TERMINATION OR TRANSFER ADVICE - Sizwe

1 CODE EFFECTIVE DATE _____ NAME AND INITIALS _____MEMBER S MEDICAL AID NUMBER PAYROLL NUMBER FORWARDING ADDRESS OR COMPANY TO WHICH EMPLOYEE TRANSFERRED_____ CODE EFFECTIVE DATE _____ NAME AND INITIALS _____MEMBER S MEDICAL AID NUMBER PAYROLL NUMBER FORWARDING ADDRESS OR COMPANY TO WHICH EMPLOYEE TRANSFERRED_____ CODE EFFECTIVE DATE _____ NAME AND INITIALS _____MEMBER S MEDICAL AID NUMBER PAYROLL NUMBER FORWARDING ADDRESS OR COMPANY TO WHICH EMPLOYEE TRANSFERRED_____ CODE EFFECTIVE DATE _____ NAME AND INITIALS _____MEMBER S MEDICAL AID NUMBER PAYROLL NUMBER FORWARDING ADDRESS OR COMPANY TO WHICH EMPLOYEE TRANSFERRED_____TERMINATION OR TRANSFER ADVICESECTION 1 TERMINATION OR TRANSFER OF MEMBERSHIPSECTION 2 DECLARATION BY EMPLOYERDISTRIBUTION OF ADVICE ORIGINAL TO Sizwe MEDICAL FUND COPY TO BE RETAINED BY COMPANYPAYPOINT NUMBER/CODE _____We confir m that the inf or mation is tr ue and correct and that the relevant contribution adjustments will be ef fected on the appropriat e contribution _____ DESIGNATION _____DATE _____ E-MAIL ADDRESS _____Please note: Company must inf or m Sizwe of resignations on the date that the member 1 EMPLOYER S STAMPCODES.

2 01detadiuqil/nwod desolc ynapmoC = 02 = Sc heme change within company03 gniyaP tceriD ot ynapmoc morf refsnarT = Member (DPM)04dia lacidem s'esuops denioJ = 05ecivres htiw deifsitassid rebmeM = 06htaeD = 07noisnep nO = 08ynapmoc morf dengiseR = 09puorg reyolpme wen ot derrefsnarT = 10ycilop ynapmoC = 11tnemyolpme morf dessimsiD = 12 = Member dissatisfied with benefits13 = Retr enched14 = Cover ag e costs too expensive15 = EmigratingSizwe Medical Fund is administered by Sechaba Medical Solutions (Pty) Lt