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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

TRANSFER A member can request a part payment prior to transfer to a preservation fund. SAR’s current view is that any deductions made in respect of divorce

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