MyPlayers Death Cover

Qu i c k G u id e to

MYPLAYERS DEATH BENEFIT COVER Brought to you by FUNDSATWORK UMBRELLA FUNDS from

C A R ING F OR Y OUR L O V ED ONE S W HEN Y OU NO L ONGE R C A N

Fro m 1 s t A p ril 2 02 0 , a s a f u r th e r p e r k of b e l o n g i n g to o u r o rg a n i s ati o n , yo u a n d eve r y M y P l aye r s m e m b e r of th e r u g by p l aye r s p e n si o n f u n d will re ce ive th e p e a ce of m i n d of k n owi n g th at a D e ath B e n ef it ( “ life cove r ” ) will p rovi d e fo r yo u r e l e c te d b e n ef i ci a ri e s i n th e eve nt of yo u r d e ath .

C OMP UL S OR Y C O V E R Yo ur com p ulsor y lum p sum d eath b e n ef it

R150 000

» R 1 5 0 0 0 0 wi l l b e p a i d to yo u r l ove d o n e s if yo u p a s s aw ay. » T h i s a m o u nt i s a d d e d to yo u r p e n s i o n f u n d s av i n g s a s a “ b o o s te r ” to a s s i s t yo u r d e p e n d a nt s .

M onthly pre mium » T h i s R 1 8 p r e m i u m wi l l b e ta x- d e d u c t a b l e . I t w i l l f o r m p a r t o f yo u r c u r r e n t p e n s i o n f u n d c o n t r i b u t i o n .

N o un d e r writing n e e d e d » T h i s m e a n s yo u wo n’ t h ave to p r ov i d e a m e d i c a l h i s to r y o r c h e c k- u p to q u a l if y.

E X T R A V OL UN TA R Y C O V E R * Yo u m ay ch oose to in crease yo ur death b e n ef it a mo unt at a n ex tra cost:

R500k

increments

* S u b j e c t to te r m s a n d c o n d iti o n s i n c l u d i n g th e f o l l owi n g: • Yo u c a n i n c re a s e yo u r cove r i n b a n d s of R 5 0 0 0 0 0 .

• Yo u r m o n th l y p re m i u m i n c re a s e s by R75 fo r eve r y R 5 0 0 0 0 0 .

• S e c u re u p to a m a x i m u m cove r o f R4 m i l l i o n p a i d - o u t f o r a p re m i u m of R 6 0 0 p m .

• N o u n d e r w r i ti n g re q u i re d f o r cove r of R 2 m i l l i o n o r l e s s .

• T h e b e n e f it wi l l b e p a i d to yo u r e l e c te d b e n e f i ci a r y.

V OL UN TA R Y C O V E R

R 5 0 0 0 0 0 (n o u n d e r w r i ti n g re q u i re d )

R75

R 1 0 0 0 0 0 0 (n o u n d e r w r i ti n g re q u i re d )

R150

R 1 5 0 0 0 0 0 (n o u n d e r w r i ti n g re q u i re d )

R225

R 2 0 0 0 0 0 0 (n o u n d e r w r i ti n g re q u i re d )

R300

R 2 5 0 0 0 0 0 (u n d e r w r i ti n g re q u i re d )

R 3 75

R 3 0 0 0 0 0 0 (u n d e r w r i ti n g re q u i re d )

R4 5 0

R 3 5 0 0 0 0 0 (u n d e r w r i ti n g re q u i re d )

R525

R4 0 0 0 0 0 0 (u n d e r w r i ti n g re q u i re d )

R600

C O S T P E R MON T H

NO T E: 1 . I f yo u c h o o s e to t a ke o u t th e E x tr a Vo l u n t a r y C ove r yo u w i l l n e e d to s u b m it a n a p p l i c a ti o n (s e e b e l ow) to M y P l aye r s .

2 . Yo u m u s t i n d i c a te yo u r n o m i n a te d b e n e f i c i a r y/ i e s f o r th i s b e n e f it (s e e fo r m b e l ow).

P l e a s e e m a i l I s m a - E e l D o l l i e ( i s m a e e l @ my - p l aye r s .c o m) o r c a l l u s o n 0 2 1 8 87 5 7 8 6

2

M y P laye rs D e ath B e ne fit Cover

O T HE R GR E AT A DVA N TA GE S OF T HI S NE W B ENEF I T 1 . Yo u r e m p l oye r d o e s th e a d m i n i s tr a ti o n a n d p re m i u m d e d u c ti o n o n yo u r b e h a l f.

2. You’ll be covered by MyPlayers Death Benefit Cover for the duration of your MyPlayers membership.

3 . Yo u c a n c o nve r t th e M y P l aye r s D e a th B e n e f it C ove r b e n e f it to yo u r ow n i n d i v i d u a l p o l i c y ( M o m e n t u m M y r i a d ) a f te r e n d i n g yo u r r u g by c a re e r, p rov i d e d th a t : • Yo u h ave b e e n co n tr i b u ti n g to th e M y P l aye r s D e a th B e n e f it C ove r f o r a t l e a s t 1 2 m o n th s , a n d • yo u a re yo u n g e r th a n 3 6 ye a r s w h e n yo u l e ave yo u r e m p l oye r, a n d • yo u i n f o r m M o m e n t u m w i th i n 9 0 d ays of l e av i n g yo u r e m p l oye r th a t yo u w i l l t a ke u p th e c o nve r s i o n of f e r.

• N o m e d i c a l ev i d e n ce w i l l b e re q u i re d . » W h at d o e s th i s m e a n? I f yo u t a ke u p th e M y P l aye r s D e ath B e n e f it C ove r at a g e 24 a n d d e c i d e to ta ke u p th e c o nve r s i o n o p ti o n b e f o r e a g e 3 6 , yo u wi l l n ot b e r e q u i r e d to d o a m e d i c a l c h e c k- u p th at m i g ht oth e r wi s e h ave b e e n a c o n d iti o n f o r t a k i n g u p th i s i n d i vi d u a l c ove r. I f, f o r e xa m p l e , yo u d eve l o p e d hy p e r te n s i o n ( h i g h b l o o d p r e s s u r e) i n yo u r th i r ti e s , yo u r i n s u r e r wo u l d l i ke l y h ave r e q u i r e d m e d i c a l u n d e r w r iti n g , wh i c h c o u l d i n c r e a s e yo u r m o nth l y p r e m i u m .

• Yo u r c ove r a m o u n t re m a i n s co n s i s te n t .

• Fo r n o n - s m o k i n g r a te s to a p p l y, a co ti n i n e ( “ s m o k i n g ” ) te s t w i l l b e re q u i re d .

My P l ayers Deat h B en e f i t Cove r

3

C ON TAC T U S

Y our s c he me ’ s f in a nc i a l a d v i s o r D av i d d e V i l l i e r s M y P l aye r s T

(0 2 1 ) 8 87 5 7 8 6

M

+27 8 2 4 6 0 2 8 03

E

d av i d @ my- p l aye r s . c o m

w w w. my p l aye r s . co m

P hys i c a l a d d r e s s : Tyg e r b e r g O f f i ce P a r k 1 6 3 U ys K r i g e D r i ve P l a t te k l o of C a p e Tow n 75 0 0

M y P l a ye r s F i n a n c i a l S e r v i c e s ( P t y) L t d i s a n a u t h o r i s e d f i n a n c i a l s e r v i c e s p r ov i d e r w i t h F S P n u m b e r 4 6 9 9 9 .

Momen t um c l ie n t c on ta c t c e n t r e T

0 8 6 1 6 5 75 8 5

F

(0 1 2) 6 75 3 970

E

m o m e n t u m c o r p o r a te c l i e n t @ m o m e n t u m . c o . z a

w w w. m o m e n t u m . co . z a /f u n d s a t wo r k

P hys i c a l a d d r e s s :

Postal address:

M o m e n t u m Fu n d s AtWo r k

P O B ox 74 0 0

2 6 8 We s t Ave n u e

Centurion

Centurion

0046

G a u te n g

4

M y P laye rs D e ath B e ne fit Cover

corporate

FundsAtWork FlexiCovers

Member number

Before completing this form please make sure that: • you have read your member guide; • you have read your benefit statement and you know which benefits you have; • you have made use of the calculator available on the website (http://www.momentum.co.za/fundsatwork); and If you have any queries regarding FlexiCovers, you may contact the Client Contact Centre on 0860 65 75 85.

Please fill in this form in the fields provided. Use the tab key to move from one field to the next.

Section 1: Employer details Employer’s name Employee number

Section 2: Member details

Title Initial/s First name

Surname

D D M M Y Y Y Y Date of birth

Yes

No

ID/Passport number

RSA ID

Passport country of origin Residential address

Postal Code

Postal address

Postal Code

Telephone - work

Fax number

Telephone - home

Cell number

Email address

Section 3: FlexiCovers group life cover (if applicable) Please indicate the cover required: R500 000

R1 000 000

R1 500 000

R2 000 000

R2 500 000

R3 000 000

R3 500 000

R4 000 000

The multiples of salary flexed can be in increments of R500 000, to a maximum of R4,000,000.

1190320

MEB

1

Member number

Section 4:Declaration by member (full names)

I hereby declare that: • all particulars furnished in this form are true and correct; • I understand the FlexiCovers that have been made available to me; and • I am aware of the effect the change in FlexiCovers will have on my take-home pay.

Signed at

D

D

M

M

Y

- 2 0 Date Member’s signature Fax this completed form to our Client Contact Centre on 012 675-3970. At the same time inform your employer of the change. You may also log on to our website at www.momentum.co.za/fundsatwork and make changes to your FlexiCovers electronically.

Y

Notes: 1. FundsAtWork will not be liable for any losses you incur if the information you supply is unclear, illegible or incorrect in any way.

2. You may be requested to go for medical examinations.

3. A benefit will not be paid if death is a result of suicide or self inflicted injury withing the first two years of selection of the flex cover over the default cover chosen by the employer.

Note We recommend that you contact your financial adviser before you make any changes to your product option, benefits and beneficiaries.

When you sign this form by inserting a digital signature it confirms that the information provided is true and correct.

Options to sign the form: 1. Print out the form, sign and scan it and send it back via email to clientcontactcentre@momentum.co.za or fax it to +27 (0)12 675 3970.

2. Place your scanned signature in the signature block.

• Store your scanned signature in a safe place on your computer.

• Select the ‘comments’ tab from your menu in Adobe.

• Select the ‘add stamp’ icon.

• Select custom stamps.

• Create custom stamps.

• You can now browse and upload your signature to save it as a custom stamp under ‘sign here’ in Adobe.

• You can now go back to your ‘stamps’ icon and select ‘sign here’ and select your saved signature.

• Place it in the document and save the document.

When you want to print the form to complete by hand you can turn off the field highlights by selecting the “highlight existing fields” on the top right hand corner of your screen.

submit form

save form

print

Momentum Metropolitan Life Limited 268 West Avenue Centurion 0157 PO Box 7400 Centurion 0046 South Africa 102 Rivonia Rd EY Building Tower 2 Sandton 2196 PO Box Sandton South Africa Tel +0860 65 75 85 Fax +27 (0)12 675 3970 Parc du Cap 4 Mispel Road Bellville Cape Town 7530 PO Box 2212 Bellville 7535 South AfricaTel +27 (0)21 940 5911 Fax +27 (0)21 940 4320 momentumcorporateclient@momentum.co.za www.momentum.co.za/fundsatwork Momentum Corporate is a part of Momentum Metropolitan Life Limited, an authorised financial services and registered credit provider Reg. No. 1904/002186/06

2

MEB

0020719

Marital status Single Married Divorced Separated

1

Member Surname Member full names

D D M M Y Y Y Y Date of birth

Member reference number RSA ID: Yes No

ID/Passport number

Home telephone number Cellphone number

Email address

FundsAStWork Umbrella Pension Fund

FundsAtWork stand-alone insurance scheme

FundsAtWork Umbrella Provident Fund

Member number

Employer name

Scheme

Fund

Section 1: Member details

Please note that this beneficiary nomination form will be used in respect of both the FundsAtWork Umbrella Funds and the Stand-alone insurance scheme benefits.

*Stand-alone insurance schemes are not provided by the Umbrella Fund that you belong to, but is under a separate insurance policy your employer has with FundsAtWork.

Please complete the fields provided. Use the tab key to move from one field to the next.

FundsAtWork Umbrella Funds and stand-alone insurance schemes* beneficiary nomination form

Full names

Title

ID/Passport number

Notes:

If there is any additional information that you would like us to know about, complete the notes field below.

Very important – the column on the right MUST add up to 100%

Surname

I hereby nominate the following persons for any benefits due to be paid in the event of my death:

Beneficiary details Date of birth

Contact telephone number

Relationship (e.g. spouse, partner, daughter, son, mother, friend, etc.)

No Yes

No

No Yes

Yes

No Yes

No

No Yes

Yes

No Yes

No

No Yes

Yes

No

Yes

Financially dependent on you (Y/N)

100%

% Share

The trustees of the FundsAtWork Umbrella Funds have a duty under the Pension Funds Act to distribute the benefits equitably between your beneficiaries, taking the provisions of the Pension Funds Act into account.

This means that even though the trustees will take your nomination into account, they have to distribute the death benefit in line with the Pension Funds Act. There is a difference between how the benefit from a fund is distributed and for example a will, where the benefits are paid exactly to whom you have specified.

You may nominate any person to receive any part of the benefit that will be paid from the Fund if you die. This should include your spouse or partner, your children, any person that is financially dependent on you or any person that you want to receive a part of your benefit.

FundsAtWork Umbrella Funds

Dependants

Nominees

2

Full names

Title

ID/Passport number

Notes:

If there is any additional information that you would like us to know about, complete the notes field below.

Very important – the column on the right MUST add up to 100%

Surname

I hereby nominate the following persons for any benefits due to be paid in the event of my death:

Beneficiary details

Your stand-alone insurance scheme benefit will be paid in accordance with your nomination.

Date of birth

Contact telephone number

Relationship (e.g. spouse, partner, daughter, son, mother, friend, etc.)

No

Yes

No

No Yes

Yes

No Yes

No

No Yes

Yes

No Yes

No

No Yes

Yes

No

Yes

Financially dependent on you (Y/N)

100%

% Share

3

The payment of death benefits under the stand-alone insurance scheme is governed by the policy conditions. The trustees of the Fund have no say on how the benefit should be distributed. You should complete this form if you have cover under the stand-alone insurance scheme provided by your employer.

You may nominate any person to receive any part of the benefit that will be paid from the Fund if you die. This should include your spouse or partner, your children, any person that is financially dependent on you or any person that you want to receive a part of your benefit.

FundsAtWork stand-alone insurance scheme

Dependants

Nominees

Date

D

D

-

M

M

2

0

Y

Y

submit form

save form

print

When you want to print the form to complete by hand you can turn off the field highlights by selecting the “highlight existing fields” on the top right hand corner of your screen.

4

MMI Group Limited 268 West Avenue Centurion 0157 PO Box 7400 Centurion 0046 South Africa Tel +0860 65 75 85 Fax +27 (0)12 675 3970 clientcontactcentre@momentum.co.za www.momentum.co.za/fundsatwork Momentum, a division of MMI Group Limited, an authorised financial services and credit provider Reg. No. 1904/002186/06

Options to sign the form: 1. Print out the form, sign and scan it and send it back via email to clientcontactcentre@momentum.co.za or fax it to +27 (0)12 675 3970.

2. Place your scanned signature in the signature block.

• Store your scanned signature in a safe place on your computer.

• Select the ‘comments’ tab from your menu in Adobe.

• Select the ‘add stamp’ icon.

• Select custom stamps.

• Create custom stamps.

• You can now browse and upload your signature to save it as a custom stamp under ‘sign here’ in Adobe.

• You can now go back to your ‘stamps’ icon and select ‘sign here’ and select your saved signature.

• Place it in the document and save the document.

When you sign this form by inserting a digital signature it confirms that the information provided is true and correct.

Fax the completed form to 012 675 3970 or email to clientcontactcentre@momentum.co.za. Please send a copy of this form to your human resources department to be kept in your file.

Member’s signature

Signed at

By signing this you declare that you understand that this nomination cancels all previous nominations, if any, that you have made with respect to your membership of the abovementioned schemes.

If your circumstances change, for example you get married or divorced or have a child or a beneficiary dies, and you want to change your beneficiary details, you must complete a new form. You may also log onto our website at www.momentum.co.za and change your beneficiary nomination electronically.

Section 3: Member’s signature

Write your motivation(s) in the notes box on page 2, thereby assisting the Trustees in understanding the reasons for your allocation.

After you have listed all your dependants you need to decide how much (if any) of your benefit you would like them to receive. Keep in mind that – - The more beneficiaries you choose to receive a share, the smaller each individual’s benefit may be.

- The percentages in the ‘% Share ’ column must add up to a total of 100%.

In the case of stand-alone schemes, nomination forms are of utmost importance and must be kept up to date at all times to ensure that the benefit gets distributed accordingly.

Step 2: Share the benefit

Step 1: List your dependants and nominees 1. First list the details relating to your spouse in the space provided. If you have more than one spouse, a customary law spouse or a life partner (i.e. someone with whom you live as if married), please include their details.

2. Next, list ALL your children, including those adopted, those from previous marriages or those born outside of marriage. Include the name of the person who will be their guardian, should you die.

3. Now list any dependants (anyone other than your spouse or children who you support financially and you feel they should be considered when distributing the benefit) 4. Finally, if there is anyone else who is not dependent on you whom you would like to receive a part of your benefit, list these beneficiaries, under “Nominees” on page 3.

Should you die, a death benefit will become payable to the beneficiaries listed on this form.

b. FundsAtWork stand-alone group life scheme:

For example, a member may propose that one minor child receives a large share while the other minor child receives nothing, if the one is disabled and the other has a bursary to cover their studying expenses.

To distribute your benefit as fairly as possible, it would help the Trustees to understand why you have proposed certain share allocations to your beneficiaries.

Step 3: Give additional motivation

After you have listed all your dependants and nominees, you need to decide how much (if any) of your benefit you would like them to receive. Keep in mind that – - The more beneficiaries you choose to receive a share, the smaller each individual’s benefit may be.

- The percentages in the ‘% Share’ column must add up to a total of 100%.

Step 2: Share the benefit

5

Step 1: List your dependants and nominees 1. First list the details relating to your spouse in the space provided. If you have more than one spouse, a customary law spouse or a life partner (i.e. someone with whom you live as if married), please include their details.

2. Next, list ALL your children, including those adopted, those from previous marriages or those born outside of marriage. Include the name of the person who will be their guardian, should you die.

3. Now list any legal dependants, such as a divorced spouse from a previous marriage to whom you are paying maintenance, or anyone else who you would be obliged to maintain financially (for example a minor child, a major child that is still studying or an aged parent).

4. Finally, if there is anyone else who is not dependent on you whom you would like to receive a part of your benefit, list these beneficiaries, under “Nominees” on page 2.

Should you die while you are still a contributing member of the FundsAtWork Umbrella Fund, a death benefit will be paid to your dependant/s and/or nominees. The benefit consists of a lump sum insurance death benefit (if applicable) plus your Retirement Savings Account Balance in the Fund. Please refer to your Member Benefit Statement on www.momentum.co.za for more information.

a. FundsAtWork Umbrella Funds:

Nominating beneficiaries for your death benefits: