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CLAIM NOTIFICATION - Pension Fund

alexander forbes Life Limited Reg No. 1997/022561/06 FAIS Licence no: 1178 alexander forbes Place, 61 Katherine Street, Sandown, 2196P O Box 652071, Benmore, 2010 Tel:+27 0860 100 333 (call centre)Fax:+27 (11) 324 3461 (call centre) CLAIM NOTIFICATIONALEXANDER forbes UNCLAIMED BENEFIT PRESERVATION FUNDL I FEAlexan der Fo rbesPension FundTickProvident FundTickMember NumberName of Employer/Paypoint1. MEMBER S PARTICULARS (please complete in full)SurnameFirst namesMaiden nameID/Passport numberCountry of issueDate of birthDDMMYYYYR esidential addressUnit numberComplexStreet numberStreet/Farm nameSuburbCity/TownCountryCodePostal addressCodeTelephone numbersHomeCODENUMBERWorkCODENUMBERCellE -mailPeriod of employment outside RSA prior to withdrawalCompleted yearsFromDDMMYYYYtoDDMMYYYYI ncome tax numberRevenue officeNon-completion of the above may result in a delay in the settlement of this DOCUMENTATION TO BE ATTACHEDC ertified copy of Identity DocumentCancelled cheque or original Bank Statement reflecting the bank account numberProof of membership of previous fund (membership certificate, benefit statement or letter from Employer)4.

Alexander Forbes Life Limited Reg No. 1997/022561/06 FAIS Licence no: 1178 Alexander Forbes Place, 61 Katherine Street, Sandown, 2196 P …

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