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WITHDRAWAL FROM FUND Bar Code - GEPF - Home

81/99870 Bar CodeTYPE OF TRANSACTION:A) PERSONAL PARTICULARS (Compulsory for all types of transactions)21. Occupation codeA. between fundsC. RetirementD. DeathE. DivorceZ102 National TreasuryPensions AdministrationWITHDRAWAL FROM FUNDSEE INSTRUCTIONS OVERLEAFY ears18. Pension retirement age (per service conditions)17. Date of service terminationC C Y Y M M D D13. Gender:MaleFemaleSingleMarriedDivorcedWi dow/erLife Partner14. Marital status:20. Employer code19. Employer name22.

Z102 Page 3 of 4 Y H) MEDICAL BENEFIT PARTICULARS 1. Does the member / spouse wish to continue with membership?Yes No 5. R R R R R R C C

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