NOTIFICATION OF WITHDRAWAL

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					                                                                                         Maxim Employee Benefits (Pty) Ltd.
                                                                                         19 Ameshoff Street, 8th floor Rennie House,
                                                                                         Braamfontein 2001
                                                                                         PO Box 32525, Braamfontein, 2017
                                                                                         Tel (011) 356-4200
                                                                                         Fax (011) 339-2167


                                         NOTIFICATION OF WITHDRAWAL
1. MEMBER’S DETAILS
Please complete in BLOCK LETTERS and tick (√) where applicable. All dates must be entered as DD/MM/YYYY.

Scheme/Fund name
Employer name
Member surname
First names
Identity number                                              Date of birth                     Date joined fund
Annual taxable salary      R
Member number                                     Payroll number                          Last working day
Month for which last                                    Member’s last monthly contribution before withdrawal R
contribution was paid
Reason for withdrawal               Resignation                       Retrenchment                           Dismissal
Member’s postal address


Member’s Telephone No’s


2. BENEFIT OPTIONS (Refer to Clause 6: Note 1 and your Benefit Statement)

 2.1                         Receive a cash payment                                                  Yes                     No

If “Yes”, full proceeds    R                                                             Other amount        R

I understand that all cheques issued by the Fund are marked "Not Transferable", "Not Negotiable" and, as such, must be paid into the
Member’s bank account. I hereby authorise the above mentioned scheme to credit the account at the following bank:
Name of Account Holder                                                   Name of Bank
Branch                                                                   Branch Code
Account number                                                           Account type

 2.2                         Leave benefit paid-up within the Fund                                   Yes                     No

 2.3                         Transfer benefit to another Fund                                        Yes                     No

Name of other Fund
Name of Account Holder                                                   Name of Bank
Branch                                                                   Branch code

Account number                                                           Account type




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3. INDEBTEDNESS TO EMPLOYER
Payment to the Employer is only permissible under a registered fund where the member is indebted in respect of a housing loan in terms
of Section 19(5)(a) of the Pension Fund Act of 1956 (PFA) or if damage has been caused to the Employer by reason of the Member’s
theft, misconduct, fraud or dishonesty in terms of section 37D(b)(ii) of the PFA, where the whole or a part of or the Member’s benefit may
be paid to the Employer in special circumstances (See Clause 6: Note 2). Separate supporting documentation must be provided.
Please advise whether the Fund has any indebtedness by the member for a housing loan or
whether the member has signed any surety in favour of any financial institution on his/her benefit            Yes              No
or part thereof, in terms of any housing loan scheme.

If so, please indicate the outstanding balance of the Loan.                                                   R
Financial Institution
Contact Person
Contact number

4. MEMBER’S TAXATION DETAILS
Income Tax number
Revenue Office

Has the member been employed in any territory outside South Africa? If so, give details, including periods:



5. AUTHORISATION AND DISCHARGE
We hereby certify that the above information is true and correct in every detail and that Maxim Employee Benefits is hereby authorised to
make payment as stated above, following the withdrawal of the member. We agree that payment either by crossed cheque or Electronic
Fund Transfer shall constitute good and effectual settlement and shall be full and final discharge to Maxim Employee Benefits and/or the
Fund, of its liability in terms of the Rules of the Fund. We indemnify Maxim Employee Benefits and the Fund if payment is made by
crossed cheque and the cheque is stolen. By law the Fund may not make benefits payable to any third party (i.e. ANY person other than
the member). Should the member provide the details of a joint account or the account of any other person, Maxim Employee Benefits will
not accept responsibility for any losses arising as a result of payment into such account.
Where the Member’s signature does not appear on this form, the Employer hereby acknowledges that the necessary disclosure regarding
the benefit payment options as well as the tax implications thereof, have been made to the Member by the Employer. Maxim Employee
Benefits shall not be held liable for any such non-disclosure and the Employer hereby indemnifies Maxim Employee Benefits against
omissions in this respect.
Remarks (if any):



                    Member’s Signature                                                                 Date


              Employer’s Authorised Signatory                                                          Date


                    Full Name and Surname


                         Designation
                                                                                                         Company

                                                                                                              Stamp


 NB: Please forward this completed form to the address indicated on previous page


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6. NOTES
1. Benefit Options On Withdrawal

     Upon termination of membership the following options regarding the payment of benefits should be considered by the member:

      a) Receive A Cash Payment

          You may choose to have your benefit paid to you in a cash lump sum. Pension fund members are entitled to receive up to
          R1 800 tax-free, whilst provident fund members are entitled to receive a tax-free amount equivalent to the greater of R1 800 or
          their accumulated member contributions. However, (in both instances) the balance of the benefit will be taxed at your average
          tax rate; OR

      b) Leave Benefit Paid-up In The Fund (if Rules allow for this option)

          You may choose to leave your benefit in the Fund when you terminate your membership of the Fund, if the Rules of the Fund
          allow for this option. The benefit will remain in the Fund accumulating with investment growth, until your retirement or death; OR

      c) Transfer To Another Fund (approved pension or provident fund, or retirement annuity fund)

          No tax is payable when benefits are transferred from a pension fund to another pension fund or retirement annuity fund, or from
          one provident fund to another. However, any benefit transferred from a pension fund to a provident fund will be treated as if it is
          a cash benefit; OR

      d) Transfer To A Preservation Fund

          A preservation fund provides you with the same concessions as transferring your money to an approved pension or provident
          fund, with the exception that it allows you to make a single cash withdrawal from your benefit at any given time up to normal
          retirement age. This cash withdrawal, whether partial or complete, would be subject to tax according to the general taxation
          legislation applicable on withdrawals. Your employer also has to be registered as a participating employer in the preservation
          fund to which you will be transferring your benefit.

          Please note that, should ANY cash amount be deductible from your benefit in terms of Section 37D of the Pension Funds Act
          (for e.g. settlement of your home loan, divorce order etc) upon your withdrawal from the fund, this will be regarded as your
          once-off cash withdrawal. You therefore would not be entitled to any further cash advances from your preservation fund.

If you are uncertain about any of the benefit options available to you, it is recommended that you seek professional advice before making
a final decision regarding your benefit options.


2.   Deductions In Terms Of Section 37D Of The Pension Funds Act

     In terms of Section 37D of the Pension Funds Act, the only payments in respect of which a member's benefit may be reduced, are:

     a)   Collateral or loans issued purely for housing purposes. Substantial proof to this effect must be supplied.

     b)   Recovery for damages caused by fraud, theft, dishonesty or misconduct, which can only be recovered if the member admits to
          it in writing, or if a compensatory court order is obtained (ordering the member to repay the damages).

          The recovery of personal indebtedness to the employer (such as personal or staff loans) is not permitted.

     Further deductions allowed in terms of Section 37D of the Pension Funds Act are in respect of maintenance payments, or divorce
     court orders endorsed against the fund, entitling the non-member spouse to a portion of the member’s benefit.




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