Cash Withdrawal From A Preservation Fund Policy: Requirements

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Cash withdrawal from

a preservation fund policy

Requirements

Important

Contact person for requirements

Name

Section 1: Member details


Full names

Gender Male ● Female ●


D D M M Y Y Y Y

Yes ● No

Postal address

Postal code

Postal code

Fax

Cellphone

● Post

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Policy/Contract number

Section 2: Anti-money laundering provisions


2.1 Source of funds and source of income


Date D D M M Y Y Y Y

Other

2.2 Politically exposed persons (PEPs)

Member
Yes No ●

Section 3: Amount of cash withdrawal


Please note:

Section 4: Personal bank details

Signature of member Date D D M M 2 0 Y Y

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Policy/Contract number

Section 5: Declaration


Turnaround times

Date D D M M 2 Y Y

Signature of spouse if
married in community
Signature of member of property

MMI Group Limited

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Policy/Contract number

Form B (Pension and Provident Fund)


D D M M Y Y Y Y

Postal code

Tax year in which received Annual income amount


D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

Total

Gross lump sum

Annual income (income earned in South Africa only)

Signature of member Date D D M M 2 0 Y Y

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