MUNICIPAL GRATUITY FUND - mymgf.co.za

1 EXIT FORM: TERMINATION OF MEMBERSHIP Surname: .. Identity Number: .. Names: .. Job Designation: .. Employee number: .. Tax number: .. PENSIONNR: .. OFFICIAL STAMP OF MUNICIPALITY DATE OF EXIT C C Y Y M M D D REASON FOR TERMINATION OF SERVICE Retirement Resignation Dismissal/Abscond Retrenchment Disability Death In the case of death the nomination form must be attached hereto.

2 Is the nomination form attached? YES/NO .. In the case of YES and the nomination form is not attached hereto we cannot continue to process this death exit and the process will be placed on hold until such time that the Council provides the nomination form. Is member entering into service of the same local authority or a UAC of the same local authority after date of termination of service, whether permanent YES/NO .. or contractual? (A UAC is a MUNICIPAL entity as defined in the Local Government: MUNICIPAL Systems Act, 2000 (Act 32 of 2000) or any other utility, agency or corporate entity of a similar nature) If member is going to join the service of another local authority, does member require benefit payment?

3 YES/NO .. Date of final contributions deducted from his/her salary must be the same as exit date, if not give reasons: .. C C Y Y M M D D Annual pensionable emoluments on date of exit: (SALARY PER YEAR) R Contributions deducted from final salary: MEMBER: COUNCIL: MUNICIPAL GRATUITY FUND Private Bag X14, Highveld Park, 0169 Member s Postal address: Member s Home address: Council s Postal address: Council s Physical Address: I Member s cellphone number Member s telephone number: Name of official: Council s telephone number.

4 ( ) ( ) ( ) Bank Details Name of account holder: .. Signature of account holder: .. Bank: .. Branch Code: .. Account number: .. Type of account: .. A: VERY IMPORTANT IN THE EVENT OF RETIREMENT AND MEDICAL DISABILITY: In the event of retirement and medical disability retirement the benefit will be payable as an annuity to be arranged by the member with an Insurer of his choice. The member may exercise an option to convert as much of the benefit as is allowed by legislation to a lump sum payment. Currently legislation allows conversion of the full benefit to be paid in a lump sum. It will be assumed that by signing this form without completing paragraph B below, the undersigned member elects to convert the full benefit to a lump sum payment in terms of the Rules of the Fund.

5 B: ONLY TO BE COMPLETED IF MEMBER DOES NOT WANT A FULL LUMP SUM PAYMENT: I do not want to receive my retirement or medical disability retirement benefit in a lump sum payment, but want of my benefit to be paid as an annuity to be arranged by me with an Insurer of my choice, and the balance to be converted to a lump sum benefit payment. The portion of the annuity must be transferred to the following of which the contact details of my broker is as follows: tel nr: .. _____ I, the above-mentioned member, hereby confirm that the information recorded above is correct: Signature of member: .. Date: .. Signed: .. Date: .. (On behalf of the Municipality) THIS FORM MUST BE FULLY COMPLETED BEFORE A TAX DIRECTIVE WILL BE REQUESTED AND PAYMENT EFFECTED AND FAXED TO (012) 683-3996