VIVIUM

BENEFIT STATEMENT	copy participant
Issue date	dd/mm/yyyy	Participant number	530.000732.0999
Currency	EUR
Page	1
Reason for issue

GENERAL INFORMATION
Details of the organizer
	Head office	MASTERPRINT
	Address	Scheldestraat 457 2050 Antwerpen
	Authorized representative	DE HEER T.DE GRAEVE

Your personal details
	Name	VAN DEN BERGH John
	Address	Korte Leemstraat 137 2018 Antwerpen
	Date of birth	05/02/1977
	Sex	Male
	National registration number
	Civil status	Married

Your professional details
	Social security status	Wage earner
	Personnel number
	Commenced employment	01/08/2001
	Date of affiliation	01/02/2001
	Percentage of employment on issue date	100%
	Survey of the employment occupation
The reference salary and the other variable elements of the calculation noted in this benefit statement are determined according to the definitions in the Special Terms and Conditions of the pension rules which are available for consultation via www.mypension.be. The various options for the guarantees, just as the moments in which a choice can be changed, are set out in the Special Terms and Conditions of the pension rules which are available for consultation via www.mypension.be.

	VIVIUM is a brand of P&V Insurances SCRL/CVBA	Head Office	Branch Office Antwerp
	Insurance company authorised under code 0058	Rue Royale/Koningsstraat 151 - 1210 Brussels	Desguinlei 92 - 2018 Antwerp
www.vivium.be	VAT BE 0402 236 531 - RLE Brussels	TEL +32 (0)2 406 35 11	TEL +32 (0)3 244 66 88

BENEFIT STATEMENT
Issue date	dd/mm/yyyy	Participant number	530.000732.0999
Page	2

FINANCING OF THE COVERS
OVERVIEW OF THE PREMIUMS

Employer's contribution

Premiums on annual basis	Employer's contribution excl. tax	Tax	Total
Pension	999.999,99	999.999,99	999.999,99
Death benefit	999.999,99	999.999,99	999.999,99
Disability	999.999,99	999.999,99	999.999,99
Waiver of premium payment	999.999,99	999.999,99	999.999,99
Accidents	999.999,99	999.999,99	999.999,99
Total	999.999,99	999.999,99	999.999,99
Single premium	999.999,99	999.999,99	999.999,99

Personal contribution
Premiums on annual basis	Personal contribution excl. tax	Tax	Total
Pension	999.999,99	999.999,99	999.999,99
Total	999.999,99	999.999,99	999.999,99

BENEFIT STATEMENT
Issue date	dd/mm/yyyy	Participant number	530.000732.0999
Page	3

OVERVIEW OF THE RESERVES TRANSFERRED

CLAUSES

Beneficiary clauses
In case of life	Text and amount
In case of death	Text and amount

BENEFIT STATEMENT
Issue date	dd/mm/yyyy	Participant number	530.000732.0999
Page	4

COVERS

OVERVIEW OF THE PENSION PLAN

<Plan name: plan x>

Pension plan - projected benefit depending on the regulatory premium
Date of affiliation	dd/mm/yyyy	Reference salary	999.999,99
Expiry date	dd/mm/yyyy	Calculation date	dd/mm/yyyy

Cover	Participant	Employer	Total
<Description of the cover>	999.999,99	999.999,99	999.999,99
Profit-sharing incorporated	999.999,99	999.999,99	999.999,99
Profit-sharing in addition	999.999,99	999.999,99	999.999,99
Total capital	999.999,99	999.999,99	999.999,99

The projected benefit is an estimate and is based on the current basic rates, <the currently applicable interest rate>, your current basic annual salary, your current family situation, your current level of employment and on the rights provision in the current pension rules. <This interest rate cannot be guaranteed for future deposits.>

Pension plan - acquired benefit

Date of calculation dd/mm/yyyy	Participant	Employer	Total
Acquired benefit	999.999,99	999.999,99	999.999,99
Total	999.999,99	999.999,99	999.999,99

The acquired benefit indicates how much your acquired reserves, on the basis of your already performed service, will be worth on the maturity date of the pension plan, provided that you leave your acquired reserves in the plan, without any other change.

BENEFIT STATEMENT
Issue date	dd/mm/yyyy	Participant number	530.000732.0999
Page	5

Pension plan - accrued reserves on calculation date

Calculation date dd/mm/yyyy	Participant	Employer	Total
Accrued reserves	999.999,99	999.999,99	999.999,99
Profit-sharing part	999.999,99	999.999,99	999.999,99
Total	999.999,99	999.999,99	999.999,99
Mathematical reserves	999.999,99	999.999,99	999.999,99
Statutory guaranteed minimum	999.999,99
The acquired reserves are the amounts that have already been saved for your supplementary pension. The average level of funding for all affiliates to this pension plan amounts to 100,00% on dd/mm/yyyy.

Pension plan - accrued reserves on previous adaptation date

Previous adaptation date [calculation date]	Participant	Employer	Total
Accrued reserves	999.999,99	999.999,99	999.999,99
Profit-sharing part	999.999,99	999.999,99	999.999,99
Total	999.999,99	999.999,99	999.999,99


Mathematical reserves	999.999,99	999.999,99	999.999,99
Statutory guaranteed minimum			999.999,99

Pensionplan - variable elements of the calculation

Description amount

BENEFIT STATEMENT
Issue date	dd/mm/yyyy	Participant number	530.000732.0999
Page	6

OVERVIEW OF THE DEATH BENEFIT PLAN

<Plan name: plan x>

Death benefit plan
Date of affiliation	dd/mm/yyyy	Reference salary	999.999,99
Expiry date	dd/mm/yyyy	Number of children
Option	Organiser's option	Calculation date	dd/mm/yyyy

Cover	Participant	Employer	Total
<Description of the cover> (+) payable to the beneficiary in case of death before the expiry date	999.999,99	999.999,99	999.999,99
Profit-sharing in addition	999.999,99	999.999,99	999.999,99
Total capital	999.999,99	999.999,99	999.999,99

(+) including profit-sharing of <xx.xx> %

Death benefit plan - orphan's pension
Date of affiliation	dd/mm/yyyy	Reference salary	999.999,99
		Number of children
		Calculation date	dd/mm/yyyy

	Participant	Employer	Total
Pension per child (+)	999.999,99	999.999,99	999.999,99
Profit-sharing (pension) in addition	999.999,99	999.999,99	999.999,99
Total	999.999,99	999.999,99	999.999,99

(+) including profit-sharing of <xx.xx> %

BENEFIT STATEMENT
Issue date	dd/mm/yyyy	Participant number	530.000732.0999
Page	7

OVERVIEW OF THE DISABILITY INSURANCE
<Plan name: plan x>

Disability insurance
Date of affiliation	dd/mm/yyyy	Reference salary	999.999,99
Expiry date	dd/mm/yyyy	Calculation date	dd/mm/yyyy
Option	Organiser's option

Cover

Illness

Private accident in
private life

Ocupational accident
at work

Pregnancy &
childbirth

Annual pension

999.999,99

999.999,99

Personal risk period

<...days>

Cover

<...>

Payment

The pensions mentioned above will be paid<monthly, quarterly>, in accordance with the payment arrangements set out in the contract.
The annuities quoted above are forecasts. At the time of the payment they will be recalculated in accordance with the terms of the contract, according to the formula "(x)% salary - statutory contribution", on the basis of the percentage of the statutory contribution you actually receive.

OVERVIEW OF THE WAIVER OF PREMIUM PAYMENT COVER

Waiver of premium payment

In the event of disability, the payment of the premium is taken over by VIVIUM, in accordance with the cover guaranteed in the contract, after the agreed personal risk period of <xx> days and in proportion to the degree of disability accepted.

BENEFIT STATEMENT
Issue date	dd/mm/yyyy	Participant number	530.000732.0999
Page	8

OVERVIEW OF THE ACCIDENTS INSURANCE

<Plan name: plan x>

Physical accidents insurance
Date of affiliation	dd/mm/yyyy	Reference salary	999.999,99
Expiry date	dd/mm/yyyy	Calculation date	dd/mm/yyyy
Option	Organizer's option

<Guarantee>	999.999,99
Risks insured	In case of private accident and occupational accident.

The guarantees and/or premiums stated in this benefit statement are notified subject to the results of a medical examination if the company decides to initiate a medical acceptance procedure.
In that case, you will be informed in writing of the result leading to a derogation.

The annuities quoted above are forecasts. At the time of the payment they will be recalculated in accordance with the terms of the contract, according to the formula "(X)%salary - statutory contribution", on the basis of the percentage of the statutory contribution you actually receive.

The text of the rules can be obtained on simple demand from a contact person designated for this purpose by the organizer (cf. page 1 of this document in section "data of the organizer" - "authorized representative").

This version of the benefit statement replaces and cancels all previous versions.

Done at Antwerp, <dd/mm/yyy>

The insurance company

SIGNATURE

for VIVIUM

Drawn up on dd/mm/yyyy

Pension slip 2017
Amounts as calculated on 1 January (based on my personal details on dd/mm/yyyy).
My pension plan: Plan X	530.000732.L00.0999
Pension plan with the organiser
Organised by MASTERPRINT - Company number 0123.456.789
My details

VAN DEN BERGH JOHN - Number NISS 123456 789 12

Membership status as at 01/01/2017: Active

Pension build-up on 01/01/2017
Based on organiser's contributions for type defined contribution pension commitment
Pension reserve as at 01/01/2017
How much has already been saved towards my supplementary pension?	999.999,99 EUR
Acquired benefits on 01/01/2017
How much will my current pension reserve be worth when the maturity date of the pension plan is reached (xx y yy m)?	999.999,99 EUR (lump sum)
Projected benefit as at 01/01/2017
How much would I receive for my supplementary pension if its savings scheme is pursued until the maturity date (xx y yy m)?	999.999,99 EUR (lump sum)
Based on employee's contributions for type defined contribution pension commitment
Pension reserve as at 01/01/2017
How much has already been saved towards my supplementary pension?	999.999,99 EUR
Acquired benefits on 01/01/2017
How much will my current pension reserve be worth when the maturity date of the pension plan is reached (xx y yy m)?	999.999,99 EUR (lump sum)
Projected benefit as at 01/01/2017
How much would I receive for my supplementary pension if its savings scheme is pursued until the maturity date (xx y yy m)?	999.999,99 EUR (lump sum)
Average financing level (of all affiliates in this plan)	100,00%
Statutory guaranteed return	999.999,99 EUR
Death cover
Death cover on 01/01/2017
How much will my surviving relatives receive if I die before the maturity date (xx y yy m)?	999.999,99 EUR (lump sum)
Supplementary cover as at 01/01/2017
Will my surviving relatives receive a supplementary benefit if I die before the maturity date (xx y yy m) as a result of an accident?	Yes
Will my children receive an additional orphan's allowance if I die before the maturity date (xx y yy m)?	Yes
Pension build-up on 01/01/2016
Pension reserve as at 01/01/2016 based on organiser's contributions	999.999,99 EUR
Pension reserve as at 01/01/2016 based on employee's contributions	999.999,99 EUR

Important information

This version replaces and renders all previous versions null and void.

The projected benefit mentioned above is an estimate based on the projected contributions as defined in the pension rules. It is provided for information purposes only and does not grant any right to a supplementary pension.

When the (early) statutory pension starts, the supplementary pension must also be disbursed. In certain cases provided for by statute, the pension rules allow for the disbursement of the supplementary pension before this time.
For this reason, the time of disbursement may differ from the statutory pensionable age provision in your pension plan as mentioned in the pension rules.

The aforementioned amounts as at 1 january, as well as the pension rules, were also forwarded to the Databank for Supplementary Pensions (DB2P), which can be consulted online via www.mypension.be.
The amounts are stated gross, including profit shares.
Tax and social security contributions are deducted when the supplementary pension or death benefit is paid out.
The amounts stated on the benefit statement apply on the date of calculation for the document and may be different from the amounts as at 1 january on this document.

BENEFIT STATEMENT

Participant number

BENEFIT STATEMENT

Participant number

Premiums on annual basis

Premiums on annual basis

BENEFIT STATEMENT

Participant number

BENEFIT STATEMENT

Participant number

Date of affiliation

Reference salary

BENEFIT STATEMENT

Participant number

BENEFIT STATEMENT

Participant number

Reference salary

Reference salary

BENEFIT STATEMENT

Participant number

Disability insurance

Reference salary

BENEFIT STATEMENT

Participant number

Physical accidents insurance

Date of affiliation

Reference salary

Expiry date

Calculation date