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PRESERVATION OF BENEFIT/WITHDRAWAL NOTIFICATION (Law for All South Africa)

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Liberty Corporate – A division of Liberty Group Limited Reg. No. 1957/002788/06
An Authorised Financial Services Provider (Licence No. 2409)
Libridge Building, 25 Ameshoff Street, Braamfontein, 2001 P O Box 2094, Johannesburg 2000
t: +27 (0)11 558 2999
For claim forms: e lcb.customerservices@liberty.co.za
For queries: e lc.contact@liberty.co.za t +27 (0)11 694 5309
In the event of any modification or variation of this standard form, Liberty will regard this form as being
invalid and of no force and effect. Do not sign blank or incomplete forms.
LCB009 10/2019 - Page 1 of 8
PRESERVATION OF BENEFIT/WITHDRAWAL NOTIFICATION
Please ensure that all the required information and benefit payment instruction details are completed as accurately as possible.
Once Liberty commences with processing the claim payment, the transaction may not be reversed.
We are required to share, collect and process your Personal Information (PI). Your PI is collected and processed by our staff,
representatives or sub-contractors and we make every effort to protect and secure your PI. You are entitled at any time to request
access to the information Liberty has collected, processed and shared.
Section 1 - Fund details
Please note, fields marked with an asterisk (*) are compulsory and claims cannot be processed without this information.
Fund name
*
Fund number
Employer name
*
Employee/payroll ref number
Member’s ID number
*
Membership number
*
Member’s full name:
Surname
First names
Please attach a copy of the member’s recently certified (not more than 3 months) ID document/copy of the back and front of the ID smart
card/passport with this form.
Date of withdrawal
*
Reason for leaving employment*
Resignation Retrenchment/Redundancy Dismissal Transfer of employment
Note: If you are aged 55 or over, you qualify for early retirement. If you wish to take up this option, Liberty Corporate will
require retirement claim documents.
Did the member hold more than 5% of the issued share capital or member’s interest in the company?
Yes No
Note: If the reason for leaving employment is indicated as retrenchment or redundancy and the member held more than 5% of
the issued share capital or member's interest in the company, SARS will treat the claim as a resignation.
Is the member a foreign person?
Yes No
Please see the definition of a foreign person in the important note section.
Does the member participate in any other Liberty fund?
Yes No
If “Yes”, please state the name of the fund and complete a separate notification form if necessary.
Section 2 - Member’s details
2.1
Member’s annual taxable income
*R
2.2
Residential address
*
Code
2.3
Postal address
*
Code
Contact numbers:
Work
*
Home
Cell
2.4
Email address
Note: Liberty may send/request information via SMS messaging. Please ensure that Liberty has your current cellphone
number as all times.
2.5
Member’s income tax reference number
*
2.6
Were any funds transferred into this fund from a public sector fund?
Yes No
If “Yes”, what was the tax free portion (pre 1998 contributions only)?
R
Please send your completed form to lcb.customerservices@liberty.co.za
Liberty Corporate – A division of Liberty Group Limited Reg. No. 1957/002788/06
An Authorised Financial Services Provider (Licence No. 2409)
Libridge Building, 25 Ameshoff Street, Braamfontein, 2001 P O Box 2094, Johannesburg 2000
t: +27 (0)11 558 2999
For claim forms: e lcb.customerservices@liberty.co.za
For queries: e lc.contact@liberty.co.za t +27 (0)11 694 5309
LCB009 10/2019 - Page 3 of 8
Section 3 - Details of any claims against the benefit
3.1
Does the member have any outstanding housing loan balance for a loan granted by the Employer, by the
Fund or through the Fund?
Yes No
If “Yes”, please provide documentary proof of the loan.
3.2
Are there any divorce orders recorded against the Fund in respect of this member?
Yes No
If “Yes”, please provide copies of the final divorce order.
3.3
Are there any maintenance orders recorded against the Fund in respect of this member?
Yes No
If “Yes”, please provide copies of the final maintenance order.
3.4
Are there any Employer claims with regard to theft, fraud, dishonesty or misconduct recorded against the Fund
in respect of this member?
Yes No
If “Yes”, please attach copies for validation.
Section 4 - In-Fund Preservation for Benefits
4.1
Does the member wish to retain (i.e. preserve) the benefit within the Fund?
Yes No
Under this option, the member's benefit will be retained in the Fund and remain invested in the current investment portfolio
selections. However, for members of the Liberty Corporate Selection Umbrella Funds, please indicate in Table 1 below, the
member's selection of investment portfolio(s) into which the benefits are to be invested. Place a cross in the column next to the
portfolio name and indicate the desired % of the benefit to be invested in that particular portfolio. The total % across all portfolios
selected must sum up to 100%. If no selection is made in Table 1, then the member's benefit will be fully invested into one of the
Default Investment Portfolios selected by the Board of Trustees of the Fund. For members of the Liberty Corporate Selection
Umbrella Funds only - if a Financial Adviser has been appointed by the member as their personal adviser, Section 8 of this
form must also be completed.
Table 1 - Investment Portfolio selection for in-fund preservation members of the Liberty Corporate Selection Umbrella
Funds
Investment Portfolio Name
Investment
Manage Fee
Indicate Selection
% Invested
Trustees' Default Portfolio Range
Liber8 Stable Growth Fund
0.60%
%
Liberty Core Conservative
0.60%
%
Liberty Core Moderate
0.60%
%
Liberty Core Balanced
0.60%
%
Multi-Managed Portfolios
STANLIB Multi-Manager Balanced Growth Fund
1.40%
%
STANLIB Multi-Manager Moderate Growth Fund
1.40%
%
STANLIB Multi-Manager Conservative Growth Fund
1.40%
%
Index-Tracking Portfolios
Liberty Balanced Tracker Fund
0.35%
%
Liberty Moderate Tracker Fund
0.35%
%
Liberty Conservative Tracker Fund
0.35%
%
Money Market Portfolio
Liberty Institutional Money Market Fund
0.30%
%
Shari'ah Portfolio
STANLIB Multi-Manager Shari'ah Balanced Fund of Funds
1.00%
%
Third-Party Balanced Portfolios
Allan Gray Balanced Fund
1.25%
%
Coronation Balanced Plus Fund
1.25%
%
Ninety One Opportunity Fund
1.25%
%
Prudential Balanced Fund
1.25%
%
Please visit www.liberty.co.za for more information regarding any of the investment portfolios listed in Table 1 above.
Liberty Corporate – A division of Liberty Group Limited Reg. No. 1957/002788/06
An Authorised Financial Services Provider (Licence No. 2409)
Libridge Building, 25 Ameshoff Street, Braamfontein, 2001 P O Box 2094, Johannesburg 2000
t: +27 (0)11 558 2999
For claim forms: e lcb.customerservices@liberty.co.za
For queries: e lc.contact@liberty.co.za t +27 (0)11 694 5309
LCB009 10/2019 - Page 3 of 8
Declaration by member
This declaration is only required if no Financial Adviser has been appointed by the member. Else, please complete Section 8.
I acknowledge that by selecting "Yes" in Section 4 and by not completing Section 8, I am declaring that I shall be an in-fund Deferred
Retiree or Preserver Member of the Fund without a Financial Adviser and without investment advice.
Signature of member
Date
Section 5 - Other options available to the member
5.1
Does the member wish to transfer all or part of the benefit (minimum R12 500) to a Liberty preservation fund?
Yes No
If “Yes”, please advise amount
R
or insert all and complete section 6.
5.2
Does the member wish to transfer all or part of the benefit to another approved pension/provident/retirement
annuity or preservation fund with another insurer?
Yes No
If “Yes”, please complete the following:
Name of fund/policy
New fund/policy number
Insurance company
SARS Fund approval number
1
8
/
2
0
/
4
/
FSB Fund approval number
1
2
/
8
/
5.3
Does the member wish to take all or part of the benefit in cash?
Yes No
If “Yes”, please advise amount R
or insert all and complete section 7.
5.4 Is the member currently an Income Plus Plan (IPP) claimant? Yes No
5.5
If the member has been on the Fund for more than 12 months, does the member wish to exercise an option (if
any) to continue his/her life assurance and/or disability cover under an individual policy?
Yes No
If the member would like more information regarding this option, please provide details so that our consultant can contact you.
(This option has to be exercised within 60 days of leaving service.)
Note: Normal retirement – if the member has reached normal retirement age, as stated in the rules of the Fund, they may not
withdraw from service or transfer their benefit to a preservation fund and must therefore, complete a retirement
notification form.
Section 6 - Transfers to Agile Provident or Pension Preserver Plans for Liberty
Please ensure that all fields are completed. (The transfer will not be processed timeously with missing information).
Agile policy number
Transferring fund details
SARS approval number
FSCA registration number
Type of fund
Pension Provident
Commencement date in the transferor fund
Date the member withdrew from the transferor fund
Selected retirement date
Amount transferred
R
Accessible/non-accessible before retirement
R
LCB009 10/2019 - Page 4 of 8
Section 6 - Transfers to Agile Provident or Pension Preserver Plans for Liberty (continued)
Bank account details for the receiving fund
Bank name
Account holder name
Account number
Branch number
Account registration number
Reference number for deposit
Branch name
Type of account
Beneficiary details
Please note: S37C of the Pension Funds Act, No. 24 of 1956 ("the Act") places a duty on the Board of Trustees of both the Agile
Preserver Pension Plan and the Agile Preserver Provident Plan to distribute the benefits equitably among dependants and nominees,
taking into account a variety of factors including their financial dependency on the deceased member before death. Your nomination of
beneficiaries below will assist the Board in the distribution decision.
It is recommended that you review/amend your beneficiary nominations regularly as your circumstances change. This can be done by
completing a Beneficiary Nomination Form at any time.
Name and Surname
ID number
Relationship to deceased member
Split %
%
%
%
%
Total =
100%
Investment details
(Please speak to your Financial Adviser regarding your portfolio choice.)
Declaration by member
1.
I confirm that the rules, terms and conditions, as well as all marketing material of the Agile Preserver Pension Plan and/or the Agile
Preserver Provident Plan (The Plan) (as the case may be) have been explained to me, and that I understand the nature of the
investment.
2.
I accept and bind myself to the registered rules of the Plan (as the case may be), and any other rules, which the Board of
Management might formulate there under.
3.
I understand that if a portion of the transfer benefit was paid out in terms of Section 37D of the Act or as cash payment, this would
be considered as my one withdrawal prior to retirement.
4.
I understand the fees structure applicable to the Plan.
5.
I confirm that I have received all the information required in terms of the Policyholder Protection Rules and FAIS. I further confirm
that I fully understand the quotation provided by my Financial Adviser for this investment.
6.
I accept all the terms and conditions that form part of this application and declaration.
*
Signature of member
Date
(signed after consultation)
LCB009 10/2019 - Page 5 of 8
Section 7 - Member’s payment details
I request Liberty to pay the amount due by direct deposit into the following account:
Name of bank
Name of branch
Name of account holder
Account number
Branch number
Type of account Savings Transmission Cheque
An ORIGINAL cancelled cheque or ORIGINAL account statement must be attached for verification purposes, otherwise
processing could be delayed. Where the name of the account holder differs due to marriage, a certified copy of the marriage
certificate must be provided.
Important
• Payment will not be made into a 3
rd
party’s account.
• Liberty will not make payment by cheque.
• Benefits are payable in South African Rands only and it is the member’s responsibility to arrange the transfer of their
funds outside South Africa.
Section 8 - Financial Adviser's details
Principal Financial Adviser
Name and Surname
Liberty 13-digit code
Telephone number
Fax number
FSP Practice name
FSP Practice number
Initial investment advice fee (% of benefit as per the member agreement)
(1)
Annual ongoing investment advice fee (% of benefit as per the member agreement)
(2)
(This will be converted into
a monthly % deducted off
the benefit value)
Other Related Financial Adviser
Name and Surname
Liberty 13-digit code
Initial investment advice fee (% of benefit as per the member agreement)
(1)
Annual ongoing investment advice fee (% of benefit as per the member agreement)
(2)
(This will be converted into a monthly
% deducted off the benefit value.)
(1)
The sum of all initial advice fees cannot exceed 1.5% (excluding VAT)
(2)
The sum of all ongoing advices fees cannot exceed 1% p.a. (excluding VAT)
Financial Adviser’s declaration
I declare that I am registered to market Retail Pension benefits under the Financial Advisory and Intermediary Services Act, No. 37 of
2002 and accept the consequences of the Act.
*
Signature of Financial Adviser
Date
Member's declaration
1. I understand that I may at any time instruct Liberty to stop deducting or facilitating the payment of any future ongoing advice fee, or I
may at any time instruct Liberty to change the amount of the ongoing fee or pay any future ongoing fee to Liberty or to another
Financial Adviser.
2. I understand that any ongoing advice fees agreed to in this mandate may continue to be paid where the Financial Adviser moves
between distribution channels or authorised financial services providers, provider that the Financial Adviser or financial services
provider is contracted with Liberty and appropriately accredited in terms of prevailing legislation.
3. I understand that this mandate will be automatically renewed on an annual basis unless I instruct Liberty to cancel it.
4. I understand that these fees will be deducted from the investment value of my policy and will therefore reduce the value of my
investment accordingly.
5. I understand that my Financial Adviser may work in a Liberty approved team and any advice fee deducted may be shared with the
team.
6. I understand that, if the Financial Adviser is part of a Liberty approved team and the Financial Adviser is for any reason unable to
receive the advisory fee, then the advice fee will become payable to another adviser within the approved team.
*
Signature of Member Date
LCB009 10/2019 - Page 6 of 8
Section 9 - Fund authorisation/member signature
(Fields marked with a * are compulsory and need to be signed/completed in full)
I acknowledge:
1. The personal information that I have provided to Liberty in this form is correct.
2. The information provided by me shall be subject to the rules of the Fund and the terms and conditions of the policy and
any relevant regulatory authority.
3. I shall be responsible for sending this form back to Liberty or to the Financial Adviser's office with my signature and
contact details.
*
Signature of member
Date
*
Fund authorised signatory (print name and sign)
Date
Company
Stamp
LCB009 10/2019 - Page 7 of 8
Withdrawals
Most members leave funds through resignation, dismissal or retrenchment. The rules of the pension or provident fund set out in detail
the various options available to a member on termination of membership. The summary below is intended only to give a member an
overview of the various benefits and options to which the member may be entitled so that the member can make an informed choice
with regard to the benefits.
We strongly recommend that money accumulated for retirement should be preserved whenever possible. Experience shows
that once money allocated for retirement is taken in the form of cash, it is very rarely replaced at a later stage.
The following options are generally available:
• Option 1: Taking the benefit in cash
The implications of taking a cash benefit on withdrawal are that the tax-free amount (currently, R25 000, per life time, plus the
member’s own contribution not previously allowed as a deduction) has been exceeded, the remaining benefit will be subject to tax.
Clearly, a cash payment means that money set aside for retirement may be used for other purposes, resulting in the member
having insufficient funds to live on after retirement.
Lump sum withdrawals due to the member being retrenched or made redundant (voluntary or involuntary) are taxed in the same
manner as a retirement claim (currently, R500 000, per life time, plus the member’s own contributions not previously allowed as a
deduction). However, this tax relief is not available to a taxpayer who was, at any time, a director of the employer company and at
the time held more than 5% of the issued share capital or member’s interest in that company.
• Option 2: Transferring the benefit to a fund operated by the member’s new employer
It is usually possible to transfer the benefit to a fund operated by the member’s new employer. Not only will such a transfer be free
of tax (unless it is a pension to provident fund transfer) but the benefit will be held to the member’s credit under the member’s new
employer’s fund. Here it will earn investment income until such time the member retires or leaves the new fund.
Please note, if transferring to another fund/participating employer administered by Liberty Corporate and individual member choice
is allowed, the member must complete a new investment portfolio selection form.
• Option 3: Transferring the benefit to a retirement annuity or preservation plan
This option is similar to transferring the benefit to a fund operated by the member’s new employer described above, with the
difference being that the money is held in the member’s own individual investment plan.
In the case of a retirement annuity, up to one-third of the final amount accumulated can be taken at retirement in the form of cash,
subject to tax at that time. The balance of the proceeds must be taken in the form of a pension that will be subject to tax. Note that
the earliest age at which the member may retire from a retirement annuity is 55.
The difference between a preservation plan and a retirement annuity is that one withdrawal may be made from a preservation plan
prior to retirement (depending on accessibility) to meet any unexpected financial needs.
• Option 4: Death and disability benefit continuation option
Where this is offered, a member who has been on the fund for more than 12 months may, within 60 days of leaving service,
exercise an option to take out an individual policy without evidence of health. However, a Cotinine test may be required to confirm
smoker status. In this way the member can continue valuable life cover (and disability cover where applicable), at the member's
own expense.
• Option 5: Preserving the benefit within the fund
When members leave their employer from 1 March 2019, they have the option to preserve their benefits within the fund. On this
option, no cash payment will be made to a member on withdrawal. Instead, their accumulated withdrawal and retirement savings
will continue to be invested inside the fund. Members of the Liberty Corporate Selection Umbrella Funds will be required to choose
their investment portfolio(s) into which their preservation benefits will be invested. This is done by completing Table 1 in Section 4
of this claim form. If no selection is made, the member's preservation benefits will be placed in one of the Default Investment
Portfolios selected by the Trustees of the Liberty Corporate Selection Umbrella Funds. The member can choose to change this
investment portfolio selection at a future date by completing an investment switch form. For members of other retirement funds, the
underlying investment portfolio will be the same investment portfolio that the member was invested in before becoming a preserver
member, or as guided by the Rules of the Fund. Whilst being a Deferred Retiree or Preserver Member in the Fund, the member
will continue to have access to investment portfolios at institutional rates. Depending on the investment portfolio selection, these
rates are typically lower than that of a preservation offering outside the Fund. When the member reaches retirement, the member
can ask for the Preserver Benefit to be paid out according to prevailing legislation and relevant pay-out options at that time.
Financial Advisory and Intermediary Services Act, No. 37 of 2002 ("FAIS")
The FAIS legislation was introduced for members' protection against the possibility of receiving inappropriate advice regarding their
financial needs. A member must ensure that their Financial Adviser is duly licensed under the FAIS Act and provides them with a
written record of the advice given to them. A member's Financial Adviser is obliged to fully disclose any material information pertaining
to the product, the product supplier and their relationship with the product supplier. In terms of this legislation, a member's Financial
Adviser must ensure that all the necessary steps have been taken to place the member in a position to make an informed decision in
respect of their withdrawal or retirement benefit.
Protection of Personal Information Act, No. 4 of 2013
We are required to share, collect and process your Personal Information (PI). Your PI is collected and processed by our staff,
representatives or sub-contractors and we make every effort to protect and secure your PI. You are entitled at any time to request
access to the information Liberty has collected, processed and shared. Errors and omissions are excluded.
The information contained in
this document does not constitute financial, tax, legal or accounting advice by Liberty.
Any legal, technical or product information contained in this document is subject to change from time to time. If there are any discrepancies
between this document and the contractual terms or, where applicable, any fund rules, the latter will prevail. Any recommendations made must
take into consideration your special needs and unique circumstances. Liberty Group Ltd is an Authorised Financial Services Provider in terms of
the FAIS Act (No. 2409). © Liberty Group Ltd. All rights reserved.
LCB009 10/2019 - Page 8 of 8
Important note:
A natural person will be regarded as a ‘foreign person’ if:
• He or she is not ordinarily resident in South Africa; or
• He or she has not been physically present in South Africa for a period of 91 days in aggregate in a tax year as well as for a period of 91 days in
aggregate of the preceding five tax years and for a period exceeding 916 days in aggregate during those five preceding tax years; or
• He or she has been physically outside South Africa for a continuous period of at least 330 full days.
Our business success resolves around our ability to pay members their benefits at a time when they need it most. Our service level agreement for the
payment of defined contribution retirement claims is ten working days from the receipt of all requirements.
However, we are often unable to meet our service obligations when we do not receive all the requirements we need, to successfully finalise payment.
We will not be held liable for any loss or damages that a member may suffer as a result of our failure to process and pay a claim within the agreed
timelines if the delay was (is) caused by a member failing/neglecting to satisfy all the requirements necessary to finalise payment. This includes, but is
not limited to a member's failure to provide us with all relevant information or documentation, or complete the forms accurately and completely.
Contact us
Please ONLY contact us if you have not received payment within this timeframe.
Queries
For more information, please contact your accredited Liberty Financial Adviser, or the Liberty Corporate support centre:
Liberty Corporate Contact Centre
Email address: lc.contact@liberty.co.za
Tel number: +27 (0)11 558 2999
Fax number: +27 (0)11 408 2264
Benefit counselling
For benefit counselling, please contact us:
Liberty Corporate Benefit Counselling
Email address: benefitcounselling@liberty.co.za
Tel number: +27 (0)11 558 2999
Complaints
Our complaints handling procedure is available on our website (www.liberty.co.za), or we can send it to you on request.
Complaints should be directed in writing to:
The Complaints Resolution Manager
OR
For Liber8 and Liberty Corporate Selection Suite of Umbrella Funds
Liberty Corporate
PO Box 2094, Johannesburg, 2000
Email address: lc.contact@liberty.co.za
Tel number: +27 (0)11 408 2771
Fax number: +27 (0)11 694 5304
The Principal Executive Officer
PO Box 2094, Johannesburg, 2000
Email address: roger.spence@liberty.co.za
Tel number: +27 (0)11 408 5685
If the complaint is not resolved to your satisfaction by Liberty, you may contact one of the legislative bodies that have been tasked to look
after your interests a customer. Please note that if a complaint is formally logged with Liberty Corporate using our complaints process, a
reference number will be provided.
For fund complaints
The Pension Funds Adjudicator
OR
The Ombudsman for Long-term insurance
PO Box 580, Menlyn, 0063
Email address: enquiries@pfa.co.za
Tel number: +27 (0)12 748 4000
Fax number: +27 (0)86 693 7472
Private Bag X45, Claremont, 7735
Email address: info@ombud.co.za
Tel number: +27 (0)21 657 5000
Sharecall: +27 (0)86 010 3236
+27 (0)21 674 0951
For complaints regarding a Financial Adviser
FAIS Ombudsman
PO Box 74571, Lynnwood Ridge, 0010
Email address: info@faisombud.co.za
Tel number: +27 (0)12 470 9080
Fax number: +27 (0)12 348 3447
The above process is our formal complaints process and a reference number will always be provided. If you do not receive a reference
number for a complaint, please contact the Complaints Resolution Manager using the contact details above.
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PRESERVATION OF BENEFITWITHDRAWAL NOTIFICATION (Law for All South Africa)

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