Transcription of Bar Code SEE INSTRUCTIONS OVERLEAF TYPE OF …
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Bar Code SEE INSTRUCTIONS OVERLEAF TYPE OF …
81/99567 Bar CodePension Fund (GEPF) National TreasuryGovernment EmployeesSEE INSTRUCTIONS OVERLEAFPage 1 of 4 ALL PAGES OF THIS form MUST BE COMPLETED IN ORDER FOR THIS form TO BE VALIDAND THE RELEVANT PARTIES MUST INITIAL THIS PAGEC ommissionerof Oaths InitialApplicant'sInitialTYPE OF TRANSACTION (Select only one type) - PENSION FOR: SPOUSE OR ORPHAN(S)A) PARTICULARS OF DECEASED (Compulsory)B) PARTICULARS OF PERSON APPLYING FOR PENSION (Compulsory) 4. Date of marriageC C Y Y M M D D5. Marital type:A. ReligionB. Customary UnionC. CivilD. Life Partner3. Maiden name1. Date of birthC C Y Y M M D D2. Income tax ) PARTICULARS OF SPOUSE/LIFE PARTNER (Only needed for spouse's pension applications)7. Residential addressC O D EC O D E6. Postal address5. E-mail address3. Tel O D E4. Cell No. C) CONTACT PARTICULARS OF APPLICANT (Compulsory) 9. Title10. Date of birthC C Y Y M M D D11.
National Treasury Government Employees Pension Fund (GEPF) Overleaf for Form Z143 May 2005 Page 1 of 1 Instructions for Completing Form Z143: Applying for Spouse’s and
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