This Special Complaint Form is to be used by individuals to lodge a complaint against the PSSPF in respect of Arrear Contributions and/or Withdrawal Benefits.

If you have another type of complaint against the PSSPF, please use the individual complaint form.

Initials*

First Name*

Surname*

Select Type of Identification*

ID Number

Passport Number

Cell Number*

Alternate Phone 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

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

Complete this section only if you have been out of the security sector for less than 6 months.

Name of previous employer in the Private Security Sector

Date last employed by previous employer in the Private Security Sector

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.

3. What is your Job Ttitle?*

4. Are/Were you a Supervisor or Manager?*

If Yes, when did you assume the role of Supervisor or Manager?

5. Contributions Commencement Date

Would you like the Adjudicator to investigate and make orders regarding the following:

6. Whether you should have been registered (timeously or at all) with the PSSPF?*

7. Whether there are any outstanding (arrear) contributions that the employer is required to pay to the PSSPF on your behalf?*

8. Whether you are entitled to receive a benefit from the PSSPF?*

9. Whether you are entitled to receive a benefit statement from the PSSPF?*

Any additional information you would like to bring to the attention of the Adjudicator

Please attach a copy of your ID, payslip showing earliest deductions and policy or fund benefit statement/proof of fund membership.Correspondence to and from the fund / administrator / employer.

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 may also upload any other supporting documents that could 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. Did you address the Private Security Sector Provident Fund or Salt Employee Benefits in writing for a resolution of your complaint before lodging it with the Adjudicator?*

- 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.

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 Ref Number

4. Where are you submitting this application from?*

5. Do you have WhatsApp?*

6. How did you become aware of our office?*

I have read and accept the Terms and Conditions.

Please notify us immediately when there is a change of your personal contact details.

PSSPF Complaint Form

Personal Details

Employer Details

Previous Employer's Details

Tell Us ABout Your Complaint

Supporting Documents

Finalise Your Complaint