Important: No claim will be paid if the required document was not submitted. Name and Surname of employee:...

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1 NOTIFICATION OF MARRIAGE Return to: IMPORTANT: The completed form must reach HR Support Services (HRSS) within 3 MONTHS of the date of marriage. If the form is not submitted to HRSS within 3 months the options will expire and no implementation will be possible. A certified copy of the marriage certificate must be attached to this form. (If the required document is not available the form may be submitted without it. However, the required document must be submitted as soon as possible.) Important: No claim will be paid if the required document was not submitted. DETAILS OF EMPLOYEE AND SPOUSE Name and Surname of employee: Identity number:..... Paycode:... Business Unit:.... Date of marriage: Telephone number:..... Spouse s ID number:..... Full names of spouse:... Address after marriage:.. Postal Code:..... A. GROUP LIFE ASSURANCE (OFFICE STAFF) 1. Death cover on member s own life 1.1 The rules of point 1.1 is only applicable if you were a member of this insurance before 1 April 1993 and have remained a member uninterruptedly since then, and now require additional death cover. Important: If you are a member in the above-mentioned category, but reduced your death cover at a previous occasion since 1 March 2002 to 2x or a lower level of your annual Total Guaranteed Package (TGP), the of point 1.2 are applicable to you. Members who joined the Insurance before 1 April 1993 qualified for 2x annual TGP death cover at commencement of membership and apart of that they can also take out additional death cover on their own life, subject to an overall maximum of x annual TGP within 3 months after marriage. The additional assured death cover is equal to a maximum of 2x the member s annual TGP and can be negotiated simultaneously or separately (in multiples of 0.x the annual TGP) within 3 months after the date of marriage. Proof of good health will be required if your new level of death cover is more than 2x your annual TGP. A190 1

2 (Mark the applicable block with an ) I require the following multiple of my annual TGP as death cover on my own life. I understand that the increase in my cover is subject to proof of good health. 2.x 3x 3.x x 1.2 The rules in this point are applicable to members who became a member of this insurance after 1 April 1993 as well as members who became members before this date, but who reduced their death cover at a previous occasion since 1 March 2002 to 2x or a lower level of their annual TGP. The maximum death cover on your own life is 2x your annual TGP. Only members who enjoy death cover less than 2x their TGP may increase their cover to a maximum of 2x their annual TGP within 3 months after the marriage. (Mark the applicable block with ) I currently enjoy less than 2x my annual TGP death cover on my own life and wish to increase it to 2. Death cover on your spouse s life (spouse cover) 1x 1.x 2x Death cover on your spouse s life is not compulsory. Employees may apply for spouse cover within 3 months after marriage. Members who joined the insurance before 1 April 1993 and have remained a member uninterruptedly since then may apply for death cover on their spouse s life up to 2x the member s annual TGP. Members who joined the insurance after 1 April 1993 may apply for death cover on their spouse s life equal to a maximum of 1x the member s annual TGP. (Mark the applicable block with ) I am a member of this insurance uninterruptedly since before 1 April 1993 and apply for the following multiple of my annual TGP death cover on my spouse s life. 0.x 1x 1.x 2x I became a member of this insurance after 1 April 1993 and apply for the following multiple of my annual TGP death cover on my spouse s life. 0.x 1x A190 2

3 B. SANLAM STAFF UMBRELLA PROVIDENT FUND (SSUF) This part must be completed if you are a member of the SSUF. When a member marries, he or she has the option within 3 months from the marriage to increase the assured death cover on his/her life: - up to the default of his/her age; or - by 2 x TGP above his/her current cover level; whichever is greater. Age of Member Up to 2 years 2 30 years 31 3 years 3 0 years 1 years 0 years 1 years years + Multiple of TGP Default Maximum The increase in cover applies from the date on which HRSS receives the request to increase the cover. Unfortunately, no such requests received after the 3 months period can be accommodated. (Mark the applicable block with an ) (a) I prefer to keep my assured death cover unchanged. or (b) I prefer to increase my assured death cover with: *indicate applicable multiple of TGP 0.x 1x 1.x 2x Or To the default of my age group *The new increased level of cover may not be more than the maximum level of the member s age group. C. FAMILY INSURANCE (OFFICE STAFF) This part must be completed only if you are a member of the family insurance. (Please refer the information brochure for full details of the family cover benefits and premiums.) When a member marries, he/she may add his/her parent(s)-in-law to the family insurance within 3 months of the marriage. The maximum age at entry of parent(s)-in-law is 79 years. Those who are eighty and older cannot be added. In the event of the death of the parent(s)-in-law owing to natural causes within months of joining the scheme, no benefit will be payable. In the event of a divorce, the cover of the parent(s)-in-law automatically lapses. : I prefer to add my parent(s)-in-law to the family insurance. YES NO [Mark the applicable block with an ] A190 3

4 PARTICULARS OF PARENT(S)-IN-LAW 1. Full name and surname:.. Identity number: Full name and surname:.. Identity number:.. Additional parent cover: Important: You may only select the additional parent cover for your in-laws if you currently have NO parents insured. (Should you have any parents insured, then the same level of cover will be applicable to your parents-in-law.) : I want additional parent funeral cover [Mark the applicable block with ] YES NO D. MEDICAL SCHEME Membership of TopMed, Bonitas or Fedhealth Medical Scheme is compulsory if you are not registered as a dependant on any other medical aid scheme. All forms referred to in this part are available on the Intranet at Wealthsmiths > My HR > My Medical Scheme. ( The completed forms must be attached to this form. 1. You may add dependants Complete the following form to add dependants: - TopMed: Amendment form - Bonitas: Member record amendment form - Fedhealth: Record amendment form - Bestmed: for the registration of dependants form 2. You may become a member of TopMed/Bonitas/Fedhealth Medical Scheme if your membership as a dependant on your spouse s/parent s medical aid has been cancelled. Complete the respective TopMed/Bonitas/Fedhealth application form. You have to provide a membership certificate of your previous medical aid that indicates when your membership ceases. A190

5 3. If you are registered as a dependant on your spouse s medical aid, you may cancel your TopMed/Bonitas/Fedhealth/Bestmed membership. : TopMed/Bonitas/Fedhealth/Bestmed: Members inform HRSS in writing that they wish to cancel their membership. At least 30 days notice is required for cancellation of your membership. Cancellations cannot be backdated. You have to include proof that indicates you are registered or will be registered as a dependant on another medical aid scheme. : [Mark the applicable block with ] I want to add a dependant(s) YES NO I want to become a member of TopMed/Bonitas/Fedhealth I want to cancel my membership of TopMed/Bonitas/Fedhealth/Bestmed YES NO YES NO From... (Date) I enclose the following forms/proof: [Mark the applicable block with ] A certified copy of my marriage certificate YES NO N/A for TopMed/Bonitas/Fedhealth membership form YES NO N/A TopMed/Bonitas/Fedhealth Amendment Form YES NO N/A Bestmed: for the registration of dependants form YES NO N/A TopMed/Bonitas/Fedhealth/Bestmed: Letter to cancel membership YES NO N/A A membership certificate of my previous medical aid scheme that indicates when my membership ceases YES NO N/A Proof that I am/will be registered as a dependant on another medical aid scheme YES NO N/A I hereby wish to apply for the additional assurance as indicated above, and authorize Sanlam to deduct the corresponding amounts from my remuneration each month and to transfer it to the scheme/fund. Signature Witness Date Updated: July 2018 A190