Z583 Form PDF Details

The Z583 form is a tax form used in the United States to report self-employment income. The form is used by individuals who are self-employed, or who have earned income from independent contractors. The form allows taxpayers to report their earnings and deductions related to their self-employment activity. The Z583 form must be filed annually, and must be accompanied by Schedule C, which breaks down the individual's income and expenses. The Z583 form can be complex, so it's important to understand how it works before completing it. This blog post will provide an overview of the Z583 form, including its purpose and instructions for completing it. We'll also take a look at some of the key changes made to the form this year

QuestionAnswer
Form NameZ583 Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesz583 form, gems z583, z583 application form, z583 medical scheme membership

Form Preview Example

PLEASE RETURN ALL PAGES, EVEN WHEN PAGES ARE NOT COMPLETED

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N ATI ON AL TREASURY

Gov e r n m e n t Em ploy e e s

Pe n sion Fu n d ( GEPF)

M ED I CAL SCH EM E

M EM BERSH I P – Z5 8 3

Pr iv at e Bag x 63

34 Ham ilt on St r eet

Pr et or ia

Ar cadia

Pr et or ia

SOUTH AFRI CA

 

 

0001

 

 

GEPF USE ONLY - GEPF STAMPS

 

BAR CODE

 

 

Tel No

: ( + 27) ( 0) 12 319 1911

Fax No

: ( + 27) ( 0) 12 326 2507

Call Cent r e

: ( + 27) ( 0) 12 319 1000

E- m ail

: enquir ies@gepf . co. za

WebSit e

: w w w . gepf . co. za

 

 

P A R T I C U L A R S O F M E D I C A L S C H E M E M E M B E R S H I P

T h i s f o r m e n a b l e s t h e G E PF t o s u c c e s s f u l l y p r o c e s s t h e a p p l i c a t i o n f o r c o n t i n u e d M e d i c a l a s s i s t a n c e o r t o

i n d i c a t e a c h a n g e i n M e d i c a l S c h e m e Pa r t i c u l a r s .

C O M P U L S O R Y A T T A C H M E N T S : S e e s e c t i o n B .

A)TYPE OF APPLI CATI ON - Please select only one opt ion

1 . A p p l i c a t i o n f o r c o n t i n u e d M e d i c a l A s s i s t a n c e a f t e r R e t i r e m e n t / D e a t h i n S e r v i c e ( R e s o l u t i o n 3 o f 1 9 9 9 a n d R e s o l u t i o n 1 o f 2 0 0 6 ) ( C o m p u l s o r y i t e m s : B , D , E , F , G , H , I , J a n d K . C i n c a s e o f d e a t h )

2 . C o n t i n u e d M e m b e r s h i p o f M e d i c a l S c h e m e - C h a n g e o f M e d i c a l S c h e m e Pa r t i c u l a r s

( C o m p u l s o r y i t e m s : B , D , E , F , G , H a n d K )

3 . A p p l i c a t i o n o f W i d o w / W i d o w e r f o r c o n t i n u e d M e m b e r s h i p o f M e d i c a l S c h e m e ( C o m p u l s o r y i t e m s : B , C , D , E , F , G a n d K )

B) COM PU LSORY ATTACH M EN TS

All cop ie s of I D d ocu m e n t s sh ou ld b e cle a r , a n d sh ou ld n ot b e old e r t h a n 6 m on t h s.

1 . C e r t i f i e d c o p y o f I D o f t h e m a i n m e m b e r o f t h e M e d i c a l s c h e m e .

2 . Pr o o f o f a l l t h e d e p e n d a n t s r e g i s t e r e d o n y o u r m e d i c a l s c h e m e . C e r t i f i e d c o p y o f I D a n d o r b i r t h c e r t i f i c a t e .

3 . M e m b e r s h i p C e r t i f i c a t e f r o m y o u r m e d i c a l s c h e m e .

4 . M e m b e r D e a t h C e r t i f i c a t e ( i f a p p l i c a b l e )

5 . Pl e a s e i n c l u d e p r e v i o u s m e d i c a l s c h e m e c e r t i f i c a t e ( s ) .

On ly a p p lica b le t o Ty p e 2 Ap p lica t ion s:

C o p y o f l a s t S a l a r y

A d v i c e

C o m p l e t e d Z 8 9 4 - B a n k p a r t i c u l a r s

S e r v i c e C e r t i f i c a t e

C) PERSON AL PARTI CU LARS OF D ECEASED M EM BER

Pension Num ber

Sur nam e

Fir st Nam e

Middle Nam e

Maiden Nam e

Tit le

Dat e of Deat h

I nit

D. O. B

Mar it al St at us

I D No

Mar r ied

 

Un m ar r ied

 

 

 

Widow / er

Div or ced

Life Par t ner

D ) PERSON AL PARTI CU LARS OF APPLI CAN T

Pension Num ber

Sur nam e

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fir st Nam e

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Middle Nam e

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Maiden Nam e

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tit le

 

 

 

I nit

 

 

 

D. O. B

 

 

 

 

 

 

 

 

 

 

 

I D No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I ncom e Tax No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mar it al St at us

 

 

Mar r ied

 

 

 

Unm ar r ied

 

 

Widow / er

 

 

Divor ced

 

 

Life Par t ner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E) CON TACT PARTI CU LARS OF APPLI CAN T

Post al Addr ess

Post al Code

Tel

No

E- Mail

Resident ial Addr ess

Post al Code

Cell No

ALL PAGES OF TH I S FORM M U ST BE COM PLETED I N ORD ER FOR TH I S FORM TO BE V ALI D AN D TH E M EM BER OR

PEN SI ON ER AN D COM M I SSI ON ER OF OATH S M U ST I N I TI AL TH I S PAGE.

Mem ber / Pensioner init ial

Com m issioner of Oat hs init ial

Z583 - MEDICAL SCHEME MEMBERSHIP

November 2007 Revision

PLEASE RETURN ALL PAGES, EVEN WHEN PAGES ARE NOT COMPLETED

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Pension Num ber

F)PARTI CU LARS OF D EPEN D AN TS - For any dependant r egist er ed on y our m edical schem e

Sur nam e

Fir st Nam e

I D No / Passpor t num ber

Ty pe *

1 .

2 .

3 .

4 .

5 .

6 .

7 .

8 .

* 1 - Spouse 2 - Child 3 - Disable 4 - St udent 5 - Life Par t ner 7 - Mot her 8 - Fat her 9 - Gr andchild A- Sist er B- Br ot her

G) PARTI CU LARS OF M ED I CAL SCH EM E

The Medical Schem e det ails r efer t o t he cur r ent and n ew m edical schem e

Medical Schem e Nam e

Medical Schem e Num ber

Would y ou lik e t o cont inue y our m em ber ship? Dat e of Benefit

Yes

No

Mem ber ship Com m encem ent Dat e

H ) PARTI CU LARS OF PREV I OU S M ED I CAL SCH EM E

Dat e on w hich m em ber ship w as t er m inat ed

Medical Schem e Nam e

Medical Schem e Num ber

I ) CH OI CE FOR M ED I CAL BEN EFI T UPON RETI REM EN T / D EATH

A s i n g l e c h o i c e b e t w e e n O p t i o n A o r O p t i o n B i s c o m p u l s o r y - Pl e a s e i n d i c a t e c l e a r l y

1 . OPTI ON A - Con t in u e d St a t e Su bsidise d M e m be r sh ip

Su b j e ct t o 1 2 m on t h s con t in u e d m e m be r sh ip of a r e g ist e r e d m e dica l f u n d on t h e la st da y of se r v ice a n d pr e v iou s gov e r n m e n t se r v ice e x ce e din g:

-

15 Year s in r espect of r et ir em ent

-

10 y ear s in r espect of m edical dischar ge

Em ploy er Nam e

St ar t Dat e

End Dat e

Em ploy er Nam e

St ar t Dat e

End Dat e

Em ploy er Nam e

St ar t Dat e

Em ploy er Nam e

End Dat e

St ar t Dat e

End Dat e

OR

2 . OPTI ON B - Gr a t u it y Pa y m e n t ( On ce - off ca sh a m ou n t )

Su b j e ct t o 1 2 m on t h s con t in u e d m e m be r sh ip of a r e g ist e r e d m e dica l f u n d on t h e la st da y of se r v ice on ly if le ss t h a n :

-

15 Year s in r espect of r et ir em ent

-

10 y ear s in r espect of m edical dischar ge

ALL PAGES OF TH I S FORM M U ST BE COM PLETED I N ORD ER FOR TH I S FORM TO BE V ALI D AN D TH E M EM BER OR

PEN SI ON ER AN D COM M I SSI ON ER OF OATH S M U ST I N I TI AL TH I S PAGE.

Mem ber / Pensioner init ial

Com m issioner of Oat hs init ial

Z583 - MEDICAL SCHEME MEMBERSHIP

November 2007 Revision

 

 

 

 

 

 

 

 

 

PLEASE RETURN ALL PAGES, EVEN WHEN PAGES ARE NOT COMPLETED

 

 

 

 

 

 

 

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Pension Num ber

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

J) TO BE COM PLETED BY TH E LAST EM PLOYER D EPARTM EN T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

St at e Cont r ibut ion t o m em ber m edical aid on last day of ser v ice

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last day of em ploy m ent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reason for r et ir em ent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ser v ice r ecor d in gov er nm ent depar t m ent s or r elat ed inst it ut ions. All per iods of ser v ice m ust be fur nished:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fr om

 

To

Depar t m ent or I nst it ut ion

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I ce r t ify t h a t a ll pa r t icu la r s in t h is for m a r e t r u e a n d cor r e ct .

Officia l D a t e St a m p of Em ploy e r

Sig n a t u r e 1

 

Desig n at ion

Sur nam e of Em ployer

Repr esent at iv e

Tel No

Fax No

E- Mail addr ess

K) CERTI FI CATI ON PARTI CU LARS

Ideclar e t hat all t he par t icular s fur nished on t his for m is t r ue and cor r ect .

Signat ur e or Thum bpr int of Mem ber

Dat e

Com m issioner St am p

Declar ed and signed befor e m e

Com m issioner of Oat hs

Dat e

Z583 - MEDICAL SCHEME MEMBERSHIP

November 2007 Revision

How to Edit Z583 Form Online for Free

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Step 1: Click the "Get Form" button in the top section of this page to access our PDF editor.

Step 2: After you access the tool, you will find the form all set to be filled out. Aside from filling out different blanks, you may as well do various other actions with the Document, particularly writing your own words, changing the original textual content, adding graphics, placing your signature to the PDF, and a lot more.

In order to finalize this PDF document, make sure you enter the information you need in every single field:

1. While submitting the z583 application form, be sure to incorporate all of the necessary fields in its corresponding part. This will help to hasten the process, allowing for your information to be processed promptly and appropriately.

Filling in section 1 in z583 form download

2. The third step is usually to submit the following blank fields: Tit le, Dat e of Deat h, I nit, DOB, I D No, Mar it al St at us, Married, Unm arried, Widow er, Divorced, Life Part ner, D PERSON AL PARTI CULARS OF APPLI, Pension Num ber, Surnam e, and Fir st Nam e.

Completing segment 2 in z583 form download

3. Completing Tel No E Mail, Cell No, ALL PAGES OF TH I S FORM M UST BE, PEN SI ON ER AN D COM M I SSI ON, Mem ber Pensioner init ial, Com m issioner of Oat hs init ial, Z MEDICAL SCHEME MEMBERSHIP, and November Revision is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

z583 form download writing process detailed (portion 3)

It is possible to make a mistake when filling in your Com m issioner of Oat hs init ial, therefore make sure that you go through it again before you'll finalize the form.

4. Your next paragraph needs your input in the following places: PLEASE RETURN ALL PAGES EVEN WHEN, Page of, Pension Num ber, F PARTI CULARS OF D EPEN D AN TS, Surnam e, First Nam e, I D No Passport num ber, Type, Spouse Child Disable St udent, G PARTI CULARS OF M ED I CAL SCH, and The Medical Schem e det ails refer. Ensure you fill in all needed information to move onward.

Tips to prepare z583 form download stage 4

5. The last step to finish this document is integral. Make certain you fill out the displayed blanks, and this includes Medical Schem e Nam e, Medical Schem e Num ber, Would you like t o cont inue your, Yes, Dat e of Benefit, Mem ber ship Com m encem ent Dat e, H PARTI CULARS OF PREV I OUS M ED, Dat e on which m em bership was t, Medical Schem e Nam e, Medical Schem e Num ber, I CH OI CE FOR M ED I CAL BEN EFI, A s i n g l e c h o i c e b e t w, OPTI ON A Con t in u e d St a t, Su bj e ct t o m on t h s con t, and Year s in r espect of ret ir em, prior to using the pdf. If not, it could contribute to an incomplete and possibly incorrect document!

Stage number 5 in filling in z583 form download

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