[Form 23] (Front)
(Please refer to the back side. Spaces marked ※are Official Use only.) Period for Handling
Immediately
□Lump-sum Refund or
Application for {
□Lump-sum Death Payment
Name Resident － Tel.
Registration No.
Beneficiary
(Representative Mailing Postal Code□□□－□□□
beneficiary of Address
equal standing)
Relationship Number of □One □ designated
to Beneficiary Beneficiaries of Representative
(Deceased) equal standing □More than One ( Persons) □ undesignated
Insured Name
Registration - Date of
(Deceased) No. death
Financial Institution to which the Account No.
benefit shall be transferred
※ Entitlement ※ Date of Eligibility ※ □Yes ※ □Yes
Code ※Ending date of calculation Disabled □No Unpaid □No
benefit
for Additional payment
☞ Please write below only if there are equal beneficiaries and a designated representative.
Name Resident Registration No.
Designation of a representative ※Degree of
No.
Date Signature Disability
Beneficiaries
of equal ① －
standing ② －
③ －
☞ “Choice of Benefit” is only for a person who is eligible for two or more benefits.
※ Choice of Eligible Benefit
Benefit Benefits (① D M Y)
②
( D M Y)
③
( D M Y) chosen ( D M Y)
(Date) (Date)
☞ Fill in below only in the case of an application by an Agent.
Reason □ Staying abroad □ Military Service Beneficiary (Seal)
Application by □ Imprisonment □Other
Agent Date of (Verified by a
application relevant Chief (Stamp)
(Verification) official)
Name Registration No. - Tel.
Applicant Relationship to
Mailing Postal Code □□□－□□□ Beneficiary
Address
I hereby apply for a Lump-sum Refund or a Lump-sum Death Payment under Free of
Article 34 of the Enforcement Regulation in the National Pension Act. Charge
Receipt
Date of Application: D. M. Y.
Applicant: (Signature or seal)
To. President of National Pension Service
1
(Back)
The Application shall be processed as follows.
Applicant Through National Pension Service
Regional Office
Fills in the Application receives application & confirms
the entitlement
Financial Institution Head Office
Receipt notifies of
deposits into the account requests payment payment
Regional Office
determines the payment, sends the
notification to applicant
《 Required Documents 》
1. The Applicant's Resident Registration Card or other Identification Card.
2. A copy of Certificate of Resident Registration (in the case of the application caused by death of the contributor )
3. If applied by an agent, a copy of beneficiary's Registered Seal Certificate. (인감증명, Ingam
Jeungmyeong, it is available at Gu Offices.)
4. If applying by way of a loss of Korean nationality or emigration from Korea, a copy of your Passport or
other relevant certificates which can prove the cause of application.
《 Tips 》
1. Spaces marked ※ are for Official Use only.
2. Please fill in all appropriate items concerning the beneficiary; name, resident registration and telephone number.
Mailing address and postal code should be written according to the Certificate of Resident Registration.
3. Account number at a financial institution should belong to the applicant and be confirmed that it is open.
4. If beneficiaries of equal standing designate a representative, the designated person shall stamp or sign on the
"Designation of a representative" space.
a. If there is no representative, each beneficiary of equal standing shall apply individually.
b. If beneficiaries of equal standing are under age 18, his/her legal agent shall stamp or sign on the "Signature"
space .
5. Fill eligible benefits and the date in the "Choice of Benefit" space only if you have a choice of benefit under
Article 28 of the Enforcement Regulation of the National Pension Act.
6. “Application by an Agent" is available only if a beneficiary is staying abroad, in prison or other reasons.
7. In case of an application on behalf of a beneficiary, the Seal should be the same as that of the beneficiary's
Registered Seal Certificate.
※ If a beneficiary is confined to a prison or detention center, it should be verified by the chief official of that
facility.
※ I apply for a Lump-sum Refund or a Lump-sum Death Payment despite knowing that I can not
receive a Special Old-Age, Disability or Survivors Pension if I receive the Lump-sum Refund.
Beneficiary: (Signature)
