NIFMT PRINTABLE FORM

Settlement Application Form

Application / Form Number

Application / Form Date

Submit a request for review of settlement or plan completion under the applicable signed agreement. Submission is not confirmation of a settlement amount or payment date.

Complete applicable fields only. Attach supporting documents listed in the application instructions. This form does not guarantee approval, payment, principal repayment or returns.

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Member and Project Details

Full name

Membership / agreement reference

Email address

Mobile number

Name of Project

Sub-project Name

Plan Category

Settlement Request

Request type

Requested settlement / completion date

Reason and details

Bank / Payment Reference

Account holder name (if required)

Bank / payment reference (if applicable)

Supporting documents attached

Documents Checklist

Signed agreement reference

Membership certificate (if issued)

Identity documents as required

Declaration

I confirm that the information provided is accurate to the best of my knowledge and understand that the applicable signed agreement and law govern the project terms.

☐ I have reviewed the form and attached the relevant supporting documents.

Applicant / Member Signature: __________________

Date and Place: __________________