CareCard Basket Application Form
|
|
- Clifford Ryan
- 6 years ago
- Views:
Transcription
1 CareCard Basket Application Form Please tick the Basket of your choice Star 27 Adult Basket 260 pm 4Star 24/7 Student Basket 1 StarBasket Jnr 140 pm Snr 145 pm 190 pm 4Star Additional Cover Spouse - 60 pm Junior 40 pm each Senior 45 pm each Please enter the number of additional covers you want One spouse and up to three students can be added to the 24/7 Adult Basket Up to two extra students can be added to the 2/7 Student Basket PINCIPAL MEMBE'S DETAILS Title First Names Surname Gender Male Female SA ID Number Birth Date Y Y Y Y M M D D Postal Address Town Tel Work Fax No TelHome Cell No Occupation Code SPOUSE AND STUDENTS DETAILS Spouse First Name Surname Gender Male Female SA ID Number Birth Date Y Y Y Y M M D D Junior or Senior Cover and Student's Full Names Birth Date 1 Junior Y Y Y Y M M D D 2 Junior Y Y Y Y M M D D 3 Junior Y Y Y Y M M D D I would like to be a CCA By ticking the CCAbox, I confirm that the details of the CareCard Business Model as well as the compensation plan have been fully explained to me. By signing here, I confirm that I have seen an official CareCard Membership Presentation and that the details of the cover contained in my selected Basket has been fully explained to me and I have read and I understand the terms and conditions as set out in the attached document and available at for the said cover. I have read and understand the official warning attached. Signature
2 CC No: Send the completed form to: INTODUCING CCA'S DETAILS Introducing CCA's Number Introducing CCA's Name Contact Number BIAN GHANSA PINCIPALS BENEFICIAY OF CHOICE NAME SA ID Number elationship: Contact No.: AUTHOISATION FO MONTHLY DEBIT ODE Enter the number of extras with the total monthly amount Monthly Basket Payment Extra Spouse 60 pm Extra Junior 40 pm Extra Senior 45 pm Total Monthly Debit Order Monthly debit orders will be processed on the last working day of each month I hereby authorise CareCard to issue payment instruction to my bank, in terms of this order to draw against the bank account below, for the collection of the amount indicated above. (The Total Monthly Debit Order), on a monthly basis, until further notice from myself with a 20 working day notice given in writing, this payment being in respect of the Basket of services selected above. I understand the payment date is the last working day of each month commencing on the start month as stated below. If there are two consecutive unmet payments, this contract and debit order instruction and mandate will be cancelled. I confirm that I have read the "Important Debit Order Information" in the attached document Bank Account Details Account Holders Name Bank Account Type Current Savings Transmission Branch Code Account Name Account No.: Signature of Account Holder Signature of Principal if different from the Account Holder Date of Signature Y Y Y Y M M D D Start Month CHAITY OF CHOICE Interim Charity of Choice eference Number
3 CareCard Membership Application On behalf of the CareCard Care4all Team, we would like to welcome you as a valuable Member. IMPOTANT INFOMATION FO YOU TO KEEP Your Name Your CC Number Your Introducing CareCard Advertiser s Information: Name Contact Number BIAN GHANSA CC Number address brianpghansar@gmail.com CONTACT DETAILS CAECAD HEAD OFFICE CareCard PMB (Pty) Ltd 2012/220399/07 CareCard Executive Director Operations: Jason Bingham Jason@carecard.co.za 218 Greyling Street, Pietermaritzburg, 3201 / PO Box 11939, Dorpspruit, 3206 Phone: / Fax: / admin@carecard.co.za / apps@carecard.co.za Websites: Public: / Members: 1STA BASKET FUNEAL & SELECT Underwritten by KGA Life (FSP 1580) KGA Client Service Select Call Centre SELECT ( ) 4STA BASKET 24/7 WOLD WIDE ACCIDENT COVE Underwriters Stalker Hutchison Admiral ((Pty) Limited (FSP No 2167) in accordance with the authority granted under Section 48A of the Short Term Insurance Act No. 53 of 198 on behalf of Santam Limited (FSP No 3416) Accident Notificatio / admin@carecard.co.za 4Star Basket Inform office@care4all.co.za PSG Insure (FSP No 7 Anita.Geldenhuys@psg.co.za Accident Expert ( / support@accidentexpert.co.za HIV/AIDS Notificati 0861 HIV CAE ( ) Mon to Fri 08:30 to 16:30
4 CareCard Company ules and egulations for CCA's IMPOTANT WANING 1 CareCard is committed to the highest ethical standard in its Business Plan and presentation of that Plan. 2 It is illegal for a Principal or CCA to persuade anyone to make a payment by promising benefits solely for getting others to join a scheme. 3 Do not be misled by claims that high earnings are easily achieved. 4 Success is more likely for people who learn communication and marketing skills through professional training, learning and reading as well as attending official CareCard training sessions, together with dedication, hard work and much effort.
5 CareCard Membership Application NOTES 1. Your CC No is your identification in CareCard. Please copy your CC No on this form s front page together with the details of your introducing CCA, for future reference. 2. This CCA must be the person who introduced you to CareCard. 3. Your beneficiary is the person who will receive any earnings and funeral/accidental death pay-outs, on your death. 4. It is vital that the banking details are filled in correctly. Please check them carefully. 5. If you are not the account holder, the authorised signature of the account holder must be in the first box and your signature in the second box. 6. Your charity of choice must have the minimum of 20 active nominations for it to start receiving funds from CareCard. If it does not have 20 active nominations, the interim charity chosen will receive your contribution in the interim. The interim charity must be an existing qualified charity. 7. By signing on the left of the application form, you confirm that you have seen an official CareCard presentation and the cover contained in your selected Basket has been fully explained to you and that you have read and understand the terms and conditions, as set out in this document and at for the said cover and services. You also confirm that you have read and understand the official warning attached. If you have ticked the CCA box, you confirm that the details of the CareCard Plan and the compensation model have been explained to you. 8. There is a one month admin waiting period. The 1Star Basket Select Products and the Star Basket cover and benefits start with your second payment. The 1Star Basket Funeral Cover has a three month waiting period from your second payment. 9. After completing the application form in full, please remove it from the cover and fax or it accompanied by the official Application Log Sheet provided by your introducing CCA. CareCard Important Debit Order Information I understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks and I also understand that the details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to me should enable me to identify the agreement. A payment reference is added to this form - CareCard - before the issuing of any payment instruction. I shall not be entitled to any refund of amounts which you have withdrawn while the authority was in force, if such amounts were legally owing to you MANDATE: I acknowledge that all payment instructions issued by me shall be treated by my above mentioned bank as the instructions had been issued by me personally. CANCELLATION: I agree that this authority and Mandate may be cancelled by me, such cancellation will not cancel this agreement. I will not be entitled to any refund of amounts which have been withdrawn while this authority was in force, if such amounts were legally owing by me. ASSIGNMENT: I agree that although this Authority and Mandate may be ceded to or assigned to a third party if the agreement is also ceded to or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party. My signature as the account holder on the CareCard Member Application Form, confirms I have read and accept all the above.
1. Personal Details and Academic History Compulsory
Registration form for CAIA Programs PLEASE NOTE: CATEGORY 1 TO 4 MUST BE COMPLETED BY ALL STUDENTS. 1. Personal Details and Academic History Compulsory Mr Mrs Miss Ms Other Initials Surname First Name/s
More informationMembership Contract. Gym membership add on R 150. Fees are due by the 1st of each Month. One Calendar Month notice is required.
Membership Contract Your name & surname Contact number Email Address D.O.B Work Number Residential address Postal address Emergency Contact Cell Number Membership: Unlimited R 1040 Student / Teacher /
More informationElectronic Version. GapCARE XtraCARE ProfessionalCARE
Electronic Version GapCARE XtraCARE ProfessionalCARE Medway MedCARE Plan WHO IS MEDWAY? Medway is a leading network of healthcare advisors in South Africa. First established in 1990, Medway has consistently
More information1. Personal Details and Academic History Compulsory
Registration form for ICB Face to Face Courses PLEASE NOTE: CATEGORY 1 TO 4 MUST BE COMPLETED BY ALL STUDENTS. 1. Personal Details and Academic History Compulsory Mr Mrs Miss Ms Other Initials Surname
More informationENDOWMENT TAX-FREE SAVINGS ACCOUNT Application Form
ENDOWMENT TAX-FREE SAVINGS ACCOUNT Application Form IMPORTANT INFORMATION Before investing, read the Terms and Conditions of the Policy carefully to decide if the product meets your financial needs. Consider
More informationPRESERVATION FUND Application Form
PRESERVATION FUND Application Form IMPORTANT INFORMATION Before investing, read the Terms and Conditions of the Fund carefully to decide if the product meets your financial needs. Consider getting financial
More informationDiscretionary Investment Application
Discretionary Investment Application Wealthport (Pty) Ltd (2012/025878/07) Wealthport (Pty) Ltd ( Wealthport ) is an Authorised Financial Services Provider (FSP No. 44158) Ballyoaks Office Park, 35 Ballyclare
More informationELAN INVESTOR CLUB PLATINUM MEMBERSHIP APPLICATION
ELAN INVESTOR CLUB PLATINUM MEMBERSHIP APPLICATION Please complete the form below in full. The below membership application form needs to be scanned in conjunction with the debit order mandate form and
More informationgapcover Covers the excess not paid by your Medical Aid GapCore GapEssential GapXtra GapPremium bridging the gap
gapcover bridging the gap GapCore GapEssential GapXtra GapPremium Covers the excess not paid by your Medical Aid Most specialist doctors charge above medical aid rates. Can you afford to pay the shortfall?
More informationShould you decide to apply for membership I would be grateful if you could return the following along with your application:
Membership Dear Sir / Madam On behalf of the Society, I would like to thank you for your interest in becoming a Member of the Royal Ulster Agricultural Society. Please find enclosed an application form
More informationGROUP ASSURANCE APPLICATION FOR DISABILITY BENEFITS
GOUP ASSUANCE APPLICATION FO DISABILITY BENEFITS GUIDELINES Please help Old Mutual Group Assurance to assess your claim correctly, and faster, by using these guidelines. 1. Complete the application form
More informationRETIREMENT ANNUITY FUND Application Form
RETIREMENT ANNUITY FUND Application Form IMPORTANT INFORMATION Before investing, read the Terms and Conditions of the Fund carefully to decide if the product meets your financial needs. Consider getting
More informationLIVING ANNUITY POLICY Application Form
LIVING ANNUITY POLICY Application Form IMPORTANT INFORMATION Before investing, please read the Terms and Conditions of the Policy carefully to decide if the product meets your financial needs. Consider
More informationShould you have any more questions about the service, please contact Liezel on or send an to
Welcome to ICBA members! The CPDtv offering to you is as follows: We offer an annual DVD subscription fee to provide a verifiable CPD service in the comfort of your home. CPDtv has already produced more
More informationFUNERAL COVER APPLICATION FORM
Universal Cover (Pty) Ltd Universal House, 15 Tambach oad, Sunninghill Park, Sandton, 2191 PO Box 1411, ivonia 2128 Tel: +27 86 112 4636 Fax: +27 86 532 6595 www.universal.co.za Universal Cover (Pty) Ltd
More informationSatrix Retirement Plan Application Form
Satrix Retirement Plan Application Form About the structure of this product Satrix Managers RF (Pty) Ltd provides an investment management solution within the Satrix Retirement Plan. This is offered under
More informationTax-free Savings Application
Tax-free Savings Application Wealthport (Pty) Ltd (2012/025878/07) Wealthport (Pty) Ltd ( Wealthport ) is an Authorised Financial Services Provider (FSP No. 44158) Ballyoaks Office Park, 35 Ballyclare
More informationDistance Learning Enrolment Contract 2017
Student number For office use only Distance Learning Enrolment Contract 2017 Once you have completed the Application Form and paid the R400 non-refundable application fee and your application has been
More informationRoyal Ulster Agricultural Society
Royal Ulster Agricultural Society Dear Sir/Madam Membership On behalf of the Society let me thank you for your interest in becoming a member of the Royal Ulster Agricultural Society. Please find enclosed
More informationThe Fidelity SIPP. Application form for single/regular contributions and transfers. You can also apply online at fidelity.co.uk
The Fidelity SIPP Application form for single/regular contributions and transfers. You can also apply online at fidelity.co.uk Use this form to: apply for the Fidelity SIPP make single or regular payments
More informationetfsa RETIREMENT ANNUITY FUND APPLICATION FORM
etfsa RETIREMENT ANNUITY FUND APPLICATION FORM The application form must please be completed in full in block letters and sent, together with the required FICA documentation, to etfsa.co.za at the following
More informationmaxima APPLICATION FORM
maxima APPLICATION FORM Broker House: Aon South Africa (Pty) Ltd Tel : 0860 835 2727 Broker Code: AON001M16 SECTION 1 CHOICE OF OPTION Choose ONE product option by placing x in the appropriate box MAXIMA
More informationPPS LIVING ANNUITY APPLICATION FORM
PPS LIVING ANNUITY APPLICATION FORM PROFESSIONAL PROVIDENT SOCIETY INVESTMENTS PROPRIETARY LIMITED ( PPS INVESTMENTS ) CLIENT SERVICE CENTRE CONTACT DETAILS TEL: 0860 468 777 (0860 INV PPS) FAX: 01 680
More informationPLEASE TYPE ONTO THE FORM OR PRINT OUT AND USE BLACK OR BLUE INK.
POTEKTO PESEVATION FUND APPLICATION FOM For members making use of an intermediary The application/joining process: n Indicate your intention to preserve your benefits: Before leaving your employer (whether
More informationApplication Form etfsa Living Annuity
Application Form etfsa Living Annuity How to Invest 1. Read the Terms and Conditions of this Policy (attached hereto). 2. Access the Investment Product Range and make an informed decision on which portfolio
More informationOPN PRESERVATION FUNDS APPLICATION FORM
OPN PRESERVATION FUNDS APPLICATION FORM PROFESSIONAL PROVIDENT SOCIETY INVESTMENTS PROPRIETARY LIMITED ( PPS INVESTMENTS ) CLIENT SERVICE CENTRE CONTACT DETAILS TEL: 0860 468 777 (0860 INV PPS) FAX: 021
More informationPPS PERSONAL PENSION APPLICATION FORM
PPS PERSONAL PENSION APPLICATION FORM PROFESSIONAL PROVIDENT SOCIETY INVESTMENTS PROPRIETARY LIMITED ( PPS INVESTMENTS ) CLIENT SERVICE CENTRE CONTACT DETAILS TEL: 0860 468 777 (0860 INV PPS) FAX: 021
More informationLiberty Medical Scheme Employer Group Application Form
PO Box Private Bag X3 Century City 7446 t 0860 000 LMS/567 f 021 657 7651 w www.libmed.co.za Thank you for your request to register as an Employer Group 1. It is compulsory for fields marked with * to
More informationYour super application and change form
United Technologies Corporation Retirement Plan Your super application and change form Accumulation members UTC gives you a number of options for your super. Use this form to: < Join the Plan if you are
More informationEmployer application to join the Discovery Health Medical Scheme in 2016
Employer application to join the Discovery Health Medical Scheme in 2016 Thank you for deciding to apply to join the Discovery Health Medical Scheme. This application contains some rules for membership.
More informationRENTAL APPLICATION FEE
RENTAL APPLICATION FEE Bank Details: Account Name: Bank: Valumax Property Management ABSA Branch Code: 632005 Account Number: 4 090 706 606 Reference Number: (ID number) for individual (Company registration
More informationDocument checklist. South African bar-coded ID, valid passport (if foreign national) or birth certificate (if minor)
SYGNIA INVESTMENT POLICY APPLICATION FORM SInkING FunD PolICY - NAtuRAL PERsons No instruction will be processed unless all requirements have been met, all relevant documentation received and the funds
More informationNo February Investor details. Surname First name(s) Date of birth ID number (Passport number if foreign national) Income tax number
5615432804 No. 18.0 February 2014 etirement Annuity Fund application Please complete this fm if you wish to become a member of the Allan Gray etirement Annuity Fund. Allan Gray Investment Services Proprietary
More informationThe Fidelity SIPP. Application to set-up or amend regular payments to your Fidelity SIPP
The Fidelity SIPP Application to set-up or amend regular payments to your Fidelity SIPP Use this form to: change the amount you are paying into your Fidelity SIPP change the fund selection for your future
More informationVESTED PPS PROFIT-SHARE ACCOUNT: VESTING FORM
: VESTING FORM PROFESSIONAL PROVIDENT SOCIETY INVESTMENTS PROPRIETARY LIMITED ( PPS INVESTMENTS ) CLIENT SERVICE CENTRE CONTACT DETAILS TEL: 0860 468 777 (0860 INV PPS) FAX: 021 680 3680 EMAIL: admin@ppsinvestments.co.za
More informationfedhealth member RECORD AMENDMENT FORM
Broker House: Aon South Africa (Pty) Ltd Tel No: 0860 835 2727 Broker Code: AON001M16 fedhealth member RECORD AMENDMENT FORM PLEASE MAIL COMPLETED FORM TO: Fedhealth Medical Scheme Private Bag X3045 Randburg
More informationENDOWMENT POLICY Application Form for Individual Investors
ENDOWMENT POLICY Application Form for Individual Investors IMPORTANT INFORMATION Before investing, read the Terms and Conditions of the Policy carefully to decide if the product meets your financial needs.
More informationmaxima APPLICATION FORM
maxima APPLICATION FORM SECTION 1 CHOICE OF OPTION Choose ONE product option by placing x in the appropriate box Comprehensive Options Saver Options Hospital Plans MAXIMA PLUS MAXIMA EXEC MAXIMA STANDARD
More informationAPPLICATION FOR ADMISSION PLEASE COMPLETE ALL SECTIONS BELOW: (PLEASE PRINT CLEARLY) Application fee R300 (Banking details below)
SECTION A Registration Reference No: (Office use only) PERSONAL DETAILS APPLICATION FOR ADMISSION PLEASE COMPLETE ALL SECTIONS BELOW: (PLEASE PRINT CLEARLY) Application fee R300 (Banking details below)
More informationVESTED PPS PROFIT-SHARE ACCOUNT: VESTING FORM
: VESTING FORM PROFESSIONAL PROVIDENT SOCIETY INVESTMENTS PROPRIETARY LIMITED ( PPS INVESTMENTS ) CLIENT SERVICE CENTRE CONTACT DETAILS TEL: 0860 468 777 (0860 INV PPS) FAX: 021 680 3680 EMAIL: admin@ppsinvestments.co.za
More informationENDOWMENT APPLICATION
ENDOWMENT APPLICATION Instructions 1. This application and supporting documentation must be emailed to instruct@ashburtoninvest.co.za. 2. Please complete all relevant sections of this application in order
More informationDocument checklist. South African bar-coded ID, valid passport (if foreign national) or birth certificate (if minor)
Sygnia RETIREMENT ANNUITY APPLICATION FORM No instruction will be processed unless all requirements have been met, all relevant documentation received and the funds reflected in Sygnia s bank account.
More informationApplying to join the Discovery Health Medical Scheme as part of an employer group in 2018
Applying to join the Discovery Health Medical Scheme as part of an employer group in 2018 Contact us Tel (Members): 0860 99 88 77, Tel (Health partners): 0860 44 55 66, PO Box 784262, Sandton, 2146, www.discovery.co.za
More informationDocument checklist. South African bar-coded ID, valid passport (if foreign national) or birth certificate (if minor)
Sygnia LIVING ANNUITY APPLICATION FORM The Sygnia Living Annuity is underwritten by Sygnia Life Limited, Registration Number 2000/022679/06. Sygnia Financial Services (Pty) Ltd, a licensed administrative
More informationCORPORATE PERSONAL PENSION EMPLOYEE APPLICATION FORM
CORPORATE PERSONAL PENSION EMPLOYEE APPLICATION FORM PROFESSIONAL PROVIDENT SOCIETY INVESTMENTS PROPRIETARY LIMITED ( PPS INVESTMENTS ) CLIENT SERVICE CENTRE CONTACT DETAILS TEL: 0860 468 777 (0860 INV
More informationDeath Claim form Application for a death claim
Death Claim form Application for a death claim Where to get more help Ask your Sanlam adviser or broker to assist you Visit your nearest Sanlam office Call Sanlam Death Claims Call Centre at (021) 916
More informationCLAIM TO WITHDRAW YOUR MONEY IN THE FUND WHEN YOU LEAVE EMPLOYMENT
ALEXANDER FORBES LIFE LIMITED Registration number 1997/022561/06 FAIS licence number: 1178 A licensed financial services provider Umbrella Funds Division Alexander Forbes, 115 West Street, Sandton, 2196
More informationFrom: Subject:
IFC! Independent Financial Consultants!! Fax To: Independent Financial Consultants Att: Iracema Fonseca Fax to email: (086) 586-4165 Fax land: (021) 593-3135 : (084) 334-4848 (W) (021) 593-3012 From: Subject:
More informationDocument checklist. South African bar-coded ID, valid passport (if foreign national) or birth certificate (if minor)
SYGNIA DIRECT INVESTMENT APPLICATION FORM NAtuRAL PERsons No instruction will be processed unless all requirements have been met, all relevant documentation received and the funds reflected in Sygnia s
More informationDocument checklist. South African bar-coded ID, valid passport (if foreign national) or birth certificate (if minor)
Sygnia TAX-FREE savings ACCOUNT APPLICATION FORM NAtuRAL PERsons No instruction will be processed unless all requirements have been met, all relevant documentation received and the funds reflected in Sygnia
More informationPension or Provident Preservation Fund application
4971329106 No. 16.0 June 2013 Pension Provident Preservation Fund application Please complete this fm if you wish to become a member of the Allan Gray Pension Preservation Fund the Allan Gray Provident
More informationFuneral Aid Insurance: Benefit claim form
Funeral Aid Insurance: Benefit claim form Name of scheme Code Important: This form must be completed by the Employer when a claim for an insured s or a family members funeral aid benefit is submitted.
More informationThe Royal Highland & Agricultural Society of Scotland ROYAL HIGHLAND CENTRE, INGLISTON, EDINBURGH, EH28 8NB
MEMBERSHIP APPLICATION FORM The Royal Highland & Agricultural Society of Scotland ROYAL HIGHLAND CENTRE, INGLISTON, EDINBURGH, EH28 8NB Tel: 0131 335 6215 Email: membership@rhass.org.uk Web: www.rhass.org.uk
More informationINSTANT SAVER 2 ACCOUNT
INSTANT SAVER 2 ACCOUNT Provided by Scottish Widows Bank SUMMARY BOX PLEASE READ THIS SUMMARY BOX BEFORE YOU COMPLETE THE APPLICATION AND THEN KEEP IT FOR YOUR RECORDS. DON T RETURN IT WITH THE APPLICATION.
More informationOLD MUTUAL UNIT TRUSTS TAX-FREE INVESTMENT BUY FORM
OLD MUTUAL UNIT TRUSTS TAX-FREE INVESTMENT BUY FORM IMPORTANT INFORMATION 1. This Tax-Free Investment is offered to individual people only (i.e. not for trusts, companies, etc.). You may invest for yourself
More informationBROMLEY HOUSE LIBRARY
BROMLEY HOUSE LIBRARY MEMBERSHIP APPLICATION FORM Benefits of Bromley House Library Membership Access to our extensive book collections, built up over our 200 year history as well as recent acquisitions.
More informationFidelity Personal Pension Top up form (for making a transfer or single/regular payments)
Fidelity Personal Pension Top up form (for making a transfer or single/regular payments) With this form you can: set up a regular payment into an existing plan make a single payment into an existing plan
More informationAPPLICATION FOR ADMISSION
APPLICATION FOR ADMISSION PLEASE COMPLETE ALL SECTIONS BELOW: (PLEASE PRINT CLEARLY) Application fee R300/BPsych R500 (Banking details below) SECTION A Registration Reference No: (Office use only) Date
More informationCURRENCY TRANSFER - REGISTRATION FORM
CURRENCY TRANSFER - REGISTRATION FORM A. PERSONAL DETAILS AND CONTACT INFORMATION First name: Date of birth: SA ID No.: (If applicable) Primary residential address: Surname: Country of birth: Foreign address
More informationThe Fidelity SIPP. Junior Application form This form is quick and easy to fill in, it should only take a short time to complete.
The Fidelity SIPP Junior Application form This form is quick and easy to fill in, it should only take a short time to complete. Use this form to: apply for the Fidelity Junior SIPP for someone under 18
More informationBecome a Mobile Leader
WORLD UK Become a Mobile Leader 1 st January 2018-30 th November 2018 Incentive Programme for Distributor Business Partner who reached Effectiveness Level of LEVEL A Car of your choice for Level 40,000
More informationThe Fidelity SIPP. Third Party Application form. Use this form to: Further information on fidelity.co.uk. Don t use this form if:
The Fidelity SIPP Third Party Application form Use this form to: apply for a Fidelity SIPP with a single or regular payment from your spouse/civil partner or any other third party. You will also be able
More informationoptional income protection insurance
guide to optional income protection insurance Guide to Optional Income Protection Insurance DuluxGroup Employees Superannuation Fund The DuluxGroup Employees Superannuation Fund (DuluxGroup Super) is managed
More informationmaxima APPLICATION FORM
maxima APPLICATION FORM SECTION 1 CHOICE OF OPTION Choose ONE product option by placing x in the appropriate box Comprehensive Options Saver Options Hospital Plans MAXIMA PLUS MAXIMA EXEC MAXIMA STANDARD
More informationPART 2: Payer s Details PLEASE COMPLETE ALL FIELDS IN BLOCK LETTERS
STUDENT PICTURE CONTACT DETAILS PART 1: Student Details PLEASE COMPLETE ALL FIELDS IN BLOCK LETTERS NB: Full time and Part Time Students to fill in Part 1,2,3,4,5 NB: E-Learning Students to fill in Part
More informationApplication Form for the Curtis Banks SIPP
Application Form for the Curtis Banks SIPP This application form is a legally binding document between you (the applicant), Curtis Banks Limited and Colston Trustees Limited. Please complete all relevant
More informationUnit Trust Application Form Individual Investors (new investors only)
Unit Trust Application Form Individual Investors (new investors only) View the full list of funds and the Minimum Disclosure Documents (MDD's) with applicable fund minimums and fees, refer to www.sanlamunittrustsmdd.co.za.
More informationPPS INVESTMENT ACCOUNT APPLICATION FORM
PPS INVESTMENT ACCOUNT APPLICATION FORM PROFESSIONAL PROVIDENT SOCIETY INVESTMENTS PROPRIETARY LIMITED ( PPS INVESTMENTS ) CLIENT SERVICE CENTRE CONTACT DETAILS TEL: 0860 468 777 (0860 INV PPS) FAX: 021
More informationThe Fidelity SIPP. Further information on fidelity.co.uk. Don t use this form if: Before you fill in this form: How to fill in this form.
The Fidelity SIPP Transfer Application form to move other pensions to your Fidelity SIPP. This form is quick and easy to fill in, it should only take a short time to complete. Or go to fidelity.co.uk to
More informationNominating your beneficiary lets you have your say about who receives your super when you pass away.
NOMINATING YOUR BENEFICIARIES FACT SHEET Place Nominating title of your IBR goes beneficiaries here. Nominating your beneficiary lets you have your say about who receives your super when you pass away.
More informationFAX COVER SHEET. To: Graham Pike of IHS From: Fax: Company: Tel: Tel: Gap Cover Application.
Informed Healthcare Solutions (IHS) 119 Main Road Heathfield Cape Town Tel: +27 21 712-8866 Fax: 0866 200 320 Email: info@medicalaidcomparisons.co.za Web: www.medicalaidcomparisons.co.za FAX COVER SHEET
More informationOLD MUTUAL UNIT TRUSTS SELLING FORM
OLD MUTUAL UNIT TRUSTS SELLING FORM IMPORTANT INFORMATION 1. Please complete all the relevant sections and sign section 10. We require all Investor and Tax Residence information for this transaction to
More informationAPPLICATION FOR ADMISSION PLEASE COMPLETE ALL SECTIONS BELOW: (PLEASE PRINT CLEARLY) Application fee R300/BPsych R600 (Banking details below)
SECTION A Registration Reference No: (Office use only) PERSONAL DETAILS APPLICATION FOR ADMISSION PLEASE COMPLETE ALL SECTIONS BELOW: (PLEASE PRINT CLEARLY) Application fee R300/BPsych R600 (Banking details
More informationKEY INFORMATION DOCUMENT
KEY INFORMATION DOCUMENT PSG WEALTH RETIREMENT ANNUITY PAGE 0 This document is a summary of key information about the PSG Wealth Retirement Annuity. It will help you to understand the product and make
More informationCOMPLETE SOLUTIONS COMPANY PENSION PLAN
PENSIONS INVESTMENTS LIFE INSURANCE COMPLETE SOLUTIONS COMPANY PENSION PLAN APPLICATION DETAILS PLEASE READ THE QUESTIONS CAREFULLY BEFORE ANSWERING THEM AND USE BLOCK CAPITALS. If any item is blank or
More informationApplication for Youthsaver Account Section A Details of the applicant aged under 18
Application for Youthsaver Account Section A Details of the applicant aged under 18 1 Title Full given name/s Surname Other names known by (if any) Gender of birth Occupation Male Female 2 Residential
More informationThe Fidelity SIPP. Application to set-up or amend regular payments to your Fidelity SIPP
The Fidelity SIPP Application to set-up or amend regular payments to your Fidelity SIPP Use this form to: change the amount you are paying into your Fidelity SIPP change the fund selection for your future
More informationVERIFICATION FORM (BLACK PEOPLE)
VERIFICATION FORM (BLACK PEOPLE) This is the Verification Form (Black People) to be completed for purposes of the BEE Verification Process in respect of the Standard Trading Process, the Own-Broker Trading
More informationOLD MUTUAL UNIT TRUSTS TAX-FREE INVESTMENT BUY FORM
OLD MUTUAL UNIT TRUSTS TAX-FREE INVESTMENT BUY FORM IMPORTANT INFORMATION 1. This Tax-Free Investment is offered to individual people only (i.e. not for trusts, companies, etc.). You may invest for yourself
More informationSTANLIB MULTI-MANAGER NCIS HEDGE FUNDS WITHDRAWAL FORM
STANLIB MULTI-MANAGE NCIS HEDGE FUNDS WITHDAWAL FOM Novare CIS (F) (Pty) Ltd egristration Number: 2013/191159/07 SAS egistration Number: 9649/248/16/9 (Pty) Ltd egistration number 1999/012566/07 FSP Number:
More informationApplication Form Current Account
Application Form Current Account Need more information? alrayanbank.co.uk 0800 4086 407 Mon to Fri: 9am 7pm Sat: 9am 1pm Returning this form It is important that you complete this application form in full
More informationTax-Free Unit Trust Application Form Individual Investors (new investors only)
Tax-Free Unit Trust Application Form Individual Investors (new investors only) Only individual SA citizens may apply. Tax Free Unit Trust allows you to make flexible contributions. You are not required
More informationApplication to change the main member on the Discovery Health Medical Scheme
Application to change the main member on the Discovery Health Medical Scheme Contact us Tel (Members): 0860 99 88 77, Tel (Health partner): 0860 44 55 66, PO Box 784262, Sandton, 2146, www.discovery.co.za
More informationWithdrawal request form
Withdrawal request form (This form must be completed for withdrawals on Endowment Plans and Flexible Investment Plans) Contact us Tel: 0860 67 5777, PO Box 653574, Benmore, 2010, www.discovery.co.za Content
More informationSTRATEGIC INVESTMENT SERVICE Unit Trusts
TRANSFER FORM IMPORTANT INFORMATION 1. Please complete all the relevant sections and sign the applicable sections. 2. The transfer notice must be signed by both the Transferor and the Transferee in the
More information(Contact us if you need help: Call between 07:30-17:30 (Mon - Fri) or
RETIREMENT ANNUITY FUND WITHDRAWAL INSTRUCTION Make an informed decision: BEFORE YOU WITHDRAW ADDITIONAL INFORMATION STEP 1 COMPLETE THE FORM & AGREE TO CONDITIONS OF MEMBERSHIP Please consider the tax
More informationFundsAtWork Family Protector - PLUS options
FundsAtWork Family Protector - PLUS options Member number Section 1: Employer details Employer s name Employee number Section 2: Member details Tax number Telephone - work (code - number) Telephone - home
More informationUNIT TRUST ADDITIONAL APPLICATION FORM
UNIT TRUST ADDITIONAL APPLICATION FORM HOW TO INVEST 1. Please send the completed Application Form, together with the required supporting FICA documentation and proof of payment to Long Beach Capital at
More informationTHE APPLICATION FORM FOR BACHELORS 1, 2, 3 BEDROOMS FLAT IN 2018 R650
THE APPLICATION FORM FOR BACHELORS 1, 2, 3 BEDROOMS FLAT IN 2018 R650 LEASE APPLICATION (SUBJECT TO AVAILIBILITY ) Application Form for Flats DATE AGENT website : www.nulandspropertiesinvestment.co.za
More informationCertified copy of South African green bar-coded ID/new smart card ID or valid passport, with visible photograph and legible text.
HOLLARD RETIREMENT ANNUITY PLAN APPLICATION FORM 1. Important Information 1.1. Please complete this application form if you would like to become a Member of the Hollard Retirement Annuity Fund. 1.2. Hollard
More information(Contact us if you need help: Call between 07:30-17:30 (Mon - Fri) or
UNIT TUST APPLICATION FO INDIVIDUAL INVESTOS BEFOE YOU INVEST Make an informed decision: ead our Product ange brochure to make sure you have chosen the right product to suit your needs. efer to our fund
More information(a) Confirmation of previous benefit structure (if different) Yes No Not applicable. (b) Copy of most recent underwriting terms Yes No Not applicable
PENSIONS INVESTMENTS LIFE INSURANCE GROUP RISK BENEFITS SUPPORTING INFORMATION WITH YOUR APPLICATION In order to confirm underwriting terms, please provide the following information. Please complete this
More informationCofunds Pension Account Application form
Cofunds Pension Account Application form SELF-DIRECTED This form is to be used for Self-directed clients only. Please use this form if you want to set up a new Cofunds Pension Account by making a single
More informationGROUP FUNERAL/WONKHE WONKHE FUNERAL PLAN APPLICATION FORM
GROUP FUNERAL/WONKHE WONKHE FUNERAL PLAN APPLICATION FORM A. LIFE ASSURED - PERSONAL / EMPLOYMENT DETAILS Mr Mrs Miss Dr Other Name and Surname Maiden, former or other name Nationality (attach certified
More informationMazwe Assist Funeral Plan and Assistance Cover
Mazwe Assist Funeral Plan and Assistance Cover **MEMBER SURNAME: FIRST NAMES: EMAIL ADDRESS: POSTAL ADDRESS: IDENTITY NUMBER: OCCUPATION: TELEPHONE NUMBER: CELL PHONE NUMBER:.DEPENDENTS ENTRY AGE 0-21
More informationYOUR ISA TRANSFER APPLICATION FORM 2017/2018.
FOR OFFICE USE ONLY Receipt number Client number Deal reference Agent number/stamp 02444461 N090AT02 YOUR ISA TRANSFER APPLICATION FORM 2017/2018. Please ensure you have read the current version of the
More informationNumber: Hearing. Communicating
APPLICATION FOR ADMISSION PLEASE COMPLETE ALL SECTIONS BELOW: (PLEASE PRINT CLEARLY) Application fees: R350 for Paper applications (Higher Certificate, Diploma, Advanced Certificate, BAppSocSci, Honours,
More informationfedhealth member RECORD AMENDMENT FORM
fedhealth member ECOD AMENDMENT FOM PLEASE MAIL COMPLETED FOM TO: Fedhealth Medical Scheme Private Bag X3045 andburg 2125 O FAX TO: Fedhealth Membership Fax No: 011 671 3647 O E-MAIL TO: update@fedhealth.co.za
More informationGCB Link2Home Account
GCB Link2Home Account Account Opening Form (Individual) Account Name Account No. Personal Banker Customer IC D D M M Y Y Y Y GCB/ILKHAF/2014/021 Account Opening Requirements One (1) passport-sized photograph
More informationSTRATEGIC INVESTMENT SERVICE
SWITCHING FORM IMPORTANT INFORMATION 1. Please complete all the relevant sections and sign section 12. 2. The completed form and supporting documentation (see below) can be scanned and emailed to sisadministrator@oldmutual.com,
More information