cleaning services

** ********* *****, ********** ****** PARK

BLOCK A, SUITE 3, CNR. REPUBLIC

AND WILLIAM NICOL DRIVE

HURLINGHAM MANOR, 2196

T: +27-11-100-****

F: +27-86-693-****

TENNANT ADMINISTRATION SERVICES (PTY) LTD

REG.NO. 1990/002515/07 FAIS LICENCE NO: 6690

DIRECTORS: S.B. FIELD, R.M.H. PITT, J.W.B. FIELD

E.M. LETTY, J.W. BUTLER, S.R. TENNANT

FORMER MEMBER EXIT FORM

Member Information

Title Initials

Surname

First Names

Identity Number

Dates of Birth

Contact Numbers

Revenue/Tax Office

Income Tax Reference Number

Residential Address

Postal Address

Attach a CERTIFIED COPY OF YOUR ID (if the new ID CARD, BOTH SIDES ARE REQUIRED) and a copy of your BANK STATEMENT STAMPED BY YOUR BANK and return to us: Email Address: *****@*******.**.**

Fax Number: 086-***-****

Telephone Number: 011-***-****

Postal Address: PO Box 64, Buccleuch, 2066

Member’s Declaration - I agree that:

All particulars furnished on this form and accompanying documentation are true and correct

This termination of service form is completed in its entirety

The benefit payment options available to me and the tax implications thereof have been explained to me in full

This payment is in full and final discharge of the Fund’s liability Member’s Signature Date

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