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DEPENDANTS AND NON-DEPENDANTS FORM …

To the trustees of (Tick your fund) Auto Workers Provident Fund Motor Industry Provident Fund Motor Industry Pension Fund Copartes Pension Fund FULL NAME AND SURNAME OF MEMBER (BLOCK CAPITALS) Date of birth Identity number Member number Employed by 1. In terms of the Pension Funds Act, a member s DEPENDANTS and persons who are not DEPENDANTS but who are nominated by the member must be considered by the trustees when they decide in what proportion lump sum benefits are to be paid from the Fund on the death of a member. To assist the trustees in making their decision please complete Section 3 to 4 below. (Please read the reverse side of this form before filling in the spaces below). 2. You MUST change your nomination every time there is a change to your DEPENDANTS and non- DEPENDANTS ( you get married, divorced, have a child and so on) 3. DEPENDANTS : Surname Initials Gender Date of birth ID number Address & Contact number Share of benefit Relationship 4.

dependants and non-dependants form disposal of lump sum death benefits (this explanation is not a legal document - the wording of the act is definitive)

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