Siyasibulela@fairsure.co.za

Employment Information

Retirement Fund

Employee Number

Employer

Member Details

First Name

Surname

Email

Cellphone Number

Identification Type

RSA ID
Foreign Passport

Passport Number

Was Retirement Number

Country of issue

ID Number

Income Tax Number

Withdrawal Details

Bank Name

Account Type

Bank Account Holder

Branch Code

Bank Account Number

Withdrawal Amount (ZAR)

Compliance

Was the member physically verified?

Yes
No

This would mean that the member handed the form in themselves, and their identity was positively verified to their photo in their ID/passport document.

Was the form stamped by the Employer?

Yes
No

Were the mandatory documents submitted with the claim form?

Copy of ID document
Proof of banking details

Two-pot claim initiation form

Employment Information

Member Details

Withdrawal Details

Compliance