Section 3: Details of investor

Transcription

1 Wealth Investment Portfolio Contract number P P APPLICATION FO: A. Flexible Investment Option B. Flexible Endowment Option C. Traded Endowment Option Investors should read the applicable Terms and Conditions and Fee Schedule with this application form prior to signature, as these documents contain the principle terms, conditions and disclosures of the contract. eference to the Administrator herein means either Momentum Administration Services (Pty) Ltd and or Momentum Group Ltd as applicable, acting in an administrative capacity. Section 1: Financial adviser The advice split below applies to the entire investment contract * Please complete the details of the preferred financial adviser. * Name Financial adviser s code Broker house code Advice fee ref no Advice fee split Are you registered to market life insurance under the Life Offices Association and are you fully conversant with and do you accept the S reference system and the consequences of this? 1. I declare that I have explained and handed to the investment owner the applicable terms and conditions relevant to the investment agreement prior to the signature of the application form. 2. I declare that I have explained to the investment owner the meaning, implications and potentially detrimental consequences of replacing an insurance policy. Declaration by financial adviser 3. I am willing to provide financial advice, including ongoing advice, to the client in respect of the product. 4. I acknowledge that notwithstanding any prior agreements with the client I will, in relation to the product, only be entitled to recover the advice fee from Momentum on condition that I have rendered advice to the client in accordance with my undertaking towards the client. 5. Considering the level of advice required by the client as stipulated in my undertaking towards the client, I propose that the advice fee set out in section 8 is a reasonable advice fee. 6. I acknowledge that Momentum will be entitled to pay the advice fee in arrears on a monthly basis and will be entitled to immediately cease further payments in the event of the cancellation of my mandate to provide advice to the client. 7. I hereby confirm that I am a Category I License holder as defined by the Financial Advisory and Intermediary Services Act, No 37 of Category II License holder as defined by the Financial Advisory and Intermediary Services Act, No 37 of Yes No FICA declaration I confirm that I have identified the client, including the investment owner, insured life/lives, contribution payer and cessionary, where applicable, and verified his/her/their details on this contract under the requirements that section 21 of the Financial Intelligence Centre Act, No. 38 of 2001, sets out. I further confirm that I have stored all the verification documents in terms of section 22 of the same Act. Yes No Signature of preferred financial adviser Date M M 2 0 Y Y Marketing adviser s name Branch name address Telephone number (code - number) Fax number (code - number) Marketing adviser s code Section 2: eplacement of insurance If you have chosen to invest in the term-certain annuity or Capital Guarantee, the eplacement of Insurance apply to those parts of your investment. ead this carefully and complete where necessary. Does this application replace the whole or any part of your existing investment with any insurer (whether replacement is to occur immediately or to replace an insurance investment that you discontinued within the past four months or that you will discontinue within the next four months)? If Yes, your financial adviser must discuss any potentially detrimental consequences with you and must fill in the eplacement Policy Advice ecord (MYIAD 013) and attach it to this application form. Yes No WEALTH E 1

2 Contract number P P Section 3: Details of investor Title Initial/s First name Surname/Name of legal entity Gender Date of birth Identity/egistration number Male Female Correspondence language: English Afrikaans M M Y Y Y Y Nationality (Attach a copy of the identity/registration document) Postal address Postal code esidential/business Postal code Telephone - work (code - number) Telephone - home (code - number) Fax - work (code - number) Fax - home (code - number) Cellphone number address Preferred method of communication Post You will receive all correspondence including your contract via your preferred method of communication. Marital status Married Single Divorced Widow/Widower Tax details Tax status of investor Natural person Close corporation Company Trust Nontaxable institution etirement fund Provisional tax payer Complete for Option A if you want to invest in a term-certain annuity or international funds Tax office Income tax reference number Preferred tax rate Date valid from M M 2 0 Y Y to Please note that if the investor is not a natural person, we need a tax directive for the income tax payable. Tax directive number M M 2 0 Y Y Complete for Option B and C Indicate nature of trust Nondiscretionary trust Discretionary trust Special trust Are all beneficiaries of the trust classified as natural persons? Yes No Title Surname Gender Date of birth Identity number of contact person Telephone - work (code - number) Cellphone number address Postal address esidential/business address Initial/s Male Female M M Y Y Y Y First name (Attach a copy of the identity document) Fax - work (code - number) Postal code Postal code 2

3 Contract number P P B C Section 5: Insured life (if different from investor) If there are more insured lives make a copy of this section and attach it to the application form. Attach copies of the identity document. Sinking Fund Policy (Option B only)* Title Initials First name Surname Marital Status M/S/D/W Date of birth/ Identity number M=Married S=Single D=Divorced W=Widow(er) * If Sinking Fund is selected, no insured life is required. Section 6: Beneficiaries (Nomination of Beneficiary for Death Benefits) Complete for Option A if you are investing in the Capital Guarantee or term-certain annuity Attach copies of all beneficiaries identity documents If there are more beneficiaries, make a copy of this section and attach it to the application form Make sure that the total allocation of benefits adds up to 100 For nomination of beneficiary of ownership on the Traded Endowment Option, refer to Nomination of Beneficiary of Ownership form (MOMNB E) at the end of this application. Where the sinking fund option on the Flexible Endowment Option has been selected please do not complete this section Title Initials First name Surname/ Name of legal entity Share elationship to investor Gender M/F Date of birth/identity/ egistration number Section 7: Bank account details For collection of lump sum and/or regular investments Provide proof of existence of the bank account (for example a used or cancelled bank cheque or bank statement not older than 3 months). Name of account holder Identity/egistration number Name of financial institution Account number Type of account (Attach a copy of the identity/registration document) Name of branch Branch code Current/Cheque Savings Transmission For payment of income if applicable (payable from local investments only) The Administrator does not allow payments to a third party Name of account holder Name of financial institution Account number Type of account Name of branch Current/Cheque Savings Transmission Branch code Depending on the payment method I have chosen, I authorise the Administrator to collect any money from the bank account I have specified or to deposit any money owed to me in this account. This authorisation will apply to this contract and includes any changes to this contract and claims for the benefits that the Administrator has granted under the contract. If I am signing on behalf of an institution, I declare that I am duly authorised to do so. I undertake to inform the Administrator of any change in my bank details and I authorise the Administrator to verify my current and/or future bank account details with my bank. I agree that the Administrator may debit my account on a date other than the date I specified. I acknowledge and understand that the Administrator may act on an investment instruction received from myself before the Administrator receives cleared funds on a debit order instruction. (The Administrator allows a maximum of per collection). Authorised signature of account holder Date M M 2 0 Y Y Banking details for direct deposits/electronic transfers (For Option A only) Name of account holder: Momentum Administration Services (Pty) Ltd Name of financial institution: ABSA Bank Name of branch: Centurion Account number: Branch code: (For Options B and C only) Name of account holder: Momentum Group Limited Name of financial institution: First National Bank Name of branch: Pretoria Corporate Account number: Branch code: Attach the deposit slip for direct deposits or the bank confirmation slip for electronic transfers, and quote the contract number for reference. 3

4 Contract number P P Section 8: Investment details Collection of lump sum investment Investment method Direct deposit into our bank account* Electronic transfer to our bank account* Electronic collection by the Administrator** Lump sum investment amount Preferred date of collection * Attach the deposit slip for direct deposits, or the bank confirmation slip for electronic transfers, and quote the contract number for reference. 2 0 Y Y M M ** If, for any reason, we do not collect the investment on the preferred date, we will collect it on the first possible date thereafter. Please note that the Administrator allows a maximum of per collection Collection of regular investment (we cannot accept any cash or cheques) Starting date for collection of investments * M M 2 0 Y Y Investment frequency Monthly Quarterly Half-yearly Yearly egular investment amount * If, for any reason, we cannot collect the investment on the starting date indicated above, collection will start on the same day of the following month and will continue after that on the same day of each period in which a contribution becomes payable. (Option A only) Transfer of participatory interests (not applicable to international investments) Is this a transfer of existing collective investment schemes held with another company? If Yes, fill in the Transfer of participatory interest form (MOMNB 242 or MOMNB 204) Is this a transfer only without additional lump sum or regular investment? Yes No If Yes, please do not complete Section 9 Yes No Investment fees efer to the Fee and Benefit Proposal for amounts and percentages to fill in the table below: Investment amount Less initial fees Lump sum investment egular investment (Options A and B only) Advice Fees VAT on initial advice fees Administration fees Net investment = = Ongoing advice fees efer to the Fee and Benefit Proposal or Fee Schedule for details of ongoing administration fees. Section 9: Fund selection efer to the latest fund list for availability of funds. 1. MANAGED SOLUTIONS Lump sum A egular B C Local Growth Solutions (Options B and C only) Momentum Defender Fund* Momentum Capital Plus Fund* Momentum Consolidator Fund Momentum Builder Fund Momentum Accumulator Fund * A built-in fund-level guarantee applies on a month-on-month basis Local Income Solutions (Options B and C only) Momentum Enhanced Income Fund Momentum Prudent Income Fund Momentum eal Income Fund 4

5 Contract number P P Section 9: Fund selection International Growth Solutions (Options A, B and C) MB MM Global Defensive Fund IC Ltd (A) (USD) MB MM Global Cautious Fund IC Ltd (A) (USD) MB MM Global Managed Fund IC Ltd (A) (USD) MB MM Global Equity Fund IC Ltd (A) (USD) 2. COE POTFOLIO All fund names must be written out in full. Fund names Lump sum Lump sum egular 3. FUNDSHOP All fund names must be written out in full. Fund names *NB: Tick if funds are from Essential Portfolio or all-in-priced funds Lump sum egular PSP BDA Number Capital Guarantee (Option A only) Term-certain annuity (Option A only) * If Essential Portfolio or all-in-priced funds are not specifically indicated, the Administrator will not allocate the investment to the all-in-priced class of funds, (if available). 4. OTHE All fund names must be written out in full. Fund names *NB: Tick if funds are from Essential Portfolio or all-in-priced funds Lump sum egular * If Essential Portfolio or all-in-priced funds are not specifically indicated, the Administrator will not allocate the investment to the all-in-priced class of funds, (if available). NOTE: For investments into international funds, refer to Processing of instructions (point 18) of the Terms and Conditions (page 10 of this application form). 5

6 Contract number P P Section 9: Fund selection (continued) Fee Money Market Fund/Account Fee Top Up The Administrator automatically monitors the MB Money Market Fund (default money market fund), if it is the chosen fee money market, to ensure that my balance covers my ongoing fees for at least 4 months. If the balance is not sufficient, units will be cancelled proportionately from my underlying unit trust fund(s) to cover approximately 12-months fees. Please ensure that my investment does NOT have the automatic fee top up * It is compulsory to have a minimum of 5 of your total investment in a local fee money market fund or account, if you have chosen alternative dealing funds, Personal Share Portfolio, international unitised investments or international multimanager portfolios. The Administrator will collect all ongoing fees from this account instead of selling units in the underlying investments. ** It is compulsory to have a minimum of 2,5 of your total investment in local fee money market fund or account if you have chosen Exchange Traded Funds and/or listed shares (Direct Shares). Make sure that the lump sum and/or regular investment allocation adds up to 100 respectively Money Market Phase-in option (local lump sum investments only) Fill in this section if you want to phase-in your investment from a money market fund or account. The fund chosen below must be part of your fund selection on page 4 and 5. Phase-in my investment from: M B M O N E Y M A K E T F U N D or If a Money Market Fund or account has been completed above, this will be the money market fund or account which will be loaded on the contract (i.e. not the MB Money Market Fund). Phase-in my investment to: Indicate the correct and full names of the funds you have chosen. Allocation must add up to 100 *NB: Tick if funds are from Essential Portfolio or all-in-priced funds Number of intervals (2-24) Frequency Weekly Monthly Preferred date of first phase-in** - M M Y Y or Immediately * If Essential Portfolio or all-in-priced funds are not specifically indicated, the Administrator will not allocate the investment to the all-in-priced class of funds, (if available). ** If the Administrator cannot phase-in my investment on the stated preferred date, phasing-in will start on the same date of the following period and will continue after that on the same day of each period. Capital Guarantee (Option A only) Please refer to the Fee and Benefit Proposal to complete. The Fee and Benefit Proposal, together with this application form, will be used to determine the Capital Guarantee. Amount Invested Guarantee date M M 2 0 Y Y *Please be aware that the log code is only valid for one business week. Guaranteed amount Log code* A 6

7 Contract number P P Section 9: Fund selection (continued) Term-certain annuity (Option A only) The Fee and Benefit Proposal, together with the application form, will form the basis of the term-certain annuity. The information contained in the Fee and Benefit Proposal must be used to complete this section and will be used to determine the income payable to you. The investment date indicated on the Fee and Benefit Proposal and the date of purchase of the annuity must be the same. A Allocated amount Gross income Taxable portion Less tax payable Net income First instalment payable on M M 2 0 Y Y Last instalment payable on M M 2 0 Y Y Period in years Annuity code* *Please be aware that the annuity code is only valid for one business week. e-investment Option Indicate the correct and full names of the funds you have chosen. Allocation must add up to 100 Commencement date *NB: Tick if funds are from Essential Portfolio or all-in-priced funds 2 0 Y Y M M * If Essential Portfolio or all-in-priced funds are not specifically indicated, the Administrator will not allocate the investment to the all-in-priced class of funds, (if available). Section 10: Linked income (only payable from local investments) Gross income as percentage of the investment O Gross income in rands Income frequency per year per income frequency Monthly Quarterly Half-yearly Yearly A C Date of first income payment** 2 0 Y Y M M ** If, for any reason, payment of the amount does not occur on the date requested, payment will start on the same day of the following month and will continue after that on the same day of each period in which a payment is due. Fund selection Pay income proportionately from all funds or Pay my income proportionately from the funds below: Indicate the correct and full names of the funds that you have chosen below, which must be part of your fund selected on section 9 Fund selection. Income Top Up The Administrator automatically monitors my chosen income funds to ensure that my balance covers 4 months income. If the balance is not sufficient, units will be cancelled proportionately from my underlying unit trust fund(s) to cover approximately 12 months income. Please ensure that my investment does NOT have the automatic income top up 7

8 Section 11: Declaration and Signatures 1. Where my financial adviser is a category II FSP license holder, I appoint him/her to manage my investments with full discretion limited discretion Contract number P P I instruct the Administrator to accept instructions that he/she gives on my behalf, as set out in the mandate between the financial adviser and myself. Please attach a signed mandate to this application form 2. Momentum Administration Services (Pty) Ltd ( MAS ) is licensed as an Administrative Financial Services Provider (FSP) as regulated by the Financial Advisory and Intermediary Services (FAIS) Act and offers non-underwritten products. 3. Momentum Group Ltd ( Momentum ) is a company carrying on business as a Long-term Insurer and is duly registered as such in terms of the Long-term Insurance Act and offers underwritten products (i.e. all products made available in terms of Momentum s Long-term Insurance license). 4. By signing the application form I acknowledge that I enter into a product agreement in respect of the product stipulated and further acknowledge that I have appointed MAS or Momentum to act as the administrators of the investment, depending on whether the product is underwritten or not. eference to the Administrator herein and in the terms and conditions shall mean either MAS or Momentum as the case may be, acting in an administrative capacity. 5. I warrant that the information provided herein is true and correct and that this application form has been completed correctly and fully. The Administrator will not be liable for any loss or damage that I may suffer as a result of incorrect or fraudulent information later inserted or any unauthorised amendments to this form I understand that in order for my financial adviser to provide me with advice on a product offered by the Administrator, my financial adviser is required to be appropriately licensed with the FSB for the corresponding product category. I further acknowledge that it is my responsibility to ensure that I obtain advice from an appropriately licensed financial adviser The Administrator will verify the licensing status of my financial adviser to confirm their licensing status when the effective date for this verification requirement is finalised by the FSB. When this requirement is effective, this will result in the Administrator s refusal to accept my instruction until such time as my financial adviser becomes appropriately licensed or I appoint an alternative appropriately licensed financial adviser I hereby indemnify the Administrator, its holding company, subsidiaries, agents and employees against any losses that I may suffer as a result of my financial adviser s failure to be appropriately licensed. 7. I acknowledge that the investments that I have chosen under this contract are not the proceeds of any crime, as defined in the Prevention of Organised Crime Act, No. 121 of 1998, as amended from time to time, as well as any new legislation that may govern the proceeds of crime in future. I am aware that any information that I have given for the purpose of this application is subject to the stipulations of the Financial Intelligence Centre Act, No. 38 of 2001, and will be dealt with in accordance with the requirements of such Act. 8. I acknowledge and accept that this application form is subject to the Administrator s Terms and Conditions - Voluntary product (WEALTH 045) as at the date of signature of this application form. I confirm that I have carefully read and understood the Terms and Conditions - Voluntary product and agree to be bound thereby. 9. I nominate and appoint the Administrator with the power of substitution to act in my name and on my behalf as agent and authorise the Administrator to apply for the necessary foreign exchange for my international investment, if applicable, and to apply for approval of any purchase/repurchase of foreign currency (including those associated with this investment after my death). 10. I acknowledge that obtaining initial and ongoing advice is a precondition for entry into the product and my financial adviser is responsible for making sure that I receive and understand all appropriate advice, product and fee information that the financial adviser is obliged to give to me, including any changes in the working practices and procedures of the Administrator. 11. I declare that I fully understand all of the fees that are applicable to my investment choice as contained in the Fee and Benefit Proposal and Fee Schedule. I acknowledge that it is my responsibility to request a copy of the Fee and Benefit Proposal from my financial adviser to fully understand the fees associated with the investment choices I have made. 12. I agree and accept the fees, charges and time periods for administrative processes as detailed in this application form, in the Terms and Conditions, New Business Statement, Fee Schedule and general business practice of the Administrator. 13. I confirm that in respect of underwritten products provided by the Administrator, I will not be liable for the payment of the ongoing advice fee to my adviser, but that the Administrator will on a monthly basis deduct the fee from my investment account. I will inform the Administrator should: 13.1 I terminate my financial adviser s mandate to provide advice to me; 13.2 I change the level of advice required from my financial adviser; 13.3 I appoint another financial adviser, in which event the Administrator shall be entitled to reduce or altogether cease making further monthly payments to my adviser or, if relevant, may continue making further payments to my newly appointed financial adviser. 14. I declare that I have been fully advised of the meaning and implication of a replacement policy and am aware of the possible detrimental consequences of replacing my investment. 15. I warrant that I am capable of evaluating and understanding the investment (through independent professional advice or on my own provided I have signed the required advice waivers and indemnities), and understand and accept the terms, conditions and risks of the investment. 16. I understand and agree that the investment option that I have selected is subject to market risk and the value thereof will fluctuate subject to market movements. I warrant that neither the Administrator nor any of its subsidiaries, agents and/or authorized representatives have made any performance guarantees regarding my investment option. I further warrant that the Administrator will not be liable for any instructions that it carries out or fails to carry out if my instructions are ambiguous, unclear or contrary to legislation and/or the Administrator s business practices. 17. I understand and agree that if any tax law, rule or directive or any other law affecting this investment changes in any way whatsoever, the Administrator may make such amendments necessary to this agreement as it considers appropriate and will notify me within reasonable time. 18. I hereby indemnify the Administrator against any losses that I and/or my financial adviser may suffer pursuant to the Administrator executing any transaction in terms of which the investment funds are to be collected via a debit order instruction against my appointed bank account, in all cases where such debit order instructions are returned unpaid by the relevant bank. I further acknowledge that I will be responsible to reimburse the Administrator for any losses that the Administrator may suffer as a result of such unpaid debit order instruction. A B C Signed at Date M M 2 0 Y Y Signature of investor Signature of parent/ guardian/trustee (if applicable) 8

9 Nomination of beneficiary for ownership Traded Endowment Option Only Contract number P P To prevent possible errors and delays, please fill in answers to questions in full, in black ink and in block letters. Section 1: Investor details Title Surname/Name of legal entity Former/other names (ie maiden name) Initial/s First name Identified by Date of birth Correspondence language ID Identity number M M Y Y Y Y Nationality English Afrikaans Gender Male Female Postal address Postal code esidential address Contact numbers (code - number) Telephone - work Telephone - home Cellphone number Fax - work Fax - home Postal code Section 2: Declaration by investment owner I instruct Momentum Group Limited (Momentum) that, in the event of my death prior to the maturity of the contract, ownership thereof shall immediately and automatically pass to: Title Surname Initial/s First name Former/other names (ie maiden name) Identified by Date of birth ID Passport Identity/egistration number M M Y Y Y Y SA ID Yes No Gender Male Female I retain the right to cancel or change this nomination and acknowledge that no cancellations or alteration whether by testamentary instrument or otherwise, shall be of any force unless Momentum has been notified in writing of such cancellation or change. I together with my heirs, executors and assigns hereby indemnify Momentum against any claims that may arise as a result of giving effect to this instruction. This nomination will automatically be void if the beneficiary referred to above predeceases me or if I cede or assign the contract or any interest in it to any person/entity other than Momentum. Witnesses must be in the presence of the investor, and each other, at the time of signing. Signed at Signature of investor Date M M 2 0 Y Y Witness 1 Witness 2 MOMNB E 1

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11 Terms and conditions Voluntary product General 1. The Application Form, Terms and Conditions, Fee Schedule and New Business Statement form the basis of the agreement between Momentum Administration Services (Pty) Ltd ( MAS ) and/or Momentum Group Ltd ( Momentum ), as applicable, and I. MAS and/or Momentum may amend the terms of the agreement, including administrative fees, from time to time after giving appropriate and reasonable notice of the changes. 2. I acknowledge that I have appointed either MAS or Momentum to act as the administrators of my investment, depending on whether the product is underwritten or not. eference to the Administrator herein and in the application form declaration shall mean either MAS or Momentum acting in an administrative capacity. 3. Any reference to the Application will mean both the Application Form and the Terms and Conditions. 4. This agreement will start once I have furnished the Administrator with the fully completed Application Form and proof of the associated financial transaction, in addition to any information and/or documents that it may need, and after it has accepted the application 5. Investments into non-underwritten products will be received and held by Momentum Wealth Nominees (Pty) Ltd for my exclusive benefit. Underwritten products (i.e. all products made available in terms of Momentum Group s Long-term Insurance license), except for investments into pooled funds, will be received and held in Momentum Wealth Nominees (Pty) Ltd in the name of Momentum Group Limited. 6. Investments into pooled funds will be received by and held in the name of Momentum. 7. Although the Administrator has a legislative obligation to furnish me with a statement regarding my investment at regular intervals, not exceeding three months, I acknowledge that I am able to access the information continuously as this is made available by the Administrator through its internet facility. I therefore relinquish the Administrator from its obligations to provide such statements. I further acknowledge that the Administrator may make the statement and all other documentation and information pertaining to my investment available to me through my appointed financial adviser. 8. I acknowledge that I am entitled to any information that the law requires a collective investment scheme or listed company to disclose. I am also aware of the Administrator s duty to obtain and transmit such information to me. However, I agree that the Administrator will only transmit such information to me if I specifically request it to do so. The Administrator may deduct any costs that it incurs in providing such information from the underlying assets in my contract. 9. I will direct any complaints that I have to the Client Liaison Officer on or them to wealthservice@momentum.co.za. The Administrator will investigate any complaints I may have and will resolve these in accordance with its Complaints esolution Process, which is available on request. 10. The Wealth Compliance Department can be contacted at Postal Address: PO Box 7400, Centurion, 0046, Telephone number: (012) , Fax number: (012) nthabiseng.mhlongo@momentum.co.za 11. Momentum holds sufficient professional indemnity and Fidelity insurance cover that is adjusted on an annual basis on the advice of external auditors. 12. The Administrator reserves the right to reject the application without providing any reasons for its decision. Financial adviser 13. I appoint my financial adviser to make sure that the Administrator receives all the information and documentation that it needs to carry out my instructions. 14. The Administrator will only allow authorised financial services providers who have a marketing agreement in place with the Administrator to submit applications on behalf of investors, and the Administrator will verify each financial adviser s license with the Financial Services Board ( FSB ). The Administrator will approve the level of advice fees payable by ensuring that the fees payable falls within the boundaries of the product rules. 15. The Administrator will not be responsible, accountable or liable for any loss or damage suffered by myself due to the delay in the processing or rejection of this application form, caused by the fact that my financial adviser is not authorised as a financial services provider by the FSB. 16. If the FSB has approved the financial adviser as an investment manager in his/her sole capacity, or if the FSB has approved the financial services provider ( FSP ) (that employs the financial adviser) as an investment manager under the conditions published under the Financial Advisory and Intermediary Services Act, 37 of 2002, then, unless the contrary is indicated, the Administrator will accept that the FSB has approved the mandate between the client and the FSP or the financial adviser. Processing of instructions 17. I authorise the Administrator to carry out all instructions that are issued to it on my behalf, in whatever form, whether received from myself or through my financial adviser, provided these are in accordance with prevailing legislation and the Administrator s business practices. 18. Where the Administrator cannot allocate the investment amount to the chosen investment components within two working days, as detailed in paragraphs 16 and 17 hereof, the Administrator will, subject to paragraph 18 hereof, add interest to my investment. It will add the interest amount to my original investment amount to be invested in the chosen investment components, excluding annuities and Capital Guarantees. Where I only choose an annuity and/or Capital Guarantee, the Administrator will allocate the interest amount to the Administrator s default money market fund. 19. In accordance with paragraph 15 above, the Administrator will attempt to execute valid instructions within two working days from date of receipt thereof. I accept however, that under the following circumstances, the Administrator may be unable to execute my instruction within the two-day turnaround time: When the investment is in international funds, the Administrator will make every effort to execute instructions within five working days, subject to the administration procedures and dealing parameters of the international funds. These procedures and parameters could limit the Administrator s ability to adhere to the five working day period for executing such instructions. (Please consult your financial adviser or our call centre if you need more information on these procedures.) Extraordinary occurrences in the industry can cause extensive market surges and an increase in dealing activity. In such cases, the Administrator s execution times will be adjusted to counteract such extraordinary increases in dealing activity. I concede that the Administrator cannot be held responsible for any delay in executing my instruction within the two-day execution period in cases where delays are due to any extraordinary occurrences within the industry Delays may also result in cases where my instructions are incomplete or unclear. 20. I have been advised and understand that the Administrator executes dealing instructions once daily on working days only. The cut-off time for execution of trades on the same day is 11:00, but same-day executions are not guaranteed. Although I concede that the Administrator will make every possible effort to ensure that my instructions are executed as soon as possible, I specifically vest the Administrator with the authority to execute instructions at any time within two working days from the date on which my instruction is received. Consequently, I indemnify the Administrator against any loss or damage that I may suffer as a result of market fluctuation that may occur during the two-day processing period, whilst my instruction is pending execution. 21. Investments into international funds are held in a non-interest bearing account until such time as my chosen portfolio trades. My financial adviser or I can instruct the Administrator to invest my net investment contributions in the Administrator s default money market fund, which is interesting bearing, until such time as it receives instructions from my financial adviser or I, to invest them into international funds. All investments will be subject to the rules and/or conditions that govern those investments, as the law or the product provider determines from time to time. 22. I acknowledge that certain instructions that I might give to the Administrator about the underlying investments that I have chosen, will be subject to the timing standards, procedures and final prices and exchange rates that the fund management companies and/or other third parties use and confirm. The Administrator will do all it can to make sure that it carries out such instructions within a reasonable period, but will not be responsible for any delays that the market conditions, the fund management companies or any other third parties cause (as the case may be). ingfencing 23. I confirm that I understand ringfenced or ringfencing to mean the suspension of repurchases of my participatory interests in a collective investment scheme under certain circumstances on any business day. 24. I irrevocably authorise the Administrator, on receiving a notice from the fund manager to suspend repurchases, to immediately withdraw the repurchase/switch instruction and to resubmit the repurchase/switch instruction on the following business day. 25. I indemnify the Administrator against any damages or loss of whatever nature that I may suffer as a result of the Administrator acting according to its instructions in the clause above. Fees 26. There are certain fees and charges that are associated with investing. These include, but are not limited to, initial fees and/or ongoing fees charged by my financial adviser, the Administrator and the fund manager. All fees are inclusive of VAT, unless otherwise stated. 27. Certain fund managers may levy performance fees in addition to the ongoing fund manager fees. Details of these fees are set out on the relevant fund fact sheet which is available on the Momentum website or available from your financial adviser. 28. I acknowledge that any changes in the terms and conditions of the contract between the Administrator and any fund managers or my financial adviser may result in the review of the ongoing administration fees applicable to my investment/s. 29. I further acknowledge that a change in respect of my financial adviser or the level of advice provided to me, particularly in relation to underwritten products offered by Momentum may result in the review of the advice fees as well as Momentum's ongoing administration fee as applicable to my investment, payable to my adviser and charged against my investment account/s. 30. The Administrator provides a number of specialised administrative functions that the Collective Investment Scheme s management company (MANCOs) normally perform. These include consolidated reporting, investment values and transaction, switching and the provision of tax certificates. In certain agreed circumstances, the Administrator may receive a rebate from the MANCOs in return for executing some of the above services. The investor will not incur any additional costs, as a result of the payment of these rebates. 31. The rebates that the Administrator receives on funds may have the effect of reducing the Administrator s ongoing administration fee to zero. 32. I agree and confirm that any reduction in rebates received on any fund that results in a reduced benefit to me will not constitute a fee increase by the Administrator. 33. The funds available on Core Portfolio may at the absolute discretion of the Administrator, change from time to time. As a result of this change, a fund that is currently available on Core Portfolio may be removed from the Core Portfolio range and made available in the FundShop range of funds. Any removal of a fund from Core Portfolio to the Fundshop may result in your administration fee increasing by a maximum of 0.40 per annum. Funds invested 34. If a class of funds ceases to exist or if the Administrator is unable to continue offering it, for any reason, the Administrator will inform me and request an alternative instruction within 30 days from the date of such request for an alternate instruction. If the Administrator does not receive such an alternative instruction, it will redeem the units and place the proceeds in the Administrator s default money market fund until it receives further instructions. 35. Any investments into guaranteed portfolios will be applied on the guarantee date as specified in the Fee and Benefit Proposal. The guaranteed value is calculated on the contributions received less initial fees growing at the guaranteed return provided that all contributions have been paid and no changes have been made to the investment. The guaranteed values are calculated based on the Administrator s current fee structure and tax applicable. A change in the fee structure or tax applicable may affect the actual guarantee values. 36. The Administrator reserves the right to withdraw my access to investments of a particular external manager s funds, including, Collective Investment Schemes (CIS) if such fund manager or CIS has notified the Administrator that it will not accept further investments in one or more funds under its management. The Administrator may then allocate the contributions to the default money market fund or any other fund/s that the Administrator may make available. 37. Should the Administrator receive repurchase instructions for the Momentum Capital Plus Fund, in excess of 25 (twenty five percent) of the total portfolio value on any particular day, the Administrator reserves the right to effect these repurchase instructions over a period of twelve months from the date of receipt of the repurchase instruction, due to the illiquid nature of the underlying assets. Should Momentum immediately exercise the right under this clause, then the Administrator will notify me of this decision within a period of 30 (thirty) days from the date of exercise. WEALTH E 1

12 38. I confirm that I am aware of the fact that should I disinvest from the Old Mutual Guarantee Fund (Smooth Bonus Fund), prior to the declaration of a final bonus, no interim bonus will be declared. If and when a final bonus is declared, this amount will be paid over to me at that stage. 39. The Administrator reserves the right to apply Market Value Adjustors in certain circumstances. For more information relating to the application of Market Value Adjustors please refer to the document called Principles and Practices of Financial Management of Momentum s discretionary participation products at I confirm that I am aware that this investment may in addition to these terms and conditions, be subject to the terms and conditions of the underlying fund that I have invested in. For more information in this regard please speak to your financial adviser. 41. Certain structured products may have additional terms and conditions which needs to be signed, available from your financial adviser. Such terms and conditions should be read in conjunction with these terms and conditions and application form. Multimanager portfolios 42. I understand that the Administrator provides a multimanager portfolio administration platform for the multimanager portfolios of investment managers that have a contract with the Administrator. These multimanager portfolios form part of the investment components of the product range that the Administrator offers to investors. 43. The Administrator requires me to submit the relevant Multimanager Portfolio Authorisation form that I have signed if I have chosen to invest in a multimanager portfolio. I acknowledge that the Administrator will deduct the additional administration fee that it discloses in the relevant Multimanager Portfolio Authorisation form. 44. The Administrator also requires me to provide it with a properly signed Momentum Multimanager Portfolio Mandate where I have chosen to invest in a multimanager portfolio range that Momentum International MultiManagers (Pty) Ltd manages as an approved investment manager. 45. The Administrator will not require me to provide it with another signed Multimanager Portfolio Authorisation form if I switch between multimanager portfolios in the same range. However, if I switch from one multimanager portfolio range to a different range, then the Administrator will require me to provide it with a relevant signed Multimanager Portfolio Authorisation and, where applicable, a properly signed Momentum Multimanager Portfolio Mandate. Direct Shares and Exchange Traded Funds 46. Dealing will only take place once a day at the closing price of the day. However, in some instances, the price at which the stockbroker executed the transaction may differ from the closing price of the particular day. 47. No fractions of shares may be bought or sold. Therefore, small cash balances may be left after a purchase transaction has taken place. The Administrator will reinvest all surplus cash in the Administrator s default money market fund unless I have chosen a different money market fund. 48. Any distributions that are received on shares or Exchange Traded Funds will automatically be invested into a money market fund. 49. In its absolute discretion, the Administrator may reject any instruction from me up to and including the settlement date. 50. I acknowledge and understand that the Administrator will buy and sell shares and Exchange Traded Funds on my behalf through its chosen stockbroker and that these transactions are subject to the stockbroker's timing, administrative and general business processes agreed with the Administrator from time to time. 51. All transactions will be subject to the rules of the JSE Securities Exchange South Africa, the Securities Services Act, No. 36 of 2004, and all other laws applicable to the investments from time to time. Personal Share Portfolio (local investments only) 52. I understand that after the Administrator has accepted the application, and has received the investment funds, it will transfer a percentage of such funds that I have indicated for investment into a personal share portfolio under the investment selection section of the application form to a cash account with the investment manager. The investment manager will then invest the funds in accordance with its best investment view or in accordance with my written instructions after consultation with an authorised representative of the investment manager. The investment manager will contact me as soon as possible after the Administrator has accepted the application. In the case of script transfers, I acknowledge that I am aware of the share transfer process and further acknowledge that only once the investment manager has loaded the shares and provided the Administrator with a value, can the Administrator calculate the value of the investment. 53. I acknowledge that the selected portfolio manager is responsible for the investment management of all assets in the Personal Share Portfolio. 54. I acknowledge that an investment in the Personal Share Portfolio is subject to the investment manager s standard business rules, investment management procedures and timing standards, which will be provided to me by the investment manager when I sign the mandate document. I acknowledge that the investment manager will provide me with statements about my investment in the Personal Share Portfolio from time to time, which are subject to final confirmation by the Administrator that still needs to deduct the disclosed administration and advice fees and statutory charges. 55. I acknowledge and understand that if my total investment in my Personal Share Portfolio amounts to less than the investment manager s minimum at any time during the duration of the contract, the investment manager may switch the current investment instruments to unit trust funds at its own discretion or according to my instructions. The investment manager will still manage the investment in the Collective Investment Scheme. Alternative Dealing Funds (Hedge Funds) (local investments only) 56. I understand that the FSB specifically requires the Administrator to disclose to its investors the risks and other characteristics inherent in alternate dealing funds (hedge funds). To this end, I am aware that the Administrator's latest version of the disclosures relating to the alternate dealing funds can be accessed via the Administrator's website, or alternatively, that I could request a copy of the disclosures from the Administrator directly at telephone no I acknowledge that I have read and understood the relevant disclosures relating to alternative dealing funds, that I am familiar with the nature and concept of alternative dealing funds and fully understand the legal nature and consequences of the risks associated with this type of investment. 57. I am aware that investments in these investment structures carry a substantial risk of loss. This loss may exceed the original investment when there is an equally small adverse movement. This may result in a total loss that is greater than the original invested amount. 58. I am aware that this investment may be, or become, illiquid for a variety of reasons and that it may be difficult or impossible to close out a position under certain market conditions. This may occur, for example, where trading is suspended or restricted at times of rapid price movements. In addition, I understand that these funds only deal on specific days and no dealing can take place on any other business days. As a result, I understand that certain prescribed prior notices will be required if I wish to make withdrawals from the fund. 59. Although the FSB does not currently regulate alternative dealing funds, it does regulate the licensing authority of a Fund Manager to manage alternative dealing funds. 60. I understand that once the Administrator has received the contribution, it will invest this into the Administrator s default money market fund, which will act as a feeder account until the next notice period for dealing. The Administrator will use the rand value in the Administrator s default money market fund to purchase participatory interests from the chosen fund manager on the dealing day. 61. I acknowledge that certain minimum criteria apply to investments and withdrawals, and that these may change from time to time. Automatic Fee and Income Top Up 62. If the fee top up option is activated, the Administrator will monitor my contract to ensure that the fee account can cover my ongoing administration fees for at least four months. If the balance is not sufficient, units will be cancelled proportionately from my other underlying funds to cover approximately 12 months fees. For this purpose, in accordance with the Administrator s business practice, units will first be cancelled from local liquid funds and if depleted, units will be cancelled from international funds, direct shares and exchange traded funds. Alternative dealing funds will not be used for this purpose. 63. I acknowledge that if I choose to receive an income from my investment and the income top up option is activated, the funds chosen to provide my income will be automatically monitored on a monthly basis to ensure the balance is sufficient to cover my income for four months. If the balance is not sufficient, units will be cancelled proportionately from my other underlying funds to cover approximately a further 12 months income. For this purpose, in line with the Administrator s business practice, units will first be cancelled from local liquid funds and if depleted, units will be cancelled from international funds, direct shares and exchange traded funds. Alternative dealing funds will not be used for this purpose. Applicable to the Flexible Investment Option only 64. The term-certain annuity and/or Capital Guarantee, if chosen, forms an independent part of the investment portfolio and restrictions on contract changes may apply. I understand that it is subject to the Long Term Insurance Act No 58 of I understand that the Administrator only allows the nomination of beneficiaries if I have chosen to invest in a term-certain annuity and/or Capital Guarantee and such beneficiary nomination does not apply to the balance of my investment. 66. I understand that on my death, the proceeds under the term-certain annuity and/or Capital Guarantee will be payable to the beneficiary/ies that I have nominated on the contract. The Administrator will pay the remainder of the proceeds invested in unitised investments, money market accounts/funds and/or multimanager portfolios to my estate. 67. The Fee and Benefit Proposal that I receive for the term-certain annuity and/or Capital Guarantee is only valid if the Administrator processes the application, and if I pay the purchase amount into the Administrator s bank account within the same week that the Fee and Benefit Proposal is generated. If the Administrator receives the investment amount on a date that differs from the investment date indicated on the Fee and Benefit Proposal, acceptance of the Capital Guarantee will be subject to a final quotation. Capital Guarantee rates change on a weekly basis. Applicable to the Flexible Endowment Option and the Traded Endowment Option 68. This investment constitutes a long-term insurance policy that the Administrator issues under the provisions of the Long-term Insurance Act 52 of I acknowledge that it is a precondition of the Administrator for entry into underwritten products that I obtain ongoing advice due to the nature of the product. The Administrator reserves the right to waive this condition in certain circumstances in which case no advice fee will be payable. 70. I acknowledge that I will not be liable for the payment of ongoing advice fees which will be payable by the Administrator as a cost against the policy in terms of the product rules. The Administrator reserves the right to withhold or terminate the payment of advice fees to the financial adviser where the financial adviser has not met his advice giving obligations to me or where the financial adviser s mandate is terminated. 71. I accept that the Administrator reserves the right to withdraw my access to its foreign holding capacity. If for any reason whatsoever and depending on the discretion of the chief actuary, it cannot continue to provide foreign holding capacity for all contributions that I have to pay, the Administrator may then allocate the contributions to the default money market fund or any other fund/s that the Administrator may make available. 72. I may cede, outright or as collateral security, this contract and the assets held under it in writing. The cession will not bind the Administrator unless the Administrator has noted the cession on its administrative system and has confirmed this in writing. Where there is a cession on the contract, the beneficiary nomination falls away and on cancellation of the cession a new beneficiary has to be nominated. 73. I may cancel this agreement within 30 days from the date on which the Administrator confirms that it has accepted this application. If I exercise this right, the amount that will become payable will be the investment value of the contract on the date that the Administrator receives the proceeds of the realised (sold) assets, taking into account the cost of any benefits, the cost of the investment and/or market currency risk exposure. The Administrator will refund all the initial fees that it charged on the investment. I understand that this process may take up to six months, depending on the investment selection that I have made. 74. The terms and conditions under the Personal Share Portfolio (local investments only) and Alternative Dealing Funds (local investments only) above will apply to the Flexible Endowment Option and Traded Endowment Option, as applicable. 75. I may revoke or change the beneficiaries whom I have appointed in the application and such change shall be of no force and effect unless confirmed in writing by the Administrator. The Administrator will as far as possible pay the death benefits to the beneficiaries that I have nominated. 76. I understand that the beneficiary will acquire rights to the benefits of this contract on the death of the last insured life. 77. On full surrender or maturity of this contract/s I agree to cede, subject to the existing terms of the contract, all of my rights, title and interest under the contract to Momentum Connect (Pty) Ltd, in consideration for which I accept payment of the value from the Administrator on behalf of Momentum Connect (Pty) Ltd. I acknowledge that Momentum Connect (Pty) Ltd, or its legal successors, may have access to my personal information contained in this policy. Applicable to the Traded Endowment Option only: 78. I acknowledge that I have purchased the underlying contracts from Momentum Connect (Pty) Ltd and acknowledge that I am applying to purchase an existing pure endowment contract. 79. I acknowledge that my Traded Endowment Option contract could be made up of more than one endowment contract. 80. The reference number issued to me in terms of this application is an administrative reference number. 81. Provided all insured lives on the contract are deceased, the Administrator will pay the investment value applicable at that time to the nominated beneficiary/ies. If all the insured lives are not deceased, then the Administrator will act on the instructions of the executor of the deceased estate, except in the case of a Nomination of a Beneficiary for Ownership. 82. Collateral and outright cessions are permitted provided that all the underlying contracts, where applicable, are ceded. Where there is a cession on the contract, the beneficiary nomination falls away and on cancellation of the cession a new beneficiary has to be nominated. 2