votre douleur en ce moment
de deuil. Soyez néanmoins assuré(e) que la famille des Nations Unies partage votre
peine.
INSURANCE BENEFITS
ANNEXES 136 Handbook for Action, In Case of Death
Exhibit 5 Sample
Disability/Death Benefit form
Important Notes:
I. Use this form to submit payment instructions ONLY for Disability or Death benefits payable under the
UNJSPF Regulations. For other types of benefits, please obtain the appropriate form from the
Secretary of your Staff Pension Committee or the Pension Fund’s website: unjspf@un.org.
II. Check the appropriate box below for the type of benefit to which you are entitled under the UNJSPF
Regulations.
III. All sections of the form overleaf should be completed and the form should be signed by you as a
beneficiary of the UNJSPF. When completing the form, please bear in mind that your benefit must be
paid to a bank account in your name or to a joint account which includes your name. Only in
exceptional cases, where a beneficiary does not have a bank account and is unable to open one, can
payment be sent in care of a UN office. Payment cannot be remitted to a mailing address, nor can it be
made to third party. Your signature on the form must be duly authenticated or witnessed, either by an
officer of the United Nations or a local governmental authority. The full name, official title and signature
of the Official authenticating your signature and their stamp/seal of office must be affixed to this form.
If your signature is not authenticated or witnessed, your payment instructions will be returned which
will delay the processing of your benefit.
IV. You are invited to provide Emergency contact details, for use by the UNJSPF ONLY when all efforts to
reach you through normal channels fail.
V. For assistance in filling out this form, please consult with the Secretary of your Staff Pension
Committee.
VI. Upon completion, submit both pages 1 & 2 to the Secretary of your Staff Pension Committee.
This form is required if you wish to receive your final payment(s) into your bank account different from the one
your salaries are currently credited to. Before completing, please read the attached instructions carefully. This form
should be completed in duplicate and returned to your executive/administrative officer, for forwarding to Treasury,
380 Madison Ave., Room M-19000, New York, NY 10017.
Staff Member’s
Name:
(Last name) (First name) (Middle initial)
Name of Bank:
Address of Bank:
Currency of Account:
Type of Account: Checking or Savings (Must be completed for an account in the USA) (Refer #5)
F.250 (11-09)
INSURANCE BENEFITS
ANNEXES 138 Handbook for Action, In Case of Death
Exhibit 7 Sample
Personal Payroll clearance action
16. PT.8 ISSUED FOR TRAVEL 17. FULL REMOVAL AUTH. ISSUED 18. LAST HOME LEAVE 19. WITH DEPENDANTS
YES NO NA YES NO NA FROM: TO: YES NO NA
INFORMATION
20. LAST DAY FOR PAY PURPOSES 21. LAST REGULAR PAY DAY 22. COMPENSATION IN LIEU OF 23. ALLOTMENT A/C NO. 24. POST NO.
NOTICE OR DEATH BENEFIT
. MONTHS
25. OT/DT REPORTED NIGHT DIFFERENTIAL PREVIOUSLY REPORTED ON OT/DT NOT REPORTED ND NOT REPORTED COMPENSATORY TIME
HRS. HRS. HRS. HRS. HRS.
26. ESTIMATED BALANCE OF ANNUAL LEAVE 27. LEAVE CARD AND REPORTS SIGNATURE OF PAYROLL OFFICER DATE
PAYROLL
ATTACHED TO FOLLOW
DAYS AS OF
28. FINAL CHEQUE: TO BE COLLECTED FROM CASHIER’S OFFICE DEPOSIT TO A/C NO.:
MAIL TO:
29. Future mailing
address:
30. ITEMS LISTED UNDER 30A. ON REVERSE HAVE BEEN CLEARED. 31.REMARKS
DEDUCTION FROM FINAL PAYMENT AS PER ST/A1/155/REV.2 AMOUNT
CLEARANCE
$
$
$ SIGNATURE FOR EXECUTIVE OFFICE OF ISSUING DEPT. DATE
(To total, put cursor in the cell & click AutoSum) TOTAL……. $
32. I have received ST/AI/155/Rev.2 and noted the DATE
SIGNATURE OF STAFF MEMBER
information in Section 1 above.
SECTION II – To be completed by the Office of Human Resources Management
33. CERTIFIED TO BE PAID THROUGH 34. PLUS: MONTHS OF PAY IN LIEU OF NOTICE OR DEATH 35. LWOP OR SUSPENSION AUTHORIZED 36. POST ADJUSTMENT CODE
including travel time BENEFIT
From: To:
37. ALLOWANCES AND BENEFITS PAYABLE 37A. ADDITIONAL INFORMATION
Language Dependency Assignment Education Rental subsidy Non-resident Mobility & REQUESTED
grant hardship
YES NO
38. TRAVEL COUNTRY 39. Full removal Rate Status of Spouse:
AUTHORIZED: expenses Single Dep. Staff member Leaving Service Has been previously Entitled to Repatriation
separated grant
YES NO YES NO YES NO YES NO YES NO YES NO YES NO
If spouse is not leaving service, file copies of this form in spouse’s Official Status and Financial Files.
41. Repatriation Grant Rate: 41A. FOR PERIOD 42. TERMINATION INDEMNITY 42A. NO OF 42B. AUTHORITY
Single Dep. YES NO MONTHS
FROM: THROUGH:
YES NO YES NO
43. COMPENSATION IN 43A. NO. OF 43B. AUTHORITY 44. EXIT INTERVIEW 45. PARTICIPATION IN 46. SM SHOULD BE REVIEWED BY THE JSPB UNDER ART.
LIEU OF NOTICE MONTHS PENSION FUND 33 OF THE PF REGULATIONS
YES NO YES NO YES NO
47. REMARKS SIGNATURE FOR OFFICE OF HUMAN RESOURCES MANAGEMENT DATE
SECTION III – To be completed by the Office of Programme Planning, Budget and Accounts
48. OUTSTANDING ITEMS AND AMOUNTS TO BE RECOVERED: AMOUNT AMOUNT
a. Salary Advance $ g. Removal/Unaccompanied shipment $
b. Travel Advance $ h. Staff Benevolent Fund
adjustments $
c. Accounts Receivable $ i. Credit Union $
d. Income tax reimbursement recovery $ j. Imprest Account $
Additional information requested: YES $ k. RentalAdvance $
e.
NO Education Grant Advance $ l. Rental subsidy/deduction $
Additional information requested: YES $ m. Other
f.
NO Audited Annual Leave ( Days $ TOTAL: $
49.
balance ) … AMOUNT 50. Information provided as requested in 37a, 48d and 48e. YES NO
a. Total to be withheld as per item30 $
b. Total to be withheld as per item 48 $ SIGNATURE FOR OFFICE OF PROGRAMME PLANNING, BUDGET AND ACCOUNTS DATE
GRAND TOTAL TO BE WITHHELD: $
DISTRIBUTION: OPPBA/ACCOUNTS DIVISION OHRM/PERSONNEL RECORDS UNIT OPPBA/DATA ANALYSIS & SYSTEMS CONTROL UNIT EXECUTIVE OFFICE
OHRM/PERSONNEL DATA UNIT PENSION FUND STAFF MEMBER
P.35 (10-04)
I, ( First, Middle, Maiden, Surname) INDEX NO. born on (Day, Month, Year)
hereby designate the person or persons named below as my beneficiary or beneficiaries under Staff Rules 1.6, or 312.4 in respect of all
amounts (salary, allowances and commutation of leave) standing to my credit at the time of death. I understand that this designation does
not affect payment of the death benefit or repatriation grant which are payable under the Staff Rules to a surviving spouse and/or dependent
child or children.
I also understand that, should I die as a result of an incident covered by the Malicious Act Insurance Policy, the proceeds will be paid to the
beneficiary(ies) named below, unless I have a surviving spouse and/or dependent child or children, in which case the proceeds of the policy
will be paid to them.
SHARE
NAME OF BENEFICIARY DATE OF
TO BE
BIRTH SEX ADDRESS PHONE NO. RELATIONSHIP
OR BENEFICIARIES (DD/MM/YY) PAID
(%)
The share of any beneficiary who may predecease me shall be distributed equally among the surviving
beneficiaries or go entirely to the survivor. If none survive me, then the entire amount shall go to my estate.
I hereby revoke all previous designations of beneficiary made by me for this purpose and I reserve the right to revoke
or change any beneficiary without his or her knowledge or consent at any time in the manner and form prescribed
by the United Nations.
Signature of Staff Member (To be signed in front of a witness (see below)) Date
ADDRESS
WITNESS
I, the undersigned, having no financial interest in this subject matter, directly or indirectly, hereby certify that this instrument was
signed in my presence by the staff member having designated his or her beneficiaries on the of .
(day) (month) (year)
(Name and Signature of OHRM Witness) (Address of OHRM Witness)
P.2 (7-09)-E
INSURANCE BENEFITS
ANNEXES 140 Handbook for Action, In Case of Death
Exhibit 9 Sample
Life insurance request form 1
FORM 1
Address:
I certify that I do not have a United States social security number and do not reside in
the United States of America.
Applicant Information (Print all information clearly) (PLEASE COMPLETE BOTH SIDES OF THIS FORM AND SIGN)
Name(LAST, First) Payroll Index Number
If US resident, indicate effective date of residency: Are you currently on a G4 visa and applying for residency?
�Yes �No
Persons To Be Insured (Complete for each person for whom insurance is desired.)
IMPORTANT: (If covered spouse was a former staff member, the higher-pensioned retiree must carry the insurance in ASHI and submit this application form.)
Full Name of Person to be Insured Relation If spouse is currently a Date of Birth Number of years Indicate whether US citizen.
(LAST, First) staff member OR was SEX (D/M/Year) of participation If US Resident. How many
former staff member in a UN health years living in the US?
provide index No. Male Female plan
US Citizen
Resident
Other __________________
US Citizen
Resident
Other __________________
US Citizen
Resident
Other __________________
US Citizen
Resident
Other __________________
US Citizen
Resident
Other __________________
Please complete other side
INSURANCE BENEFITS
ANNEXES 142 Handbook for Action, In Case of Death
Application for ASHI and Pension Fund Deduction (page 2 of 2)
Medicare Eligibility
If eligible, Medicare Part B is a requirement at age 65. Please see our pamphlet on Medicare or
go to their website: www.medicare.gov.
Pending National Plan/Medicare Part B Subsidy Implementation please provide the following:
Disability*
Do you or any of your dependents listed above been certified by the social security administration as disabled
or have one of the following conditions:
*If staff member and/or dependents have been certified by the Social Security Administration as disabled,
they are eligible to obtain Medicare regardless of age.
Please note that this form must be completed in its entirety or the application will be rejected.
Pension Fund Authorization (Please sign the form and write the date signed.)
I, hereby, authorize the United Nations Joint Pension Fund to deduct from my monthly pension benefit, and to remit
directly to the United Nations, the premium contribution for my After Service Health Insurance Coverage. I also
authorize the United Nations Joint Pension Fund to provide from time to time, as required, to the office(s) of the
organization responsible for administering the health insurance scheme, information on the amount of my pension
and its basis of calculation, as may be required for determination of the insurance premium.
___________________________________________________________________ ____________________________________
Applicant’s Signature Date Signed (Day/Month/Year)
INSURANCE BENEFITS
ANNEXES 144 Handbook for Action, In Case of Death
Exhibit 12 Sample
Claim for compensation Under Appendix D
Pension Number
INSTRUCTIONS: Please read the instructions below before filling out this form
1. A residual settlement (equal to your own contributions with compound interest) becomes due to the designated recipient(s) should
you die in service and there are no survivors entitled to a benefit under articles 34, 35, 36 or 37 of the Regulations of the United
Nations Joint Staff Pension Fund.
Note: A residual settlement may become payable after a former participant in receipt of a monthly benefit dies, provided that (i) there
are no survivors entitled to a benefit under articles 34, 35, 36 or 37, AND (ii) the total amount of the benefits previously paid to him/her
was less than his/her own contributions with compound interest. The difference would be paid to the designated recipient(s).
2. If more than one recipient is designated, the recipients will share equally unless otherwise indicated. The share of a designated
recipient who may predecease you will be distributed among surviving recipients in the ratio of their own shares. If no one is
designated before your death or if no one designated survives you, the settlement will be paid to your estate.
3. Please complete this form using BLOCK LETTERS in type or print and return it duly signed to the Secretary of your Staff Pension
Committee, or to the UNJSPF if you are a staff member of the UN, e.g., UNICEF, UNHCR, UNFPA, UNDP, etc. It is suggested that you
keep a copy of the completed form with your other important documents.
4. You may alter your designation of a recipient at any time by submitting a new form which will supersede the previous one.
I, ________________________________________________________________
(Last name) (First) (Middle)
hereby designate the person(s)/entity(ies) shown hereunder as recipient(s) of the residual settlement. I hereby cancel and revoke any
previous designation.
Date: ________________________________
(day) (month) (year)
*(Signature of Participant)
*NOTE: The completed form must bear your ORIGINAL SIGNATURE, no faxes or e-mails will be accepted.
INSURANCE BENEFITS
ANNEXES 146 Handbook for Action, In Case of Death
Exhibit 14 Sample
Claim for Loss or Damage to Personal Effects
CLAIMANT INFORMATION
1. LAST NAME: 2. FIRST NAME: 3. INDEX / ID No.: 4. SEX: ___ STAFF MEMBER
___ MILITARY OBSERVER
M F
___ CIVILIAN POLICE
E-MAIL ADDRESS:
INCIDENT DETAILS
11. MEASURES TAKEN TO RECOVER LOST ITEMS: (If none were, or could have been taken, explain why.)
12. PERSONAL INSURANCE STATEMENT: (If insurance is available, please submit copies of appropriated settlement/payment statement(s) rejection notices, etc.)
___ YES, I do have personal insurance coverage that may be applicable to this incident/loss.
___ NO, I do not have personal insurance coverage that may be applicable to this incident/loss.
COMMENTS:
13. MEASURES TAKEN TO RECEIVE COMPENSATION FROM OTHER PARTIES THAT MAY BE LIABLE FOR THE LOST OR DAMAGED ITEMS:
(Such as airlines/transportation companies, event organizers, hotels, government institutions, etc.)
14. IF CLAIM IS BEING SUBMITTED AFTER THE TWO-MONTH TIME LIMIT, PLEASE PROVIDE EXPLANATION:
CERTIFICATION
15. I declare that the above information, as well as that provided in the enclosed list of lost or damage items, are true and accurate statements to the best of my knowledge
and, hereby submit a claim for compensation for loss of or damage to my personal effects in accordance with the provisions of ST/AI/149/Rev. 5.
—Victor Hugo
Tomorrow at dawn…
— Victor Hugo
www.un-epst.org
09-49502—July 2011—1,000