FOMU YA MALIPO KWA MRITHI ASIYE MWANACHAMA WA TSA

Jina Kamili la Marehemu (Name of the deceased)

Tarehe Aliyofaliki (DOD)

Day

Month

Year

Mahali Alikofariki (Place of Death)

Jina la Mrithi (Name of the Heir)

Anuani (Address)

Namba ya Simu (Phone)

Kiasi cha Fedha (Amount)

US$

Date and time

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Month

Year

Time

HoursMinutes

MAELEZO MUHIMU KWA MRITHI: Mimi ndiye mrithi halali wa marehemu niliyemtaja hapo juu. Kiasi cha fedha kilichotajwa kitakapolipwa sitakuwa na madai zaidi kwa Tanzania Sharing Association kuhusu stahiki hizi.

Sahihi ya Mrithi (Signature)

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Kitambulisho cha Mrithi (DL/ID)

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