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RG 2000 TELEPHONE 870-2000 FAX 870-2387 Website:http://www.Mibfa.co.za TO BE COMPLETED BY MEMBER WITH ASSISTANCE OF EMPLOYER / TRADE UNION. I hereby apply in terms of the Rules of the Scheme for benefits due to permanent disablement. NAME (in full) IDENTITY NUMBER* DATE OF BIRTH MARITAL STATUS * MARRIED SINGLE WIDOWED DIVORCED ADDRESS:.

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