FUND DETAILS (To Be Completed by Employer)

WITHDRAWAL NOTIFICATION

TO THE ADMINISTRATOR:

(to be used in liquidation cases)

BROKSURE ADMINISTRATORS (PTY) LTD

P.O. BOX 16254, VLAEBERG, 8018

Tel: (021) 424 1299

Fax: (021) 424 2039

Email:

FUND DETAILS (to be completed by employer)

Name of fund.…………………………………………………………………………………………………………………………………..……

Name of employer.……………………………………………………………………Division / branch ……………………………………….

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MEMBER DETAILS (to be completed by member)

Title.…………(Mr/Mrs/etc.) Last name. ……….…………………………First names……………………………………………..……...

Date of birth …………………..………ID no………………….………..…….………Income tax no.……………………..……...…………….

Residential address.…………………………………………………………………………………………………………………………………

……………………………………………………Postal code.………..……………Contact numbers ………………………………………...

Postal address………………………………………………………………….. ……………………………Postal Code ……….…………….

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WITHDRAWAL DETAILS (to be completed by employer and employee)

1 Date of exit from fund (last day of a month in dd / mm / yyyy format) ………………………………

2 Benefits (For options see attached notes)

(a) Does the member wish to convert group life (if available) ? (see Note 1) Yes / No

(b) Does the member wish to convert disability income insurance (if available) ? (see Note 1) Yes / No

(d) Does the member wish to transfer his/her benefit to an approved preservation fund or

to an approved retirement annuity fund ? (see Note 3) Yes / No

(e) Would the member like a financial advisor from Broksure to provide advice ? Yes / No

General Please refer to the attached notes which provide further guidance.

Note 1 In the cases of choices (a) and (b) above, conversions are not available to those members already admitted to disability claims. Conversions in other instances must be notified to the fund’s risk underwriters, via the fund’s Administrator, within 30 – 60 days of membership termination, depending on the registered insurer.

Note 2 A withdrawing member may transfer his/her benefit to another approved fund with another employer – please seek advice from your financial advisor.

Note 3 A withdrawing member may transfer his/her benefit to an approved preservation fund or to an approved retirement annuity fund – please seek advice from your financial advisor.

AUTHORISATION (to be completed by employer and employee)

I / We declare that the above information is correct and authorize the benefit to be paid as follows :

Send cheque (after deduction of any taxes) to my postal address as given above.

Pay cheque (after deduction of any taxes) into my bank account, details as follows :

Bank ………………………………………………………….. Branch ………………………………………………

Branch code ……………………………………………………. Account name………………………………………

Account number………………………………………………… Type of account……………………………………

Send cheque (after deduction of any taxes) to my employer’s address for my collection.

Transfer into another approved fund, details of which will be provided later.

Member’s signature…………………………………………Employer’s signature……………………………….

Date…………………………………………………………. Date………………………………………………….

Options available on withdrawal of member

Benefits are payable by the fund following withdrawal. Withdrawal means resignation, dismissal or retrenchment. The rules of the fund will provide specific detail which must be followed. Different options can apply to different categories of membership. The summary below is intended only to give an overview of the various options to which you may be entitled so that you can make an informed decision regarding the payment of your benefit. If possible it is best to choose an option which preserves your benefit making it available at retirement. We recommend that you consult with a registered financial service provider.

Option 1 : Annuity

The rules of the fund make provision for benefits payable on withdrawal to accrue in the form of an annuity which would be purchased by the fund in the name of the member from a registered long term insurance company. Should this option not be suitable, the member may indicate in writing to the trustees and / or administrator that up to 100% of the benefit is to be paid as a lump sum cash amount. Any lump sum cash amount is subject to taxation.

Option 2 : Lump sum cash

A withdrawing member from either a pension fund or a provident fund has the option of taking up to 100% of the benefit as a lump sum cash amount which would be subject to taxation. The first R22,500.00 of a lump sum cash amount is tax-free. Withdrawal lump sums from R22,501 up to R600,000 are taxed at 18%, from R600,001 up to R900,000 are taxed at 27% and amounts in excess of R900,000 are taxed at 36%.

Option 3 : Transferring to a retirement annuity fund or to a preservation fund

This option comprises the transfer of the member’s withdrawal benefit to a retirement annuity fund or to a preservation fund without incurring any deduction for tax. On transfer, the member becomes a member of the retirement annuity fund or the preservation fund and must abide by that new fund’s rules and no longer is a member of his original employer fund.

In the case of a transfer to a retirement annuity fund, when the member reaches retirement age, up to one third of the final amount accumulated therein can be taken at retirement in the form of a lump sum cash amount, subject to taxation and the balance of the proceeds must be taken in the form of an annuity. The capital sum used to purchase the annuity is not subject to taxation but the income stream resulting from the purchase of the annuity will be subject to tax. The earliest age at which the member may retire from a retirement annuity fund is 55 and the latest 70 years of age.

In the case of a preservation fund, the member must first become a member of that preservation fund which must be (i) a pension preservation fund if the member’s transferring fund is a pension fund or (ii) a provident preservation fund if the member’s transferring fund is a provident fund and (iii) either of which must be approved by the South African Revenue Services (SARS).

Preservation funds usually require minimum investment amounts which vary from one financial institution to another financial institution managing and administering the preservation fund. An aspect of a preservation fund is that one (and only one) withdrawal may be made from a preservation fund prior to retirement to, for instance, meet any unexpected financial need which aspect is not available from membership in a retirement annuity fund. By choosing to invest in a preservation fund, the member’s ‘years of service’ that have accumulated in the original ‘old fund’ is included in the determination of the member’s eventual tax free lump sum at retirement from the preservation fund whereas this is not available on retirement from a retirement annuity fund.

Option 4 : Transferring to a new employer fund

It frequently happens that an exiting member from an employer fund joins a new employer and is offered membership of that new employer’s fund. The option to transfer the benefit payable by the ‘old fund’ to the ‘new fund’ may be chosen as an alternative to a transfer to a retirement annuity fund or to a preservation fund. The new employer’s fund must be approved by SARS. The transferring amount may be subject to taxation if the member transfers from a pension fund (old employer’s fund) to a provident fund (new employer’s fund) and consequently this type of transfer is not recommended. This problem does not arise if the transfer is from an employer pension fund to another employer pension fund or from an employer provident fund to another employer provident fund or from an employer provident fund to an employer pension fund.

Option 5 : Leaving the money as a paid-up benefit

Subject to the rules of the fund, a member may choose to leave the withdrawal benefit as a ‘paid-up’ benefit in the fund. The benefit so payable continues to be identified in the member’s name in his/her member individual account in the fund and continues to attract the investment returns being experienced in the fund. Investment returns may be positive or negative depending on investment market vagaries.

Option 6 : Cession of an individual life policy

Subject to the rules of the fund and if an individual life policy has been effected on the member’s life but owned by the fund, the member may be able to take cession of the individual policy subject to any taxation which may be incurred by the member. Alternatively the policy may be surrendered and the cash resulting therefrom, received by the fund, be used to enhance the member’s withdrawal benefit.

Option 7 : Group life assurance and if applicable disability income insurance cover conversion (ie continuation)

Subject to the rules of the fund, the member may, within 30 to 60 days of leaving service, exercise an option to effect an individual policy without evidence of health, but subject to an HIV test. Following the exercise of such an option, the member takes ownership of a policy document issued by an underwriter and then becomes personally responsible for the continuing payment of any premiums due thereon. The period of 30 to 60 days during which this option may be available varies depending on the underwriter involved.

Option 8 : Retrenchment

Please consult with a financial service provider should you be retrenched as special tax concessions apply in respect of which you may be eligible.