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Labour, Department of/ Arbeid, Departement van 117 Compensation for Occupational njuries and Diseases Act (130/1993, as amended): Rules, forms and particulars which shall be furnished in terms of the Act 40612 GOVERNMENT NOTCE 4 No. 40612 GOVERNMENT GAZETTE, 10 FEBRUARY 2017 Government Notices Goewermentskennisgewings DEPARTMENT OF LABOUR DEPARTMENT OF LABOUR NO. 31/01/2017 NO. 117 10 FEBRUARY 2017 Rules, Forms and Particulars which shall be furnished in terms of the Compensation for Occupational njuries and Diseases Act, 1993 (Act 130 of 1993, as Amended)., Vuyo Mafata, Compensation Commissioner, hereby repeal under Section 6 A (b) of the Compensation for Occupational njuries and Diseases Act, 1993 (Act 130 of 1993, as Amended) item 3 of my prescription as published under notice no. 444 in the following Government Gazette no 39928 of 15 April 2016 and replace it with the following:- Return of Earnings [Section 82 (1)] 3. "The Return of Earnings shall be on Form W.As. 8 [AnnexureA] with the particulars required therein, as the case maybe ", and this form will not be posted to registered employers and is obtainable from http / /www.labour.gov.za line All employers are encouraged to file on as per link http / /www.labour.gov.za COMPE ' `ATON COMMSSONER

STAATSKOERANT, 10 FEBRUARE 2017 No. 40612 5 Azitir labour Department: Labour REPUBLC OF SOUTH AFRCA CODA, 1993 (ACT 130 OF 1993) Section 82(1) The Hon., Prof., Dr., Rev., Messrs., Mr., Ms., RETURN OF EARNNGS W.As. 8 To be completed and submitted by all employers to Assessments Division 955, Pretoria, 0001 Compensation House Cnr Hamilton Street & Soutpansberg Road, Arcadia Call centre 0860105350 Only original document will he accepted. nformation relating to earnings (staff costs) should be kept for at least 4 years. REFERENCE /CA NUMBER 2016 BP NO. Year of assessment 01 March 2017 to 28 February 2017 Date of issue This return must be submitted on or before THS FORM CAN ALSO BE SUBMTTED ONLNE: www.abour.gov.za 31 March 2017 REFER TO THE ENCLOSED GUDELNES BEFORE COMPLETNG Tt'tE RETURN. DO NOT SUBMT THS FORM F REGSTERED ONLNE PART 1: EMPLOYER PARTCULARS Complete the white blocks only where particulars have changed. Use block letters where applicable, and mark with an X 1.1 Co /CC Registration name (per CPC). Sole Proprietor: Name of owner. 1.2 Trading name (if applicable) 1.3 Co or CC number. 1.4 Employer's D number. 1.5 Unemployment nsurance no. 1.6 Postal address. 1.7 Physical address. Postal code: 1.8 Telephone number. 1.9 Fax number. 1.10 Cell phone number. 1.11 E- Mail address. 1.12 Particulars of operation. a) Describe the nature of business/ farming activities/ goods sold or manufactured or services rendered. b) Describe the materials used in the manufacturing of goods. c) Describe the nature and extent of construction /erection undertaken. d) n case of farming, indicate the nature thereof. e) Do you use tractors and /or power- driven saws. 1.13 Status of business. a) Ongoing (under same ownership and control as previous year.) b) Ceased. c) Sold with. Assets only. Assets & liabilities. Name & Address of New owner / CC or Co. Region Code Code _ Livestock Tillage Mixed farming: %Livestock % Tillage Yes 1 Li No i 1 1 L d) Liquidated /Sequestrated By Court Order Quote Estate no. e) Owner deceased. NO 1 1

6 No. 40612 GOVERNMENT GAZETTE, 10 FEBRUARY 2017 PART 2: Reference number: Declaration 01 March 2016-28 February 2017, the undersigned confirm that the number of employees and their earnings (staff costs /salaries & wages) for the 12 months ending 28/02/2017 are as follows: Actual Earnings:01 /03/2016-28/02/2017 Provisional Earnings:01 /03/2017-28/02/2018 Month Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Total of employees and amount of earnings (staff costs /salaries & wages) per month paid to all employees (excluding directors of a Company or members of a close corporation) up to a maximum of R 377 097 per person for the above period. of directors/members and amount of ear Winos (staff costs /salaries & wages) per month paid to directors of a,y Company or members of a Close Corporation up to a maximum of R 377 097 per person for the above period. of employees and ' amount of earnings (staff r costs /salaries & wages) per month expected to be paid to all employees (excluding directors of a Company or members of a close corporation) up to a maximum of R 403 500 per person for the above period. of directors /members and amount of earnings (staff costs /salaries & wages) per month expected to be paid to directors of a Company or members of a Close Corporation up to a maximum of R 403 500 per person for the above period. Earnings - (Rands only) Total earnings of both employees and Directors /Members: FNAL EARNNGS PAD ESTMATED EARNNGS Total cash value of free food and/ or quarters. (if applicable) in Rands. GRAND TOTAL OF EARNNGS State in words the grand total of earnings: ' State in words the grand total of earnings: Give reason where earnings differ by 30% from the previous year: Declaration by employer: Name: Designation: SGNATURE: Telephone e -mail Address: Declaration by Agent/Payroll Administrator: Name: Designation: SGNATURE: Telephone e-mail Address: Company Banking nformation: Office use only - Codified. Bank Name: Account Branch Code: Branch Name: Type of Acc: NB: T S THE RESPONSBLTY OF THE EMPLOYER TO ENSURE THAT THE NFORMATON DECLARED S ACCURATE AND CORRECT, THEREFORE NO REVSONS WLL BE ENTERTANED T S COMPULSORY FOR BOTH EMPLOYER AND AGENT PAYROLL ADMNSTRATOR TO SGN THE DECLARATONS ABOVE, T S A SEROUS OFFENCE TO MAKE A FALSE DECLARATON OR FAL TO RENDER A RETURN WTHN THE PRESCRBED PEROD. THE ONUS S ON THE EMPLOYER TO NOTFY THE COMMSSONER WTHN 7 DAYS OF ANY CHANGES N THE PARTCULARS SO FURNSHED (E.G NATURE OF BUSNESS OR CLOSURE OF BUSNESS;ETC) n the event that more than one return is furnished for the same assessment period this office will accept the first return as final Criminal proceedings will be instituted for misrepresentation of facts

STAATSKOERANT, 10 FEBRUARE 2017 No. 40612 9 MPORTANT NFORMATON AND GUDELNES F THE RETURN S NOT SUBMTTED TO THS OFFCE ON OR BEFORE 31 MARCH 2017, A PENALTY NOT EXCEEDNG 10% (TEN PERCENT) OF THE FNAL ASSESSMENT, MAY BE MPOSED, N TERMS OF SECTON 83(6)(b). THE ACT EMPOWERS THE DRECTOR GENERAL N TERMS OF SEC 83(6)(a) TO ESTMATE THE EARNNGS. WHO S AN EMPLOYEE AS REFERRED TO N PART 2. "Employee" means a person who has entered into, or works under a contract of service or apprenticeship or learnership with an employer, whether the contract is expressed or implied, oral or in writing, and whether remuneration is calculated by time or work done, or is in cash or in kind and includes - Casual / temporary employee employed for the purpose of the employer's business /farming activities. Working director of a Company or member of a Close Corporation /Body Corporate, who has entered into a contract of service, or of apprenticeship or leamership, in so far that the employee acts within the scope of his /her employment in terms of such contract. (Excluding shareholders or "silent partners" who are only paid dividends or sharing profits). NB. A sole owner or partners in a businesslfarming operation are not regarded as "employees" as contemplated by the Act and their earnings should, therefore, not be included. A person provided by a labour broker, against payment to a client for the rendering of a service or the performance of work and forwhich service or work such person is paid by the labour broker, is an employee of the labour broker. The earnings of such persons should not be included in the client's Return of Earnings document. WHAT ARE EARNNGS (STAFF COSTS /SALARES & WAGES) AS REFERRED TO N PART 2 Earnings are all payments made regularly, before any deductions, whether in money or in kind, to employees. The following list are not exhaustive, but are intended only to highlight certain remuneration items for which there may be some doubt as to their inclusion or exclusion. ncluded in the gross earnings before any deductions are the following: Overtime of a regular nature, (not intermittent or irregular overtime). Bonuses of any kind, including incentive bonuses and annual bonuses. Commission, even though the amount may vary from month to month. The cash value of food and quarters supplied to employees as part of a remuneration package. Cash value of fringe benefits such as a company car, free accommodation or accommodation at a reduced rate, etc. Travel and other allowances paid regularly as part of the package. Where the employee is remunerated in accordance with a package of benefits, all items forming part of the package, other than employer contributions such as medical aid contributions. Earnings /Drawings paid to working Directors of a Company Members Attach a list with their names, D numbers and addresses. Excluded are the following: Payments of a reimbursive nature. Overtime worked occasionally. Payments for specific non -recurring tasks which do not form part of an employee's normal duties. Ex gratia payments. ntangible fringe benefits such as the taxable portion of medical aid /pension contributions by the employer, etc. Payments to cover special expenses such as subsistence and travelling costs, lunch and costs for business meetings. Travel and other allowances paid occasionally. Profit sharing of Directors and Members. FNAL EARNNGS : When a business is sold /ceased, liquidated/sequestrated or the employer deceased) ndicate the date in the space provided on the front page (item 1.13) and declare the final earnings paid to that date. MNMUM ASSESSMENT SECTON 83(2)(b) As a result of continuously rising costs, the 2016-2017 minimum assessment has been increased to R 1080 per annum. LETTER OF GOOD STANDNG This letter can be obtained once the employer has complied with the requirements of the COD Act, inter alia: Submitting the latest return of earnings. Assessment has been paid or instalments have been arranged and paid. The letter of good standing can only be generated online at https: / /cfonline.labour.gov.za /OnlineSubmissions Usernames and passwords are the same as the one used when submitting on returns of earnings Use the 99... number on the CF registration number then you link your company WEBSTE ADDRESS The Compensation for Occupational njuries and Diseases Act, 1993 and Amendments are available on the website at httpllwww.labour.gov.za

10 No. 40612 GOVERNMENT GAZETTE, 10 FEBRUARY 2017 RETURNS OF EARNNGS ONLNE SUBMSSON The office has introduced the online submission of Return of earnings. The employers can submit their return online. Go to www.labour.gov.za under online services block/tab you click" on the next screen click Compensation Fund Return of Earnings Submcssians then am a new user and want to Register -> cc Then fill in the required fields and apply " to register There is also a process flow attached Useful Documents: fit, ROE Process Flow] on the website with steps to guide you. f you encounter any problems please send an email to roe @labour.gov.za