Complete this form if you are an individual and lodging a complaint against an employer or fund.

Initials*

First Name*

Surname*

Select Type of Identification*

ID Number

Passport Number

Cell Number*

Alternative Contact Number

How would you like us to contact you?*

Email is the preferred method for us to communicate with you as it will be quicker to update you regarding the progress of your case,

E-mail Address

Date Joined Employer*

Date Left Employer

Do not select a date if you are still currently employed.

Postal Address Details

Address Line 1*

Address Line 2

City*

Post Code*

Province*

Name of Employer*

Employer Address Line 1

Employer Address Line 2

Employer Post Code

Employer Phone Number

Employer Email Address

Fund Name

Fund Administrator

Fund Phone Number

Fund Email Address

1. On what date did you first become aware of the issue(s) that you have described in your complaint?*

2. If 3 years have passed since you first became aware of the issues, provide the reason(s) why you did not lodge your complaint sooner.*

If your complaint is not older than 3 years, indicate Not Applicable.

3. Tell us about your complaint and what you are dissatisfied about.*

You can capture up to 10 000 characters.

4. What is the desired outcome or relief sought from the PFA?*

You can capture up to 10 000 characters.

Please attach a copy of your ID or passport, payslip showing deductions and policy or fund benefit statement/proof of fund membership.These documents are mandatory for us to proceed with the investigation.

Failure to submit these mandatory documents will delay the investigation of your complaint. In addition to the mandatory documents,you can also upload other supporting documents that will assist in the investigation of your complaint.

Attachments (Max size is 5MB per document)

You can send us attachments in PDF, JPG,Word,Excel or TIFF format. You can also upload as many documents as you want, just click Choose Files.

To assist the Office of the Pension Funds Adjudicator to best handle your complaint, please select the applicable responses from the questions below and click Submit.

1. Would you like the Adjudicator to investigate whether there are any outstanding (arrear) contributions that the employer is required to pay to the fund or whether any unlawful deductions have been made?*

2. Have you instituted legal (court) proceedings in this matter?*

If “Yes”, in which Court (Name):

Court Case Ref

3. Has this complaint been sent to any other Ombud?*

If “Yes”, in which Ombud (Name):

Ombud Reference Number

4. Did you address the relevant retirement fund or administrator in writing for a resolution of your complaint before lodging it with the OPFA?*

- If “Yes”, you must provide proof of such correspondence held. - If “No”, your complaint will first be referred to the retirement fund or administrator for a possible resolution of your complaint within 30 days. If not resolved after 30 days, it will be further investigated by the Adjudicator.

5. Where are you submitting this application from?*

6. Do you have WhatsApp?*

7. How did you become aware of our office? (Select the relevant option)*

I have read and accept the Terms and Conditions.

Individual Complaint Form

Personal Details

Employer Details

Fund Details

Tell Us ABout Your Complaint

Supporting Documents

Finalise Your Complaint