UIF MATERNITY MATTERS UIF Claims Made Easy

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1 UIF MATERNITY MATTERS UIF Claims Made Easy Postal address 9B Tyburn Way Dawncliffe, Westville, 3629 NAME & SURNAME: CELL PHONE NUMBER: HOW MANY MONTHS UIF WILL BE CLAIMED? ADDRESS PRIOR TO MATERNITY LEAVE: Please ensure you have an address where correspondence will be sent to once applicant is on maternity leave. ADDRESS WHISLT ON MATERNITY LEAVE: POSTAL ADDRESS: MATERNITY START DATE: / / DUE DATE: / / RETURN TO WORK DATE: / / DETAILS OF PREVIOUS UIF CLAIMS START DATE OF CLAIM DATE RETURNED TO WORK MATERNITY / ADOPTION OTHER Retrenchment etc *Note: if you have claimed for anything other than maternity in the last 4 years, you will NOT be able to claim again! EMPLOYMENT HISTORY: Please provide Applicants Employment History for the previous 4 (four) years EMPLOYER NAME DATE STARTED DATE TERMINATED (Applicant to Complete & Sign) Power of Attorney Andrea D Lowe T/A UIF MATERNITY MATTERS I, (Name & Surname) ID number:, Appoint AD LOWE, trading as UIF Maternity Matters, to be my lawful agent for managing and transacting my claim for maternity benefits in terms of Section 25 of the Unemployment Insurance Act 63 of 2001, in the Republic of South Africa with full powers of authority and in my name and for my account and benefit. I, acknowledge that UIF Maternity Matters is in no way responsible and has no control or influence in the process of my UIF application with the South African Department of Labour. UIF Maternity Matters is in no way responsible for or has control over the amount of UIF paid to a client and decisions made by the SA Department of Labour. I, acknowledge and understand the above and fully understand the services of UIF Maternity Matters and agree to all of the Terms and Conditions as mentioned in the below. Thus done and signed at on this day of 2015 SIGNATURE OF APPLICANT: (PLEASE RETURN JUST CURRENT PAGE TO US WITH YOUR UIF DOCUMENTATION FOR CHECKING)

2 PAYMENT OPTIONS (NOTE: Please forward us the NOTIFICATION OF PAYMENT prior to checking of forms) AMOUNT PLEASE NOTE A. STANDARD 4 MONTHS R 600 Paid in full prior to checking B. LATE REGISTRATION FEE R 700 Once baby is 5 months old. Paid in full prior to checking C. INITIAL APP ONLY R450 For claims between 1 month and 6 weeks only. Paid in full prior to checking D. 2 MONTHS ONLY R500 Paid in full prior to checking E. 3 MONTHS ONLY R550 Paid in full prior to checking F. FOLLOW UP PAYMENTS ONLY R75 / month Follow up monthly payments only, excludes initial application and only once your first payment has been received. Paid in full prior to checking BANKING DETAILS Account Name: UIF MATERNITY MATTERS FNB (Branch Code : ) Type of Account: Cheque Account Number Please use your initials, surname and first six digits of ID (Applicants Details) as reference eg: IB. SOMEONE TERMS AND CONDITIONS I, undertake to READ AND FOLLOW the instructions given to me by UIF Maternity Matters. I understand that UIF Maternity Matters cannot be held responsible for forms that are incorrectly completed by me or any other party. UIF Maternity Matters check each application prior to submission and will contact the APPLICANT should there be any problems. I, undertake to provide a UI 19 form from my Employer to UIF MATERNITY MATTERS on my return to work stating my return to work date in order for UIF MATERNITY MATTERS to finalise your claim with the Department of Labour. I, understand: that my application will NOT be submitted before the FULL amount is paid. This fee is NOT transferable or refundable. UIF Maternity Matters may however use their discretion where deemed necessary. Their decision regarding these refunds is final, and they will enter into no correspondence regarding this matter. Please note: If your baby is older than 5 months when your application reaches us, an additional R100 administration fee is charged due to the additional pressure on the system. The full fee is payable before the application will be submitted. that any previous UIF claims NOT finalised with the Department of Labour is my responsibility and UIF MATERNITY MATTERS will not be held responsible to finalise these claims. it is my responsibility to make sure that all forms and documents reach UIF Maternity Matters in time. the correct forms and documents for my application should reach UIF Maternity Matters before my baby is 5 months old. I understand that if my application reaches UIF Maternity Matters after my baby is 5 months old there is an additional administration fee of R100. all forms submitted to UIF Maternity Matters as part of the application (except the UI19 and UI2.7) should be in original form. that if I claimed from the Department of Labour for any other reason other than maternity leave in the last four years, I may not be able to claim now and I will phone the Department of labour to confirm my status before I pay any monies over to UIF Maternity Matters. If I am the owner of my own business I will first contact UIF Maternity Matters to discuss

3 my options before I pay any monies over to them. I have checked that UIF is deducted from my salary advice before I pay over any money over to UIF Maternity Matters. CONFIDENTIALLY UIF Maternity Matters (The Recipient) shall limit disclosure of Confidential Information within its own organization to its directors, officers, partners, having a need to know and shall only disclose the information to the Department of Labour for Unemployment Insurance Fund purposes. The Recipient will not disclose the confidential information obtained from the dis-closer unless required to do so by law. This Agreement imposes no obligation upon Recipient with respect to any Confidential Information (a) that was in Recipient s possession before receipt from Discloser; (b) is or becomes a matter of public knowledge through no fault of Recipient; (c) is rightfully received by Recipient from a third party not owing a duty of confidentiality to the Discloser; (d) is disclosed without a duty of confidentiality to a third party by, or with the authorization of, Discloser; or (e) is independently derived by Recipient. PLEASE NOTE: UIF Maternity Matters will not disclose or discuss any confidential information with any person (including partners, husband, and parents) other than the applicant. Your documentation will not be shared with anyone other than the Department of Labour and any remaining documents or copies will be shredded 3 month after your application is paid in full. UIF Maternity Matters undertakes the following: We provide the APPLICANT with an Information Pack containing all the forms and instructions. We advise you on how to complete the forms. We will submit your application within 1 week of receiving it, as long as your maternity leave has begun, all documents are both included and correct, as advised to by UIF Maternity Matters. We submit your continuation forms monthly until your Maternity Leave is finished. We assist you as far as possible if any problems arise regarding your UIF claim. UIF Maternity Matters has no legal agreement or affiliation with the Department of Labour regarding any UIF claim for maternity benefits, and therefore cannot be held liable for any damages as a result of any actions taken, or decisions made by the Department of Labour regarding our service or your claim. We cannot give advice on behalf of the Department of Labour. UIF Maternity Matters will not be held responsible for any payments, or non-payments, by the Department of Labour as a result of false or insufficient information supplied by you, or any other reason. I, understand that once UIF Maternity Matters has submitted the application to the Department of Labour the processing and approval of the application must follow due course, as stipulated by the Department of Labour and UIF Maternity Matters has no control over this process. I, understand that UIF Maternity Matters cannot control payments by the Department of Labour. When registering with UIF MATERNITY MATTERS the onus is on the Applicant to ensure they are eligible to claim UIF. We cannot be held responsible if your application is refused by the Department of Labour. Please note: The Department of Labour DO NOT accept applications after the baby is six months old. If UIF Maternity Matters receives the forms within two weeks of your babies six months birth date we do not take any responsibility for your application as we have to follow procedure and appointment times at the Department of Labour, however, we will undertake to do our best to submit your application in time. Once UIF Maternity Matters has received the forms they will communicate this either via: . If the Applicant does not receive confirmation the onus is on the Applicant to contact UIF Maternity Matters to confirm receipt of the forms. Please ensure an address is supplied. If you have another communication preference, please stipulate at the onset of the process.

4 GUIDELINES FOR COMPLETING UIF FORMS DO NOT DATE ANY FORMS. DO NOT USE TIPPEX OR CORRECTION PEN ON ANY OF THE FORMS. DO NOT CROSS OUT OR OVER-WRITE ON FORMS, THEN SIGN NEXT TO AMENDMENTS DO NOT SEND ORIGINALS DOCUMENTS TO US UNTIL WE HAVE CHECKED THE FORMS (Sent electronically to us) It is advisable that copies are made of all documentation prior to sending to Maternity Matters. Form UI2.3 DO NOT DATE NEXT TO YOUR SIGNATURE. YOUR DOCTOR MUST DATE etc Number of copies, completed by: Notes: 1 x original document; To be completed by the Applicant and the Doctor. Your Date of Commencement is the first day from which your Loss of Earnings occurs (ie Rate of pay changes) even if this is a Saturday, Sunday or public holiday Complete the Details of previous application section. Ignore Occ Code Complete the Are you still employed question. (If you have resigned or are not employed, please answer NO ) The Medical Certificate must be completed by your doctor (Doctor can date) Sign the form and initial in the blank area next to the date DO NOT DATE, the department will date your form on your behalf on the day it is submitted. eg: ALowe Date _[leave blank] AL UI2.8 MUST BE APPLICANTS OWN BANK ACCOUNT. NO JOINT ACCOUNTS ARE ALLOWED. UI2.7 1 x original document; T To be completed by the Applicant and the Bank 1 x original OR copy document; To be completed by the current Employer PLEASE INCLUDE A LETTER OF EMPLOYMENT FROM YOUR CURRENT EMPLOYER, on Company Letterhead. To be completed, signed and stamped by your Bank / Financial Institution. Bank can date. If your bank account is still in your maiden name, please change it to your married name first. Please only use 6 digit branch code. Applicant to Sign and Date the Applicant Section of the document. The Name of Contributor and ID number at top refer to you. The UIF Ref refers to your Employer. (This number doesn t always fit in the space provided. Either squeeze it in or write it above the blocks provided) If you are have resigned or are not employed, please do not complete this document. Example of how to complete the table on the UI2.7 (in this example, Maternity Commencement Date is 01 April 2014) (1) Gross Remuneration (Prior to Confinement) Per month or Per week Periods during which different Rates of remuneration were received Gross Remuneration that worker will receive whilst on Maternity Leave (Per month or Per week) R5000 From *01/04/14 To 30/04/14 R 1, *Must be the first day of maternity, ie first day that your Rate of Pay changes From 01/05/14 To 31/05/14 R 1, From 01/06/14 To 30/06/14 R 1, From 01/07/14 To 31/07/14 R 1, *If you are receiving NO PAY then fill in NIL in the last Column.

5 (2) Gross Remuneration (Prior to Confinement) Per month or Per week Periods during which different Rates of remuneration were received Gross Remuneration that worker will receive whilst on Maternity Leave (Per month or Per week) R5000 From 01/04/14 To 31/08/14* NIL From To From To *Must be the last day of maternity, before From To you return to your normal rate of pay. The Return to work date is 01/09/14 (in this eg) UI19 1 x original OR copy document; To be completed by each individual Employer you have worked for, over the past 4 years. Please insert UIF Reference number, PAYE Number, and company details. Please insert employee's details, including remuneration AND HOURS (even though the form states this is only for Hourly paid workers: Average working hours / month = 173 (8 hours a day * 5 days * 52 weeks = 2080 / 12 = 173) Company representative to insert name, ID number and date. Employer to enter the Start Date and Termination Date (which is the day before maternity leave begins, even if over the weekend) on this form. Please note: the following changes must also be reflected on your UI19 Company Name (provide a letter), Branch transfers, Contract changes and previous Maternity leave * see below example) UI4 5 originals. No photocopies Please send 4 with your original application and keep ONE for after baby is born. This one will be signed by you and your Gynae, to confirm baby's birth date. Please sign but DO NOT DATE Please complete all forms with your personal information, including Question 8 Date returned to work on each form (even though you have not returned to work yet - If you have resigned or are not currently employed, please ignore) Supporting Documentation Certified ID Document NO TEMPORARY ID's. Bank statement If you were married but have not yet changed your name, this will not be a problem. Must be recently certified (within last 3 months) Ensure the certification is the original stamp, not photocopied. 1 page bank statement. Allowed: ATM bank statements, ed Bank statements and Online statements (as long as your Name and Account # reflect)

6 Pay slip 1 month pay slip from prior to maternity leave. Employer's name and address & UIF deductions are to appear on the pay slip. (Or company stamp required) Certified Marriage certificate (if applicable) Ensure the certification is the original stamp, not photocopied. We often receive queries regarding the relevance of the marriage certificate. The department will not process claims without it. If you were married in a traditional ceremony and did not change your surname, this is not required. If you are not married, kindly advise me that no marriage certificate applies. Ensure the certification is the original stamp, not photocopied. Those married in traditional services do not need to submit a marriage certificate Divorce (if applicable) Ensure the certification is the original stamp, not photocopied. (Only to be sent if you are divorced and have not re-married. If you have remarried, then this does not apply)

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