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2,8

employment & labour

Department:
Employment and Labour
REPUBLIC OF SOUTH AFRICA
F
llrt-ElNl=Gritlfl?5{ur

AUTHORISATION TO PAY BENEFITS INTO BANKING ACCOUNT

To be completed by the Financial lnstitution (BanUPost Otfice)

NB: Please note that no corracllons on thls form be accepted.

Name of account Qr
name sumame in block lefters)

Document:
q tl" i I
Name of Financial lnstitution I te
Branch code:

4- 1 o D f
c) I I 1 3 o I I
L 3 b
lndicate with an "X"
Savings account Current account Transmission account
A

Dormant Active
Y
I declare thet the abovementloned lnformatlon is cuffent and complete in every aspect and that the Unemployment lnsurance
Ct;mmissicner wlll not he held liable for any incorrect payment wh!ch might arise due to incorrectllncomplete information supplied hy
me,
3 ['r*..{': d4

EANK
t_ 47 AO 10
of BanUPost Office Official)

0 I |{ov 2$22
Signature of 'TlrBllPk Offitial Stat rp
Ot
4167
To be completed by the Applicant

The Unemployment Insurance Commissioner/Claims Officer

( name and surname in block letters)

hereby requesUinstrucUauthorise you to pay my benefils, if approved, into the abovementioned account held at the Financial lnstitution (BanUPost
Oiiice), unless othenvise instructed in writing,

I declare that the information as furnished by the abovementioned Financial lnstitution is to my knowiedge accurate and complete. I indemnify the
UIC of any liabiiity in the event of payment being made into the provided banking account should this account be incorrect or incomplete"

Date

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employment & labour ff

s -:\l/,'. Department:
Enrployrnent and Labour
REPUBLIC OF SOUTH AFRICA

AUTHORISATION TO PAY BENEFITS INTO BANKING ACCOUNT

UIF
W()RKIN(] FORY.()U

To be completed by the Financial lnstitution (BanUPost Office)

NB: Please note that no on this form would be accepted.

Name of account LliL

(Full name and surname in block

Document:
q 4 I & I / 5 t I 6 C G
U 1
Name of Financlal lnstitution

Account number:

+ ,.7
O 0 I C I t 1 a o l I L =)
\-) d
lndicate with an "X"
Savings account
x Current account Transmission accounl

Dormant Actlve
X
I declare that the abovementloned informatlon is current and complete ln every aspect and that the
Canmissioner will not be held llable for any lncorrect payment which mlght arise due to by
me,
ffiATdK

"01t{0v2022
supplied an

Teller 1
Official

To be completed b}' 16" Applicant

The Unemployment lnsurance Commissioner/Claims Officer

(F name and surname in block letters) 1r

Document:

hereby requesUinstrucuauthorise you to pey my benefits, if approved, into the abov€mentioned account lreld at the Financial lnstitution (BanUPost
Office), unless otherwise instructed in writing.

I declare that ths information as furnished by the abovementioned Financial lnstitution is to my knowledge accurate and cornplete. I indemnify the
UIC of any liability in the event of payment being made into the provided banking accounl slrould this account be incorrect or incomplete.

Date
 Brnployff"rcffi & labour
Depal.1rrent
Employm€nt and Labour
REPUBLIC OF SOUTH AFRICA ut-l9
as amended
Employer's Declaration of Employees for the monlh
lnformation to be submitted in terms of Section 56 (1&3) read with Regulation 13 (1&2)

DETAILS
1.1 UIF Employer Reference No. Branch No. 1.2 PAYE Reference
No (lf registered with
) tl Ll- 9 a e-) -t I 1 SARS)
1.3 Trading name of busrness c- 1.4 Physical address: . V tUg

1 .5 Address where employees listed in item 2 work (if different to the address in 1.4) 1.6 Postal address
'* leoa"; r{1Ac5c-f,r-r1,-! Flf\tt v, lLr _t(::?6:

18E
<U6,]
B*nra 1.7 Co. Reg. No
(CIPRO No) trttrtllllil!i
'1.10 phone numoer, Ctfi'?iet aLl.(, 1.11 Authorised person""-
2.EMPLOYEE DETAILS
A B c E F G H I
Surname lnitials ldentity Document Number Total (Gross) Totai Commencement date Termination Date Reasons lndicate l{ non-
Remuneration hou rs of Employment Termination (use whether Contributor
paid to worked termination codes contiibuto slale reason
Employee Per during the as supplied at the r or non- (use codes as
Month month bottom of the contributo supplitri al the
R c D D M M D o M M Y Y page) r (YES bottom of the
OR NO) page)

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r, LE. fE (] E.'ni{. (Nameoremproyeo. ro ruo Lb lq> t q oo {(le8?oecrrr" that the above information is true and correcl. I understand that it is an offence lo make a false statement.

EMPLOYER'S SIGNATURE DATE

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,Cry,d,
ernplCIyment & labour
Depa(rnent
Empl0yment and [-abour
REPUBLIC OF SOUTH AFRICA ut-l9
UIF
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Description Code J (Reason for non-contribution*** Employer's stamp (if available)

lf the employer is not a resident in the RSA. or is a body corporate not 1 Temporary employees
registered in the RSA, an authorised person must carry out the duties of
the employer in terms of this Act.
D- Remuneration means actual basic salary plus payment in kind (Declare 2 Employees who earn commission only (
actual qross salary)
3 No income paid for the payroll period
paid weekly. convert wages to monthly salary (weekly wages X 52112)
E- Total hours worked, i.e- actual hours worked during the month.
Employers may also submit these details eleclronically from payrolls or
on the UIF's website at www.labour.orq.za
Only applicable for commercial employers, Domestic employers - provide
surname and initials.
Constructive dismissal can only be determined by the CCMA: Bargaining
Council or Labour Court

Reasons for termination codes

2 Deceased 6 Resiqned 10 lllness/Medical boarded 14 Business closed

3 Retired 7 Constructive dismissal"*' 'l 1
Retrenched/Staff reduction 15 Death of Domestic Emolover 19 Parental Leave
4 Dismissed 8 lnsolvency/Liquidation 12 Transfer to another Branch 16 Voluntary severance packaqe
5 Contract expired 9 Maternitv/Adoption 1 3 Absconded 17 Reduced Work Time

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empl*yrnent & labour
Depanment.
Employment and Labour
REPUBL'C OF SOUTH AFRICA ur-19 W()RKING
F
63 200'l as amended
Employeas Declaration of Employees for the month
lnformation to be submitted in terms of Section 56 (1 &3) read with Regulation 13 (1&2)

I.EIIIPLOYER'S DETAILS
1.1 UIF Employer Reference No Branch No. 1.2 PAYE Reference
No (lf registered with
h p + L) cl
-)
d t+ I + SARS)
1.4 Physical address: ..4ts.r;,rr
'1.3 Trading name of busrness Ga.fctCC=e1-i\/\s f.+.tQ {-nrpD r€ (3c-+<>cit- tj t) .Ja-q fT)t\(ir c-\ l((; r-{ E_ y;cLft

1.5 Address where empioyees listed an atem 2 work (if different to the address an 1 .4) 1.6 Postal stt:

1 8 E-mail (* -,r ('ir(+1u(rr g1j!lig!Br9!r"!i:

cOrft
1.9 Fax no
V

ni {a
ure,lmr, 1.7 Co Reg. No
(CIPRO No) tll I
I

'1.10 Phone numoer:OP{) ai+ ?tJ,&, 1.11 Authorisec person""_

2.EMPLOYEE DETAILS
A B c D- E F G H I
Surname Initials ldentity Document Number Total (Gross) Total Commencemenl date Termination Date Reasons lndicate lf non-
Remunerataon hours of Employment Temination (use whether Conlributor
Paid to worked terminaiion codes contributo stale reason
Employee Per during the as supplied at the f or non- (use codes as
Month month bottom of the contribulo supplied at lhe
R c D D M M Y D D M M Y Page) r (YES bottom of the
OR NO) oaoe)

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7 lr-nuo-c:c: lLi+ n I h 4 t 7 a I D f) I 7 6 lc:-
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TTIIIIIIIIIIIIIITIIII
[-EPE€ E,M (Nameotem!lo!er).lDNo.(,6larl?ookrta:\.decrs€$artheaboveinrormatiqistueandconecl.rund€Brandrhariris offene lo roke. rarse sraremenr.

EMPLOYER'S SIGNA

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 employment & labour
Departm€nt:
Employment and Labour
REPUBLIC OF SOUTH AFRICA ul-19

Description Code Employer's stamp (if

lf the employer is not a resident in the RSA, or is a body corporate not 1

registered in the RSA, an authorised person must carry out the duties of
the emplover in terms of this Act. huo^
D' Remuneration means actual basic salary plus payment in kind (Declare 2 Employees who earn commission only
actual qross salary) ?
J No income paid for the payroll period
G
lf paid weekly, convert wages to monthly salary (weekly wages X 52112) l./o f 0255 0,Bor 3t{0
l*nr0rtfto
Total hours worked, i.e. actual hours worked during the month- 2I35
Employers may also submit these details electronically from payrolls or
on the UIF's website at www.labour.org.za
Only applicable for commercial employers, Domestic employers - provide
surname and initials.
Constructive dismissal can only be determined by the CCMA: Bargaining
Council or Labour Court

Reasons for termination codcs

2 Deceased 6 Resigned 1 0 lllness/Medical boarded 14 Business closed '18 Commissionin

3 Retired 7 Constructive dismissal'*" 11 reduction 15 Death of Domestic Employer Parental
4 Dismissed 8 lnsolvency/Liquidation 12 Transfer to another Branch '16 Voluntarv severance packaqe
5 Contracl expired I Maternitv/Adoption '13 Absconded 17 Reduced Work Time

:.'
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De,padrnent:
La bou r
REPUBLIC OF SOUTH AF:RICA
SAIARY SCHEDTII,E
S ir/M ad a rn

Kindly please furnish this office with salary schedule (salary hreakdown)foryour employees use
the form below:-

lDINTITY NUMBI:R q l?ttg_11 boa+ _

SURNAME AND INITIALS OF EMPI.OYEI
COMPANY UIF REF NO
g+rre+ t>"q I ta
COMPANY NAME
PERIOD OF SERVICE ot l\ Ol - ,31
MONTH 2418 2019 2020 2021 2022
January @,q19-tr.
Irebruary R54tc"cr:":
March PZtto-oc
April
May
June
:
July
August
September rl
_l
October
November ,R ED.Dg
December E.81&-cr) f,

'lhe purpose
of this schedule is [or us to capture the correct salary which was paid to your
employee(s) each rnonth and for you as an Enr pltayer to pay the fund the correct anrount of
money

Thanking you in advarrce Iliu Pi.(l Yhl{ ANi)

5rc;NatuR-e,
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OFFICE STAMP

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Stand No1A255 P0.Box 3246

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9 l,aagokgwane Mnabatho .':
\'itage 2735

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De,partment: il
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La bou r ,il

.REPUBLIC OF SOUTH A.FRICA l.;

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SALARY SCHEDI"I,8 .t

Sir/Mada m
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Kindly please furnish this r.lffice with salary schedule (salary breakdown)foryour empl<:yees use
the form below:-
i
IDENl'lTY NUMII{:R tf stl6oE? 1
1L
',i
SURNAN4E AND INITIALS OF FMPLOYEI Y 'i'f
'1

COMPANY tJIF REI. NO

p(I,+y+oq lr+ ,{
.,ii.

COMPANY NAME G*er-c'r(3e.Lr^IALJG rfftlssr-E S- !4

PERIOD OF SERVICE C)T r)d e? -gt c)B a7 fl

'ii
MONTH 2018 2019 2020 2021 2{t22 ',
.::
January 1

February
in
March i
April lrttua *otr .,

May Etiqto-oo
June Eu-oeo- og
July Fq-oqo-os>
August .l+o&l3 -en q
i
September I I,
't' j
0ctober i
November "i
December
rt
'i
I
.J
The purpose of this schedule is for us to captLrre the correct salary which was paid to your
employee(s) each month and for you as an Employer to pay the fund the correct amount of
nroney

t hanking you in advance EM? Lo n R,^" o ---!#f&E- -B-:-Y\wp

SI(JNAl'URI:
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STAMP:
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Sfand Alo 10?55 p O.Box 3246 tr

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Magokgwane Mnabatho I
\';llage 2735
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