UIF Simplicity Maternity Benefit Registration Form First Name Last Name Maiden Name (If Applicable) Address City Postal Code Country Identity Number Occupation Email Home Number Work Number Mobile Number Start Date of Maternity Leave Due Date Duration of Maternity Leave First Name Last Name Email Address Contact Number Relation to you Employer 1 Start Date End Date Employer 2 Start Date End Date Employer 3 Start Date End Date Employer 4 Start Date End Date Employer 5 Start Date End Date Have you claimed from the UIF before? If so, in which year and what kind of UIF claim was it? How long have you been contributing to the UIF? What is your current monthly gross salary before deductions? Does your employer contribute to your salary while you on maternity leave? If so, what percentage? How did you come to hear about us? Through a friend Google Bing Facebook Instagram Hospital UIF Simplicity agent Bernice van der Berg Other If you selected other, please specify. Send
