Discovery Group Retirement Plan New employee application form

Transcription

1 Discovery Group Retirement Plan New employee application form Contact details Tel: , PO Box , Benmore 2010, Content of this form Page 1. Employee details 1 2. Investment details 2 3. Investment choices 3 4. Payment details 3 5. Financial adviser details 3 6. Statutory disclosure, terms and conditions and declarations 5 Appendix A: FICA and other documents required 10 Appendix B: Replacement policy advice record 11 When to complete this form 1. New employees for a group retirement plan How to complete this form To enable Discovery Invest to process this application form quickly and accurately, please ensure that it is completed in full and that you submit all required documents requested with the application form. Please complete the form in black ink and print clearly. Write one letter per block. Where you need to make a choice between different options, please mark your selection with an X. Process to submit this form to Discovery 1. Please fax this form and all supporting documents to Discovery Invest on or it to invest_groupra@discovery.co.za 2. If you have any questions about this form, please contact Discovery on Employee details Employer name Group Retirement Plan number 1.1 Employee details Natural person First name (as per ID) Surname Initials Title Date of birth Y Y Y Y M M D D ID/passport number Nationality of passport Sex M F Telephone (H) Fax Postal address Physical address Preferred language of communication: English Afrikaans 1.2 Tax status of employee Telephone (W) Cellphone Code Code Registered tax payer? Yes No Income tax reference number Page 1 of

2 1. Employee details (continued) 1.3 Beneficiaries You may nominate one or more person(s) or institution(s) as beneficiaries to receive the proceeds of the Retirement Plan in the event of your death. The Pension Funds (Section 37C), however, requires the board of trustees of the Discovery Retirement Annuity Fund and the Discovery Invest Retirement Annuity Fund to distribute the benefits equitably between your dependants and nominated beneficiaries at the time of your death. This beneficiary nomination will assist the board of trustees in making their decision. General If you are married in community of property, written consent is needed from your spouse to nominate a beneficiary other than your spouse. If you do not obtain your spouse s written consent, he/she may be entitled to claim a share from you if your joint estate is divided. If this applies to you, you must complete the standard Discovery Invest Request to change details form. Please review your beneficiary nomination regularly to take account of changed circumstances. You can change the beneficiary nomination at any time by completing and submitting the Request to change details form, which is available on If more beneficiaries are required, please complete the Request to change details form. Please complete the details of the beneficiaries you wish to nominate: 1. Beneficiary: Legal entity Natural person Percentage allocation % Full name Title Date of birth Y Y Y Y M M D D ID/company registration number Passport number Nationality of passport Relationship Sex M F 2. Beneficiary: Legal entity Natural person Percentage allocation % Full name Title Date of birth Y Y Y Y M M D D ID/company registration number Passport number Nationality of passport Relationship Sex M F 3. Beneficiary: Legal entity Natural person Percentage allocation % Full name Title Date of birth Y Y Y Y M M D D ID/company registration number Passport number Nationality of passport Relationship Sex M F 2. Investment details 2.1 Product details Source of funds (compulsory for FICA) You can only apply for one product per application form. Recurring investment Investment amount R Date of commencement Y Y Y Y M M D D Page 2 of 11

3 3. Investment choices 3.1 Investment choices Please complete the section below, with your investment choice options. You will find detailed information about the investment choices in the Meeting your investment needs brochure or on Percentage of net investment Payment details 4.1 Pay the investment to Discovery The Employer will make payments on behalf of their contributing employees for the Group Retirement Plan into the following bank account Account name: Discovery Life Ltd Life Retirement Annuity Client deposit account Bank: First National Bank Branch: Johannesburg Branch code: Account number: Account type: Current Total 100% 4.2 Direct debit order authority The employer must provide us with employer installation form with the company resolution letter indicating authorised signatories authorising all debit order instructions before submitting employee application forms. If the employer has selected to make payment by debit order, the employer installation form will specify billing date for all contributing members. 5. Financial adviser details 5.1 Financial adviser fees Recurring investment Initial fee discount % (from 0% to 100%) I have read and understand the commissions and fees structure of this investment and agree that commissions and fees are payable to my appointed financial adviser and Discovery. These commissions and fees have been explained to me and I agree that these commissions and fees can be paid. The fees charged by Discovery can be changed, but only if Discovery informs me, in writing, of the changes. Signature of employee Date Y Y Y Y M M D D Page 3 of 11

4 5. Financial adviser details (continued) 5.2 Financial adviser details 1. Primary financial adviser: FICA declaration: I, Financial adviser full name Financial adviser code Intermediary house Intermediary house code Distribution channel confirm that I am an authorised financial services provider or representative. PRI number (ABSA and FNB intermediaries) I warrant and confirm that I have identified and verified the identities of the applicant(s) with regard to this Yes No application/contract in terms of the Financial Intelligence Centre Act 2001, and related Regulations. I warrant that I have copies of the relevant documentation in my possession Yes No OR I have verified and attached the required FICA documents to this application. Yes No Replacement of an existing policy declaration: If this application is to replace an insurance policy discontinued within the past four months or to be terminated within the next four months, please discuss and complete the Replacement Policy Advice Record and attach it to this application form. I hereby declare that I have requested and recorded the client s responses to the questions (refer to Appendix B) with regard to replacement and that the client is fully aware of the possible detrimental consequences of the replacement of an insurance policy. I further declare that, irrespective of the client s response to the questions, I explained the following to the client: The meaning of replacement That a replacement is potentially prejudicial The levying/deduction of a termination charge and That where a replacement is considered, the client is legally entitled to comprehensive information regarding the consequences of replacement. Quote declaration: I declare that I have presented a final quote (quote number compulsory) to the employee. The investment options as reflected in the quote correspond to the information in the employee s application form and I confirm that the product fees, commission, benefits and all other information in the quote was explained to the employee. Financial adviser s fee split: % Signature of primary financial adviser Date Y Y Y Y M M D D 2. Secondary financial adviser: Financial adviser full name Financial adviser code Intermediary house Intermediary house code PRI number (ABSA and FNB intermediaries) Distribution channel I confirm that I am an authorised financial services provider or representative. Financial adviser s fee split: % Signature of secondary financial adviser Date Y Y Y Y M M D D Page 4 of 11

5 6. Statutory disclosure, terms and conditions and declarations 6.1 Statutory disclosure Net asset value (NAV) All prices are calculated on a NAV basis. NAV is the total value of all assets in a portfolio, including any income accrual and less any permissible deductions from the portfolio divided by the number of units or participatory interests in issue. Permissible deductions include brokerage, Uncertified Security Tax, auditor s fees, bank charges, trustee/custodian fees and the service charge levied by Discovery Life Collective Investments (Pty) Ltd. Upfront manager charges The upfront manager charge is deducted from the full investment value and the remaining amount is allocated to the clients selected investment options. Any additional investment will incur an upfront manager charge. The charges range from 0% to 0.57% depending on the relevant investment chosen. Service charge The annual service charge for the individual portfolios is accrued daily and levied monthly on the market value of the fund or portfolio. The annual service charge will be deducted from the income received by the portfolios. Annual Protector Premium A non-vatable Annual Protector Premium of 1.20% of the fund value is charged for providing the unique protection applicable to the Classic Retirement Plan. This Annual Protector Premium will be divided by 12 and deducted monthly from the Classic Retirement Plan fund value. Total expense ratio The total expense ratio or TER of a portfolio is a measure of a Fund s assets that have been surrendered as payment for costs of management of the fund andis expressed as a percentage of the daily average value of the portfolio and is calculated over a period of usually a financial year. Switching A switch involves selling the participatory interest in one portfolio and allocating and investing the proceeds in another portfolio. Discovery will waive the first four voluntary switch fees, thereafter a fee of 0.25% of the amount switched will be charged. Fee rebate Discovery Invest may receive fee rebates from certain investment managers from time to time and these will be passed on to Employees by purchasing additional units which will be added to the employee s portfolio. Dividends Tax Discovery is a regulated intermediary and withholding agent in terms of Section 64 of the Income Tax Act. If the Employee is an individual or a Trust with individuals as beneficiaries, Dividends Tax will be withheld at the full prescribed rate on dividend distributions unless the Employee qualifies for exemption and completes the necessary declarations. Income distributions Income distributions are made at regular intervals on all portfolios and may vary depending on the chosen portfolio. Portfolios either declare distributions monthly, quarterly (31 March, 30 June, 30 September, 31 December), bi-annually (30 June, 31 December) or annually (31 December). These distributions are paid by no later than the last working day of the following month. Electronic transactions Discovery will be entitled to implement all instructions and applications of whatsoever nature received by Discovery on their internet site, by telephone, fax or any other form of electronic medium and which appear to emanate from the employee. Discovery is indemnified against any such losses, claims or damages which arise from acting on instructions received via these forms or any other form of electronic mediums processed on behalf of the employee or which purports to be processed on behalf of the employee, notwithstanding that it may later be proved that any such instructions were not given by the employee. General Collective Investment Schemes in Securities (CIS) are generally medium to long term investments. The value of participatory interests may go down as well as up and past performance is not necessarily a guide to the future. Fluctuations or movements in exchange rates may cause the value of underlying international investments to go up or down. With regards to the money market portfolio, the price of each unit is aimed at a constant value. Excessive withdrawals from the portfolio may place the portfolio under liquidity pressures; and in such circumstances a process of ring-fencing of withdrawal instructions and managed pay-outs over time may be followed. The money market portfolio is not a bank deposit account. The total return to you is primarily made up of interest received but, may also include any gain or loss made on any particular instrument. In most cases this will merely have the effect of increasing or decreasing the daily yield, but in an extreme case it can have the effect of reducing the capital value of the Fund. CIS are traded at ruling prices and can engage in borrowing and scrip lending. The Manager may borrow up to 10% of the market value of the portfolio to bridge insufficient liquidity. A schedule of fees and charges and maximum commission is available on request from Discovery Life Collective Investments (Pty) Ltd. Commission and incentives may be paid and if so, would be included in the overall costs. The exposure limit to a single security in certain portfolios can be greater than is permitted for other portfolios in terms of the Collective Investment Schemes Control Act 45 of Details are available from the Manager. Forward pricing is used. Fluctuations or movements in exchange rates may cause the value of underlying investments to go up or down. The manager does not provide any guarantee either with respect to the capital or the return of a portfolio. A fund of funds is a portfolio that invests in portfolios of Collective Investment Schemes, which levy their own charges, which could result in a higher fee structure for these portfolios. A feeder fund is a portfolio that, invests in a single portfolio of a collective investment scheme, which levies its own charges and which could result in a higher fee structure for the feeder fund The Manager reserves the right to close certain portfolios to new investors in order to manage the portfolio more efficiently in accordance with its mandate. More details are available from the Manager. The holding of off shore investments in certain portfolios is subject to current South African Reserve Bank (SARB) regulations. Where foreign securities are included in the portfolio, any material risks will be included in the fund fact sheets. Any capital gain realised on the disposal of a participatory interest in a CIS will be subject to Capital Gains Tax (CGT). All portfolios are valued on a daily basis on any business day at 16:00, with the exception at month end, when portfolios are valued at 17:00. Investments and repurchases will receive the same price for that day if received before 11:00 for the money market portfolio and 15:30 for the other portfolios. You confirm that neither Discovery Life Collective Investments (Pty) Ltd or any staff provided you with any advice (as defined in the FAIS Act) and that you have taken particular care to consider on your own or with the assistance of your financial adviser whether the investment chosen is appropriate considering your individual needs, personal objectives and financial situation. Discovery Life Collective Investments (Pty) Ltd (the Manager) is a member of the Association of Savings and Investments (ASISA). Manager Trustees Discovery Life Collective Investments (Pty) Ltd Standard Chartered Bank 155 West Street, Sandton 2146 Johannesburg Branch, 4 Sandown Valley Crescent, Sandton 2196 Telephone: Telephone: Page 5 of 11

6 6. Statutory disclosure, terms and conditions and declarations (continued) 6.2 General terms and conditions 1. What we mean by certain words 1.1 When we use the term Discovery, we include Discovery Invest and Discovery Life. 1.2 When we refer in the terms and conditions that follow to the products, we mean the Discovery Investment Plan: Retirement Plan 1.3 Where we refer to employee, we mean the person who invested in the product or the owner of the investment. 1.4 Where we refer to life assured, also known as the insured, we mean the person whose life event will determine the provision of benefits by the insurer. 2. Licences and authorities 2.1 The products are administered by either Discovery Invest or Discovery Life. 2.2 Discovery warrants that it holds professional indemnity and fidelity insurance cover as required by the Financial Advisory and Intermediary Services Act (FAIS Act). 2.3 Discovery reserves the right to accept or reject the employee s application form and/or subsequent transactions/instructions and will not enter into any discussion with regard to accepting or rejecting the application and/or subsequent transactions/instructions. 2.4 The products and agreements entered into by Discovery, in respect of any investment options, are subject to all statutory and regulatory. 3 Financial advisers 3.1 If Discovery is not the appointed financial adviser then Discovery does not provide any advice to the employee. 3.2 Discovery will only allow financial advisers who are authorised and licensed by the Financial Services Board (FSB) to act as financial services providers on behalf of employees, to advise the employee in making the appropriate investment choices. 3.3 Unless the financial adviser is an employee of Discovery, the employee cannot hold Discovery legally responsible for suffering any loss or damage if the financial adviser is not authorised as a financial services provider, and the processing of this application form is delayed and afterwards rejected because of that fact. 3.4 The financial adviser has the responsibility to act within his/her/its licence conditions and authority. Unless the financial adviser is an employee of Discovery, the employee cannot hold Discovery responsible or liable for suffering any loss or damage as a result of the financial adviser acting outside the scope of his/her/its authority and licence conditions. 3.5 The financial adviser must ensure that the employee receives and understand all appropriate advice, product and fee information. 4. Documents the employee can expect from us On commencement of the investment, we will the documents that include a summary of the personal and investment details and investment choices and an investment fact file. If we don t have a direct address, we will post the documents to the employee. The employee has 10 business days from receipt of the documents to inform us if any of the personal or investment information is incorrect. 5. Communication between the employee and Discovery To process any instruction on a specific day, Discovery must receive the instruction before 10:00; otherwise the instruction will only be processed on the following business day. (Any instruction so received will only be processed once the money reflects in the relevant bank account, has been matched and all documentation and proof of the deposit or electronic funds transfer [EFT] have been received by Discovery). This may take up to 24 hours to process. 6. Investment options and performance 6.1 Discovery is not held responsible or liable for any losses incurred due to delays, oversight or any other errors attributable to the manager of any investment options and any losses or harm the employee may suffer directly or indirectly as a result of occurrences relating to the investment that are beyond their control. 6.2 If any statutory or regulatory impact the return generated by any investment options, Discovery or the Retirement Funds reserve the right to revise the value of the investment accordingly and the employee will have no recourse against Discovery or the Retirement Funds. 6.3 Please note that if any investment options selected have been capped, the investment amount specified for the capped investment option will default to the Discovery Money Market Fund until Discovery is notified of an alternate investment choice. The details of the capped investment option will be communicated to the Employee in the occurrence of this event. 6.4 If Discovery is obliged to remove/withdraw some or all of the funds from an investment option in order to comply with statutory or regulatory then such funds will be invested into the Discovery Money Market Fund until the employee notifies Discovery of another investment option. Discovery or the Retirement Funds will not be legally responsible for any loss or harm that the employee may suffer as a result of such withdrawal and subsequent investment into the Discovery Money Market Fund. 6.5 All income that is earned on the investment options will be automatically reinvested in the same investment option until Discovery receives instructions from the employee. 7. Escalator funds (if applicable) 7.1 Escalator Funds include a riskier asset and a cash component. The value of the fund at any point in time is based on the market value of both the underlying riskier asset and the cash component. 7.2 The 80% Dynamic Market Value guarantee level is based on the overall value of each Escalator Fund and not on the value of the riskier asset only. The guarantee applies at all times and not only at the end of a specified time period. 7.3 For Geared Escalators, the exposure to the riskier asset may exceed 100%. This additional exposure is achieved by effectively borrowing money. Should the additional growth on the additional exposure be less than the interest rate on the borrowed component, the overall fund value will decrease. 8. Membership of the Retirement Annuity Fund 8.1 If the employee makes a contribution to the Retirement Plan, the employee will become a member of a Retirement Annuity Fund. Once the employee is a member of a retirement annuity fund, the relationship with the retirement annuity fund will be governed by the rules of the relevant Retirement Annuity Fund. 8.2 If the employee makes a lump sum contribution, then the employee will become a member of the Discovery Investment Retirement Annuity Fund. If the employee is to make recurring contributions, then the employee will become a member of the Discovery Retirement Annuity Fund. The financial adviser will advise the employee which Retirement Annuity Fund the employee will become a member of. 8.3 The Discovery Retirement Annuity Fund and the Discovery Investment Retirement Annuity Fund ( the Retirement Funds ) are Retirement Annuity Funds registered by the Financial Services Board (FSB) in terms of the Pension Funds Act ( the Act ) and approved by the South African Revenue Service ( SARS ) in terms of the Income Tax Act. 8.4 The Retirement Funds are each managed by a Board of Trustees. In terms of the Act, when performing its functions, this board of trustees must act in accordance with the fiduciary duties owed to the Retirement Funds and the duty of care and good faith owed to the members and other beneficiaries of the Retirement Funds. 8.5 The membership of the relevant Retirement Fund commences once Discovery or the Retirement Funds have received this application form and the first contribution. 8.6 The employee will be bound by the Retirement Fund rules, the Act, this application form, the investment fact file and all other business practices of Discovery and the Retirement Funds. 9. Contribution to the Retirement Plan 9.1. Once the employee has become a member of the Retirement Funds, the Fund will invest all contributions paid by the employee Once the employee has made a contribution to the Retirement Funds, the contribution cannot be refunded to the employee. Page 6 of 11

7 6. Statutory disclosure, terms and conditions and declarations (continued) 9.3. The employee may choose how the contributions to the Retirement Funds are to be invested. If an investment option is not chosen in the application form, or if the investment option details are unclear, or if the investment option chosen by the employee is no longer offered, or if no written instructions regarding the investment options have been received from the employee, all contributions will be placed in the Discovery Money Market Fund until a valid instruction is received from the employee or the financial adviser. Discovery or the Retirement Funds is not held legally responsible for any loss the employee may suffer as a result of Discovery placing the contributions in the Discovery Money Market Fund in terms of this paragraph. 10. Benefits payable The employee can only receive the benefits due in the event of the employee s death or retirement. This includes retirement due to ill-health where the employee is able to prove, to the satisfaction of the Board of Trustees, that the employee is medically disabled and qualifies for a disability benefit in terms of the rules of the Retirement Funds. In the event of the employee s retirement, the employee may receive the full amount in cash, if the value of the investment is less than R The employee can retire from the Retirement Funds at any time from the age of 55, apart from for the reason of ill-health, when the employee can retire at any age The benefit or right to the benefit from the Retirement Funds is subject to sections 37A and 37B of the Act. The employee cannot use the benefit or right to the benefit as security or transfer it to someone else or make it over to a third party. The employee s creditors cannot attach the benefit or right to the benefit On retirement (including ill-health retirement) the employee accrues a right to an annuity. The amount of the annuity depends on the value of the investment options selected by the employee as at the date of the retirement. The employee may be able to take a portion of the annuity amount as a lump-sum payment. The lump-sum amount is prescribed by legislation and is currently one third of the annuity amount. The balance of the annuity amount must be used to purchase an annuity in the employee s name from an insurer registered in terms of the Long-term Insurance Act. In terms of the rules of the Retirement Funds, the employee has to select the registered insurer from whom the annuity will be purchased. The employee may also withdraw their funds before retirement, provided that their fund is less than R In the event of the employee s death, the benefit payable by the Retirement Funds is subject to section 37C of the Act. In essence, this section of the Act gives the Board of Trustees discretion, which must be equitably exercised, as regards who should receive the benefit. The Act provides that dependants, as defined in the Act, and beneficiaries as nominated in writing by the employee, can receive the benefit. If the investor does not have any dependants and has not nominated a beneficiary then the benefit will be paid into the investor s estate. 11. Transfer to other retirement annuity funds The employee is able to transfer their benefit in the Retirement Funds to other Retirement Annuity Funds registered by the FSB and SARS. 12. General terms and conditions for the Waiver Benefit The Waiver Benefit is underwritten by Discovery Life and is governed by the Long-term Insurance Act Only natural persons can apply for the Waiver Benefit For full details about the Waiver Benefit, please refer to the investment fact file or contact Discovery or the financial adviser Please note that the cover provided under the Waiver Benefit commences once Discovery has received the first premium and has accepted the risk. 13. Terms and conditions for the Early Retirement Disability Protector and the 100% Escalator Death Guarantee (risk benefits as defined in the accepted quote) The risk benefits are underwritten by Discovery Life and are governed by the Long-term Insurance Act The risk benefits are only available to natural persons and not other entities such as close corporations, companies, trusts, etc For full details of the risk benefits please refer to the investment fact file which together with this application form and any amendments to the contract, forms part of the investment contract. 14. Liability The risk benefits will not commence and no liability whatsoever will attach to Discovery for any obligation under the risk benefits until notice of acceptance of the risk has been given and the first premium for the risk benefits has been received No claim will be paid to or in respect of the life assured under the risk benefits if the claim arose directly or indirectly from a condition, illness, impairment or disability that existed prior to the commencement of the risk benefits and which the life assured knew of and sought medical treatment or advice for from a recognised medical practitioner Any contributions paid into the Employee s Discovery Classic Retirement Plan within three months of a disability claim will not qualify for the Early Retirement Disability Protector. 15. Consent To consider a claim under the Risk Benefits the life assured irrevocably authorises Discovery to: Get from any person, including Discovery Health, Discovery Health Medical Scheme and Vitality Healthstyle (Pty) Ltd (including Discovery Card), any information including any private health, wellness and lifestyle and medical information including HIV status of the life assured which Discovery deems necessary Share with other assurers that information and any other information relating to the life assured contained in this application form or in any related policy or investment contract Get from and provide to any credit bureau or life insurance or credit providers industry association or other association for an industry in which Discovery operates, any information of the applicant/life assured relating to his or her creditworthiness or any consumer credit information including without limitation credit history, financial history, personal information and judgement or default history. This authority cannot be cancelled and endures after death the of the life assured. 16. Fair Collection Notice 6.1 This Fair Collection Notice ( Notice ) notice explains how we obtain, use, disclose and otherwise process personal information, which may include health and financial information ( Personal Information ), as required by the Protection of Personal Information Act ( POPIA ) Acceptance of these terms and conditions is voluntary, but is a requirement for activation and servicing of your policy. If you do not accept these terms and conditions, we cannot activate and service your policy Discovery Invest (we/us) will keep any information, including Personal Information relating to yourself and your dependants and/or beneficiaries, supplied to us in this application or collected from other sources ( Your Personal Information ) confidential. You confirm that when you provide Discovery Invest with Your Personal Information, your dependants and/or beneficiaries have provided you with the appropriate permission to disclose their Personal Information to Discovery Invest for the purposes set out below and any other related purposes You hereby consent to the collection, collation, processing, storage and disclosure of Your Personal Information for any purpose relating to this product (or use of your DiscoveryCard if applicable) for the purpose of: Administering this policy and for the assessment of any claim(s) under this policy; Enabling any entity within the Discovery Group and/or any third party provider or financial services provider or its representative approved by Discovery to advise you of or offer to you any enhanced benefits or new products which become available from time to time which you may become entitled to or qualify for; and Providing relevant information, including Your Personal Information, to a contracted third party who requires such information to render a service to you in relation to this policy, provided that such contracted third party agrees to keep the information confidential. 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8 6. Statutory disclosure, terms and conditions and declarations (continued) 16.5 Please note: We may amend this Notice from time to time. Please check our website periodically to inform yourself of any changes; You have the right to object to the processing of Your Personal Information; Should you believe that we have utilised Your Personal Information contrary to applicable law, you will first resolve any concerns with us. If you are not satisfied with such process, you have the right to lodge a complaint with the Information Regulator, once established You confirm that Your Personal information may be provided to any other entity within the Discovery Group where you or your dependant/s already have a relationship with, or where you or your dependant/s have applied for a product or benefit from, such entity. This information will be provided for the administration of your or your dependant/s products or benefits By signing this application form, you authorise Discovery Invest to: Obtain and share information about your creditworthiness with any credit bureau or credit provider s industry association or other association for an industry in which Discovery Invest operates. This includes information about credit history, financial history, judgments and default history and sharing of information with tracing agents Please contact us if you do not wish to receive any direct telephonic marketing from us You have the right to request a copy of the Personal Information we hold about you. To do this, simply complete the Data Subject Request Form on and specify what information you would like. We will take all reasonable steps to confirm your identity before providing details of your personal information. Please note that any such Data Subject Request may be subject to a payment of a legally allowable fee. You have the right to contact and ask us to update, correct or delete your personal information You agree that Discovery may transfer Your Personal Information outside the borders of the Republic of South Africa if you provide an address which is hosted outside the borders of South Africa. We may also need to transfer your personal information to another country for processing, storage or academic research. We will ensure that anyone to whom we pass your personal information agrees to treat your information with the same level of protection as we are obliged to You agree that Discovery may retain Your Personal Information until such time as you request us to destroy them (unless we are obliged by law to retain it, regardless of such request) If Discovery Limited becomes involved in a proposed or actual merger, acquisition or any form of sale of some or all its assets, we may use and disclose Your Personal Information to third parties in connection with the evaluation of the transaction. The surviving company, or the acquiring company in the case of a sale of assets, would have access to Your Personal Information which would continue to be subject to this Notice Discovery Invest is required to collect and retain information in terms of the following legislation: The Financial Advisory and Intermediary Services Act (FAIS); The Financial Intelligence Act (FICA) The Long Term Insurance Act (LTIA); The Pension Fund Act and The Collective Investment Schemes Control Act amongst others By signing this application form, you authorise Discovery Invest to share information, including Personal Information, in this application or in any related document with: Insurers; Industry Registers such as ASISA and ASTUTE; and Contracted third parties, such as tracing agents. 17. Discovery may refuse to pay a claim If Discovery is unable to get sufficient information in order to consider a claim under the risk benefits then such claim will not be paid Discovery may refuse to pay claims under the risk benefits if the death of the life assured is due to suicide In the case of the Early Retirement Disability Protector and 100% Escalator Death Guarantee, Discovery may refuse to pay a claim if the disability or severe illness was of the life assured was deliberately self-inflicted In the case of the Early Retirement Disability Protector and 100% Escalator Death Guarantee, Discovery may refuse to pay a claim if the disability or severe illness was as a result of: a) Wilful and deliberate breaking of any law or wilful involvement in any riot, insurrection, usurpation of power, martial law, by the life assured or war b) Regular participation by the life assured in any hazardous sport or pursuit c) Intentional and negligent consumption of poisons, drugs and narcotics unless prescribed by a registered medical practitioner (neither the life assured nor his immediate family or dependants may perform the role of registered medical practitioner in such a case) d) Consumption of alcohol above the legal limit, or excessive consumption of alcohol. 18. Discovery may cancel the risk benefits if: A fraudulent claim is submitted; Fraudulent means or devices are used to make a claim; False information is provided to get a benefit; If the claimant knowingly allows someone acting on their behalf to provide false information in order to get a benefit; The life assured deliberately and wilfully conspires to cause illness or disability that gives rise to a claim. 19. Cession The risk benefits may not be ceded or made over or assigned to any person. 6.3 Declarations I, (full name) the Employee, hereby declare the following: Warranty: 1. I have read and understood the contents of this application form. 2. I agree to be bound by the terms and conditions of this application form, the investment fact file and Business Practices Manual which, read together, will be the investment contract. 3. I agree that any commission payable in terms of the Long-term Insurance Act of 1998 and that any fee payable in accordance with the FAIS Act of 2002, and referred to in section 5.1 of this application form, may be paid from my investment to my appointed financial adviser on my behalf. I further agree to pay from my investment, the fees as charged by Discovery in the amounts and on the basis explained to me by my financial adviser. 4. I agree that Discovery will, at their discretion, have the option to pay or collect any amount through the Automated Clearing Bureau or electronic funds transfer (EFT), or by direct debit or credit against my bank account by means of a debit order or credit note addressed to my bankers. Any amounts so received by Discovery will be deemed not to have been received by them and no transaction in respect of such application may be made until the amount of the debit order, cheque or EFT payment has been unconditionally credited to Discovery s bank Page 8 of 11

9 6. Statutory disclosure, terms and conditions and declarations (continued) account with its bankers. 5. I agree that any alterations made to this application form by me or my financial adviser is not binding unless Discovery agrees to accept the alterations. Acceptance will be communicated by the processing of this application form, the receipt of any monies paid to Discovery and the issuing of the investment fact file. 6. I understand that the products may be subject to tax. I acknowledge that if any of the tax laws, tax regulations, the SARS practice or other laws governing the products change, this may have an effect on the products and the benefits that are payable to me. Discovery has not given me any tax advice and I undertake to take such advice if I think it necessary. 7. I understand that I bear any and all risks associated with the investment options chosen, as I have personally selected the investment options into which the investment amounts are to be placed. 8. I understand that the value of the benefits payable by the products will vary depending on the performance of the investment options. Discovery has made no representations or guarantees to me regarding the performance of the investment options. 9. I confirm that, to the extent that Discovery is not my appointed financial adviser, Discovery has not advised me to invest in a particular investment option and as such are not responsible for any choices I have made. 10. I confirm that I made the decision to invest in the products out of my own free will and from advice given to me by my financial adviser. 11. I confirm that the monies paid into the products are not from the proceeds of crime. 12. I confirm that Discovery can take instructions from my financial adviser regarding the investments or product, if I have provided the correct mandate. If Discovery acts on any instruction from my financial adviser and it is later found that my financial adviser did not act in terms of the instructions or authority that I gave him/her/it, I confirm and agree that, unless my financial adviser is an employee of Discovery, Discovery will not be legally responsible for any loss or damage I may have suffered. 13. Discovery will not be responsible for any failure, malfunction or delay of any networks or electronic or mechanical device or any other form of communication used in the submission, acceptance and processing of applications and/or transactions. Discovery will not be legally responsible to make good or compensate me or any third party for any damages (whether direct or consequential), losses, claims or expenses. It is my responsibility to ensure that this application form, any instructions that are part of the application form and subsequent instructions submitted electronically by fax or to Discovery, have been received by Discovery. I acknowledge that, Discovery does not consider a fax confirmation or printed copy of a sent as proof of it receiving the document or instruction. 14. Where this application form has been signed by my spouse, my spouse confirms that he/she has read the terms and conditions of this application and agrees to be bound to them. My spouse specifically confirms the nomination of beneficiaries made in this application form and understands the legal consequences of such nomination. 15. I warrant that I have disclosed all material information to Discovery as regards the Waiver Benefit (if applicable). 16. I understand that if I have breached the warranty contained in 15 above, that Discovery can declare the waiver benefit issued to me void and that I will forfeit any contributions paid in respect of the Waiver Benefit. 17. If I have selected the Waiver Benefit, then: a) I authorise Discovery to get from any person, including Discovery Health, Discovery Vitality and the Discovery Health Medical Scheme any information relating to my health, wellness and lifestyle including my HIV status, which Discovery deems necessary at the application for insurance stage, the claim stage and on an ongoing basis. b) I authorise Discovery to share with such insurers any information contained in this application form or any related policy or any document either directly or through a database operated by or for insurers as a group, at any time (even after my death) and in such detailed, abbreviated or coded form as may from time to time be decided by Discovery or by the operators of such database Invest Aware Regulation 28: I know and understand that if Discovery is ever obliged to withdraw all or a portion of the funds from any of the investment choices I have made in order to comply with a statutory or regulatory requirement then Discovery will invest such withdrawn funds into the Discovery Money Market Fund until I have informed Discovery of another investment choice Invest Aware Escalator funds (if applicable): The guarantee that the Escalator funds will not fall below 80% of the highest value reached (the guarantee level) is a guarantee provided by Deutsche Bank or BNP Paribus (BNP), as the case may be, and not Discovery Life Limited. This means that I bear the risk if Deutsche Bank or BNP is unable to meet the guarantee for any reason whatsoever Quote declaration: 1. My financial adviser presented me with a final quote (quote number compulsory) 2. The investment options as reflected in the quote correspond to the information in my application form and I confirm that the product fees, commission, benefits and all other information, contained in the quote was explained to me by my financial adviser Replacement of an existing policy declaration: Is this proposal to replace the whole or any part of your existing insurance with any insurer (whether the replacement is to Yes No occur immediately or to replace an insurance discontinued within the past four months or within the next four months)? If Yes, the financial adviser must discuss and complete the Replacement Policy Advice Record and attach it to this proposal form. Does this proposal constitute a replacement of an investment policy with a recurring premium investment or risk policy that Yes No will lead to or has led to the levying/deduction of a termination charge (causal event charges and administration charges) of more than 15% of the replaced policy s fund value? Refer to the definitions in Part 3 of the Regulations of the Long-Term Insurance Act, 1998 (commission regulations) (not required if the replacement policy effected as a result of the internet, telephone or direct marketing). The Discovery Business Practices Manual describes the various administration processes and the general administration of your investment. (This is available on Signature of employee Signature of spouse (if applicable) Date Y Y Y Y M M D D Page 9 of 11

10 APPENDIX A FICA and other documents required Due Diligence Requirements: New Applicants must send the following applicable FICA documents together with a fully completed Discovery Investment Plan application form. Additional or updated documentation may be requested in certain circumstances. Please ensure that the information provided on the FICA documentation is clear and certified if a copy. All FICA documents must be less than 3 months old except for income tax forms / property insurance policy schedules. If a Financial Service Provider (FSP) / Representative is utilised, a certified copy of the FSP license is required. Page 10 of 11 Founding Statement and Certificate of Incorporation Resolution of the members to invest Members as per Natural person Trust Investing in Name of Minor Investor Clubs and Stokvels Company Partnership Close Corporations Clear copy of one of the following: Latest Annual Reports and Accounts Resolution of the partners to invest All Partners as per Certificate of Incorporation (COR15, COR22 and COR39) Board resolution authorising the investment (and/or approval to act as trustee if a corporate trustee) Directors as per All shareholders holding 25% or more of voting rights at a general meeting as per Copy of constitution/founding document Copy of register of participants Letter electing and authorising person to act on behalf of the club/stokvels Representative as per Administrator reserves the right to request FICA documents for all participants Minor Certified copy of birth certificate Legal Guardian as per Trustees as per individual, or company for corporate trustees Extract of Trust Deed pages showing name of Trust, parties to the Trust and signature pages Letter of Authority from Master (SA Trust) or Foreign Regulator (Foreign Trusts) to Trustees National identity card or document Current valid passport Identification Close Corporation CK1 and CK2 Members as per All Partners as per Company COR15, COR22 and COR39 Directors as per Name(s) and address(es) of all directors All shareholders holding 25% or more of voting rights at a general meeting as per Representative as per Address of Legal Guardian as per individual Trust as per individual Trustees as per individual Clear copy of one of the following, confirming name and address: A utility bill Telkom account An income tax form / extract An insurance policy schedule A most recent lease / rental agreement Confirmation of address Proof of Banking details as per Proof of VAT registration (if applicable) Proof of Income Tax Number Authorised signatory list including specimen signatures Proof of Banking details as per individual Proof of VAT registration (if applicable) Proof of Income Tax Number Authorised signatory list including specimen signatures Proof of Banking details - as per individual Proof of VAT registration (if applicable) Authorised signatory list including specimen signatures Proof of Club or Stokvels banking details as per Authorised signatory list including specimen signatures Proof of Trust banking details as per individual Proof of VAT registration (if applicable) Proof of Income Tax Number Proof of South African banking details either: Cancelled cheque or bank statement (no internet or credit card statement accepted) A letter from bank confirming banking details Proof of Income Tax Number Related due diligence

11 APPENDIX B Replacement policy advice record (To be completed in consultation with your intermediary please note that this does not serve as a cancellation of the replaced policy; you must advise the insurer in writing about cancellation of a policy) Name and surname of policyholder ID number of policyholder Name and surname of intermediary (or registration no in case of juristic persons) Full name of FSP (brokerage or insurer) New policy: Type of policy: Investment or Risk Policy or Proposal number Insurer Policy being replaced: Type of policy: Investment or Risk Policy or Proposal number Insurer 1. Reasons why replacement may not be advisable If you do replace any policy, we want to ensure that you make an informed choice. Please read the following information carefully and discuss with your intermediary. You will pay some charges and fees twice (eg commission, underwriting expenses and other initial charges levied by the insurer) initially on the existing policy and once again on the new policy. You may pay higher premiums for risk (or a bigger part of the premium) on the new policy because you are older now or your health situation might have changed. Your new policy may not have the same life cover or premium guarantees as the existing policy. Check the period for which the life cover or other cover amounts are guaranteed before the insurer is entitled to change your premiums or reduce or remove cover. Your new policy may not have the same investment performance guarantees as the existing policy (if applicable). Your new policy may have more exclusions, restrictions or waiting periods particularly if your health has deteriorated. The amount of money that you can withdraw under the new policy may be less (if applicable). A new policy will usually have legal restrictions on access within the first five years. You may lose the tax advantage of your existing policy (if applicable). The surrender value or paid-up value of your existing policy may be as low as 65% of the policy value before the change, and could be even less than premiums paid in since unrecovered initial expenses must first be deducted. Check what charges you will be paying on termination of the old policy and see whether the advantages of the new policy will make up for any such charges. The investment risk under the new policy may be higher. Remember that the past performance of a fund or asset manager of a fund is not necessarily an indication of future performance. 2. Reasons for the change of policy/policies 2.1 Did you establish whether the existing/terminated policy could be amended to provide similar benefits to the replacement policy? Please print clearly 2.2 If such amendment is/was possible, why do you regard it as appropriate that the terminated policy be replaced by the replacement policy? Please print clearly 3. Replacement of policy was as a result of (to be completed if the new business was effected via electronic business): Internet Telephone Direct Marketing 3.1 Please indicate the date, time of the phone call/negotiation and (if applicable) reference number: Date Y Y Y Y M M D D Time Reference 3.2 There may be more factors regarding replacements that could influence your decision. Do you require further advice? Yes No 4. Declaration (signatures are compulsory unless the replacement policy was effected as a result of the internet, telephone or direct marketing) Intermediary I confirm that I have taken all reasonable steps to confirm that the information in this Replacement Policy Advice Record (RPAR) is true and correct. I confirm that in pursuance of my advice to the policyholder to replace the policy(ies) mentioned in this RPAR. I have fully discharged my duties as set out in section 8 (d) of the General Code of Conduct for Authorised Financial Services Providers and their Representatives (the Code) and have retained a record of such advice as required by section 3 of the said Code. Signature Name Date Page 11 of 11 Y Y Y Y M M D D Policyholder I confirm that the adviser has fully explained the consequences of the replacement of the policy(ies) mentioned in this Replacement Policy Advice Record and I understand the consequences of such replacement(s). Signature Name Date Y Y Y Y M M D D Contact telephone and/or address