Income tax certificate

Mr DJ Eybers Main member: Mr DJ Eybers

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Main member's ID number: 5410105176081
8299
Birchleigh Membership number: 076886170
Kempton Park Telephone number: 011 249 7800

Co
1621

Your tax information for the tax year ending 28 February 2017
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This is the information you need to complete your tax return:

1. Contributions from 1 March 2016 to 28 February 2017: R84,784.00

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2. Claims not recovered from the Scheme: R23,617.54

3. Total number of members active on the Scheme each month

This includes the main member and all dependants.

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Month March 2016 April 2016 May 2016 June 2016 July 2016 August 2016
Number 3 3 3 3 3 3
Month September October November December January February
2016 2016 2016 2016 2017 2017
Au

Number 3 3 3 3 3 3

Please turn over

16 Fredman Drive, Sandton, PO Box 786722, Sandton 2146 | Tel 011 529 2888 (Switchboard) | Fax 011 539 3453 | healthinfo@discovery.co.za | www.discovery.co.za
Board of Trustees: M van der Nest SC (Chairman), D Naidoo, G Waugh, D C King, Dr D G Moodley, N G Morrison,
Principal Officer: Dr Nozipho Sangweni
Discovery Health Medical Scheme, registration number 1125.

2017/01
Dependant details

Full name and surname Date of birth Status of

membership
Ann Eybers 08/10/1966 Active dependant
Donovan John Eybers 06/02/1989 Active dependant