2. Allocation of Premium Received Policyholder name: Investor/Entity No:

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1 Addendum to Linked Endowment Investment Application/Additional Contribution Form (Hedge) 1. otes 1.1. The minimum investment amount is R00, 000 and additional contribution amounts are set at a minimum of R100, 000; 1.2. The Private Wealth Portfolio is a combination of sub policies. All future instructions must be instructed at a sub policy level. The minimums above apply to the sum of the sub policies Investment portfolios may have a sub-minimum investment amount either larger or smaller than the product minimum. Please ensure you are aware of the minimums imposed by the investment managers on their investment portfolios; 1.4. Each investment portfolio will attract investment portfolio fees and performance fees as specified by the investment manager and such fees are dependent on the applicants selection made; 1.. The Private Wealth Portfolio does not offer any capital guarantee, or any guarantee on investment returns, however some of the available underlying linked investment portfolios may offer a guarantee; 1.6. THIS FORM MUST ACCOMPAY YOUR IVESTMET APPLICATIO/ AITIOAL COTRIBUTIO FORM, WITHOUT WHICH YOUR IVESTMET WILL OT BE PROCESSE. 2. Allocation of Premium Received Policyholder name: Investor/Entity o: 2.1. Initial Investment: Please ensure you have completed and signed an Investment Application and attach it to this addendum; ote that the initial premium received will be split equally into sub policies and the initial investment portfolio selection made herein will be applied to each of the sub policies at inception date; The Initial Premium should equal the lump sum value and exclude any market value of an Asset Transfer, if required Total Initial Premium Investment: R 2.2. Additional Contribution: Please ensure you have completed and signed an Additional Contribution Form and attach it to this addendum; The Additional Contribution should equal the lump sum value and exclude any market value of an Asset Transfer, if required Additional contribution premiums received can be applied across all sub-policies OR to specific sub-policies. Please complete either of the options below; Total Additional Contribution Amount: R Apply equally across all my sub-policies. My sub-policy numbers are: Sub-policy 1: Sub-policy 2: Sub-policy 3: Sub-policy 4: Sub-policy : OR Apply to the following sub-policies. Specify RA amounts only for the sub policy split. Percentages will not be accepted and any addendums completed with percentage figures will be rejected. My sub-policy numbers and additional contribution splits are: Sub-policy 1: Sub-policy 2: Sub-policy 3: Sub-policy 4: Sub-policy : R R R R R Hollard is a licensed Financial Services Provider FSP o Registration o. 1993/00140/06 Page 1 of 11

2 3. Investment Portfolios Selection 3.1. Fund List: aily Priced and Traded Funds Investment Portfolio ame Allan Gray Balanced Fund (Code: PWABI) Allan Gray Stable Fund (Code: PWASI) 1.70% p.a. 1.28% p.a. 10% of outperformance when the fund delivers a positive return in excess of the benchmark, over a rolling 24 period 10% of outperformance when the fund delivers a positive return in excess of the benchmark, over a rolling 24 period IVESTMET AMOUT 4.3%.7% % OR R 3.8% 6.2% % OR R otice & ealing aily aily Coronation Balanced efensive Fund (Code: PWCBI) 1.0% p.a. 4.1%.9% % OR R aily Coronation Capital Plus Fund (Code: PWCCI) 10% of outperformance when the fund delivers a positive return in excess of the benchmark, over a rolling 12 period. 3.% 6.% % OR R aily Coronation Strategic Income Fund (Code: PWCSII) 0.8% p.a. 3.3% 6.7% % OR R aily Top 20 Fund (Code: PWCTI) 20% of outperformance when the fund delivers a positive return in excess of the benchmark, over a rolling 12 period. 3.6% 6.4% % OR R aily Grindrod Global Property Income Fund Class A (Code: PWGGPI) 1.7% p.a. 4.4%.6% % OR R aily Hollard Prime ynamic Income Fund B (Code: HPIF) 0.7% p.a. 2.8% 7,2%% % OR R aily Hollard is a licensed Financial Services Provider FSP o Registration o. 1993/00140/06 Page 2 of 11

3 Investment Portfolio ame IVESTMET AMOUT otice & ealing Hollard Prime Equity Fund B (Code: HPEF) 1.10% p.a. 3.2% 6.8% % OR R aily Hollard Prime Money Market Fund B (Code: HPMMF) 0.30% p.a. 2.3% 7.7% % OR R aily Hollard Prime Property Fund B (Code: HPPF) 3.1% 6.9% % OR R aily Hollard Prime Strategic Assertive Fund of Fund s B (Code: HPSAF) 1.3% p.a. 3.% 6.% % OR R aily Hollard Prime Strategic Balanced Fund of Funds B (Code: HPSBF) 1.30% p.a. 3.4% 6.6% % OR R aily Hollard Prime Strategic efensive Fund of Funds B (Code: HPSF) 1.2% p.a. 3.4% 6.6% % OR R aily Hollard Prime Yield Plus Fund B (Code: HPYPF) 0.% p.a. 2.6% 7.4% % OR R aily Investec Cautious Managed Fund (Code: PWICI) 1.0% p.a. 4.1%.9% % OR R aily Investec Opportunity Fund (Code: PWIOI) 0.9% p.a. 20% above hurdle 3.% 6.% % OR R aily Investec Value Fund (Code: PWIVI) 0.8% p.a. 20% above benchmark 9 3.3% 6.7% % OR R aily Hollard is a licensed Financial Services Provider FSP o Registration o. 1993/00140/06 Page 3 of 11

4 Investment Portfolio ame IVESTMET AMOUT otice & ealing Melville ouglas ynamic Strategy Fund (Code: MSF) See table below 3.% 6.% % OR R aily Prudential ividend Maximiser Fund B (Code: PWPPM) % OR R aily Stanlib Aggressive Income Fund (Code: PWSAFI) 1.10% p.a. 3.6% 6.4% % OR R aily Stanlib Balanced Fund (Code: PWPSBAI) 1.0% p.a. 3.7% 6.3% % OR R aily Stanlib Balanced Cautious Fund (Code: PWSBCI) 1.0% p.a. 3.7% 6.3% % OR R aily Stanlib Income Fund (Code: PWSII) 0.7% p.a. 2.6% 7.4% % OR R aily Stanlib Property Income Fund (Code: PWSPII) 1.30% p.a. 3.% 6.% % OR R aily Plexus - Xcede Property Fund (Code: PWXPI) 1.18% p.a. 3.7% 6.3% % OR R aily Plexus - Xcede Balanced Fund of Funds (Code: PWXBI) 1.94% p.a. 4.6%.4% % OR R aily Plexus - Xcede Conservative Fund of Funds (Code: PWXCI) 1.87% p.a. 4.%.% % OR R aily Hollard is a licensed Financial Services Provider FSP o Registration o. 1993/00140/06 Page 4 of 11

5 3.2 Fund List: Monthly Priced and Traded Funds Investment Portfolio ame 36One Fund (Code: THOE) 36One Hedge Fund (Code: THOP) Abax Constellation Fund (Code: ACFP) Abax Hedge Fund (Code: AHFP) Alpha Equity Hedge Fund (Code: AAEHI) Atlantic Point Hedge Fund (Code: APHF) Blue Ink - Big Oak Fund of Funds (Code: PWBBI) Blue Ink - Blue Sky Fund of Funds (Code: PWBSI) Blue Ink - Evergreen Fund of Funds (Code: PWBEI) Blue Ink - Fixed Income Fund (Code: PWBFII) IVESTMET AMOUT 20% performance fee 3.% 6.% % OR R 20% performance fee 3.% 6.% % OR R 20% performance fee 3.% 6.% % OR R 20% performance fee 3.% 6.% % OR R 1.0% p.a. 10% p.a. above a high water mark 3.2% 6.8% % OR R % OR R 1.0% p.a. 1% of total performance.3% 4.7% % OR R 1.0% p.a. 1% above the hurdle rate of STeFI 4.3%.7% % OR R 1.7% p.a. 4.3%.7% % OR R 1.% p.a. +VAT. 1.% above hurdle of STeFI, crystallised annually 4.3%.7% % OR R otice & ealing Hollard is a licensed Financial Services Provider FSP o Registration o. 1993/00140/06 Page of 11

6 Investment Portfolio ame Capricorn Imalivest Fund (Code: CIFP) Capricorn Performer Fund (Code: PCAPPF) Capricorn Stable Hedge Fund (Code: PWCSHI) Fairtree Fixed Income Fund (Code: PWPFFI) Fairtree Multi Strategy Fund (Code: PWPFMS) Fairtree Wild Fig Fund (Code: PWFWF) Laurium Long Short Fund PWP (CL3) (Code: PLCALLP) Laurium Market eutral Fund 7 (Code: LBRFLLP) Matrix Multi Strategy Fund (Brait) (Code: BMSF) Mazi Visio Market eutral Fund (Code: MVM) IVESTMET AMOUT 1.2% p.a. 20% above a high water mark 4.9%.1% % OR R 1.2% p.a. 20% above a high water mark 4.9%.1% % OR R 1.2% p.a. 20% above a high water mark 4.9%.1% % OR R calculated annually, subject to a 3.% 6.% % OR R high water mark calculated annually, subject to a 4.7%.3% % OR R high water mark calculated annually, subject to a 4.7%.3% % OR R high water mark 20%, subject to investor receiving a cash return (STeFI) annually 20%, subject to investor receiving a cash return (STeFI) annually 3.% 6.% % OR R 3.% 6.% % OR R 1.0% p.a. 20% p.a. above STeFI 4.0% 6.0% % OR R subject to an effective quarterly hurdle rate of SAFEX 3.% 6.% % OR R otice & ealing Hollard is a licensed Financial Services Provider FSP o Registration o. 1993/00140/06 Page 6 of 11

7 Investment Portfolio ame IVESTMET AMOUT otice & ealing Skybound - The Firecrest Fund 10 (Code: HSFCI) 4.7%.3% % OR R Skybound - The Lighthouse Fund 10 (Code: HSFII) 4.7%.3% % OR R Skybound - The Managed Equities Fund 10 (Code: HSMEI) 4.7%.3% % OR R Skybound - The Proactive Opportunities Fund (Code: HSPAI) 4.7%.3% % OR R SA Tower Fund (Code: TOWF) 1.0% p.a. 10% per annum above cash rate (with hogh water mark) 3.% 6.% % OR R Tri Alpha - SA Alternative Programme (Code: TSSAP) subject to an effective quarterly hurdle rate of SAFEX % OR R Visio II Golden Hind Fund (Code: PWVCI) 1.0% p.a. subject to an effective quarterly hurdle rate of SAFEX 3.% 6.% % OR R Hollard is a licensed Financial Services Provider FSP o Registration o. 1993/00140/06 Page 7 of 11

8 3.3 Fund List: Offshore Hedge Fund Investment Portfolio ame IVESTMET AMOUT otice & ealing Capricorn GEM Fund US 4 (Code: CGEMFI) 2.00% p.a. no vat 20% above a high water mark 4.9%.1% % OR R 1 ay aily Skybound - The China Red Fund US 4 (Code: HSCRUI) 4.7%.3% % OR R aily Skybound - The China Red Fund GBP 4 (Code: SCRGBP) 4.7%.3% % OR R aily 3.4 Fund List: Personal Share Portfolios (PSP) Investment Portfolio ame IVESTMET AMOUT otice & ealing Investec Bank 3 Month Fixed Return Fund Investec Private Client Securities (Code: PWIF,,,) 0.00% p.a. 2.0% 8.0% % OR R 1 ay days Investec Securities Long Term Growth Personal Share Portfolio Investec Private Client Securities (Code: PWIP..) 1.10% p.a. 3.2% 6.8% % OR R 1 ay days Investec Securities Opportunities Personal Share Portfolio Investec Private Client Securities (Code: PWIPP...) 0.8% p.a. 20% above benchmark 9 3.2% 6.8% % OR R 1 ay days *Please note investments into PSP s will only be traded once segregated accounts have been opened at the respective stockbroker *Should you have a combo investment which includes an investment into one of the selected funds under points 3.1, 3.2 or 3.3 all investment will only trade once the PSP account has been opened and active. Hollard is a licensed Financial Services Provider FSP o Registration o. 1993/00140/06 Page 8 of 11

9 1. Asset Management Fees are charged ly and are reflected in a reduction in the value of the unit price of the portfolio, and are charged on the value of the assets in the investment portfolio in question; 2. s are charged ly and are reflected in a reduction in the value of the unit price of the portfolio; 3. Worst case refers to an RiY calculation using the product charge, the highest possible upfront and ongoing service and advice fee, and the application of the full performance fee and asset management fees; 4. Asset Swap Fees of 0.0% p.a. of the value of the funds held in these portfolios are charged ly in arrears and reflected in the unit price. Asset swap capacity is only made available with the prior approval of Hollard;. High Water Mark means if the fund under performs its appointed benchmark, the asset manager will need to make back that performance before charging a performance fee. Please refer to the asset manager for the relevant high water mark; 6. ay and days in the context of otice and ealing Period above refers to a working day; 7. otice and dealing periods are set by the asset manager of the fund in question. If you have arranged an alternative date to the standard dates to process your particular transaction, authorisation of such is required by Hollard, in writing from the asset manager. Hollard will process all trades in line with the standard notice and dealing periods stated herein, unless otherwise notified. Hollard will not be held liable for any losses the client may experience in the event that the expectation was for an alternative dealing date and no authorisation was obtained from the relevant asset manager and given to Hollard prior to trade. 8. On daily traded funds, all trade instructions received by Hollard by 12pm daily will be processed for trade by T+2. All instructions received after 12pm will we processed for trade on T+3. Monthly traded hedge fund pricing for all trades will be confirmed as near to the end of the following the trade date as pricing is dependent on the asset manager in question and is not within the control of Hollard; 9. Please refer to the relevant fund fact sheets for the benchmark specific to these funds; 10. These funds are subject to initial fees, negotiable between the applicant and FSP, of between 0% and a maximum of 3.0% of the value of the premium placed in the investment portfolio. An initial fee of the maximum of 3.0% has been factored into the calculation of the Worst Case RiY stated above. Fees Applicable to Melville ouglas Portfolios are: BASIC FEE (Asset Management Fee) Excl. VAT A PARTICIPATIO FEE () Excl. VAT Funds Managed Annual Percentage Category Percentage Up to R2 m 1.000% Less than R2 m.00% For the next R3 m 0.30% R2 m R m 4.7% For the next R m 0.32% R m R10 m 4.0% For the next R1 m 0.27% R10 m R2 m 4.00% For the next R2 m 0.22% R2 m R0 m 3.00% Over R0 m 0.17% Over R0 m 2.00% 3.2. Alternative Trade ate Confirmation: I have arranged an alternative trade date with the relevant asset manager of my selected investment portfolio and attach the letter of authorisation. A ARRAGEMET WITH MULTIPLE ASSET MAAGERS WILL REQUIRE MULTIPLE AUTHORISATIO LETTERS. OFFICE USE OLY Asset Manager confirmation of special arrangement for alternative trade date: (Authorisation letters must be attached). Hollard is a licensed Financial Services Provider FSP o Registration o. 1993/00140/06 Page 9 of 11

10 * Effect of expenses The reduction in yield (RiY) shows the extent to which the return on the assets will be eroded due to expenses charged against the policy. The assumed gross investment return of 10% used to calculate the RiY shown in the table is not guaranteed, but merely used to illustrate the impact of expenses. The actual investment return earned on premiums paid in, will depend on the gross investment return earned on the assets and the extent to which this return is reduced by taxation and expenses. ote on performance fee The above RiY figure includes a performance fee levied on the underlying funds. This amount assumes that the fund return is the same as that of its benchmark, as disclosed in the relevant fund fact sheets produced by the investment manager in question. The actual performance fee could be higher or lower depending on the performance of the underlying fund. The performance fee is specific to the fund and is also disclosed in the investment manager fund fact sheets. Effect of Inflation The gross investment return will depend on financial market conditions and the rate of inflation during the policy term. Inflation has a major impact on investment returns, and in general higher inflation leads to higher investment returns and lower inflation leads to lower investment returns. Real rates of return (the excess of the investment return over the inflation rate) give a more meaningful indication of how the investment has performed. Effect of Taxation epending on the type of policy, insurance companies pay different rates of tax on investment returns. The effective tax rates may also be different between insurance companies, based on their level of expenses. All benefits paid out under a policy are net of tax and there are thus no further tax obligations for the policyholder. The RiY percentages shown herein may be higher or lower, depending on the performance of the underlying investment portfolio/portfolios and any changes/reductions made to the charges stated herein. The RIY calculation assumes that the return on a fund is equal to its benchmark and equal to any hurdle rate for that particular fund. This means that the effective performance fee used in the calculation is zero. The actual performance fee could be higher if the actual performance of the fund exceeds its benchmark or hurdle rate. Performance fees can range from 0% to 20% for different funds as shown on the fund fact sheets. 4. Product Charge and FSP Commission Annual Product Charge Monthly Fees 0.0% p.a. on the value of the investment account. Monthly fees are facilitated through a cash holding in each of the linked portfolios for this purpose. Financial Services Provider Commission and Fees Upfront Commission: Between 0% and a maximum of 3.0% + VAT of the value of the premium received. Ongoing Service and Advice Fee: Between 0% and a maximum of 1.0% + VAT of the value of the investment account. Tax Charges Tax charge on taxable gain.00% Tax charge on taxable income 1.00% ividend Withholding Tax 1.00% = These funds have the following Tax Charges Tax charge on taxable gain: 0% Tax charge on taxable income: 0% ividend Withholding Tax: 1% These charges are subject to review should any changes in legislation occur which directly affect the tax position of Hollard Life. Please note that the total investment returns from hedge funds are subject to the taxable income charge. Hollard treats all growth on hedge funds as income and thus the tax charge on income will apply to such funds. Hollard is a licensed Financial Services Provider FSP o Registration o. 1993/00140/06 Page 10 of 11

11 . eclaration and Signature.1. I hereby confirm the selection made herein is my selection in relation to the investment/additional contribution with Hollard and that I have made this investment portfolio selection and investment of my own free will;.2. I further confirm that I have not received any advice from Hollard as to the suitability of the investment portfolios available to me or to the choice I have made and confirm that I understand that no such advice will be forthcoming to me from Hollard in the future in relation to this investment or any others I may have;.3. I agree that this statement made here is binding on me and agree to abide by all the terms and conditions associated with my investment into the Private Wealth Portfolio as stated in all documents pertaining to my product choice;.4. I understand that this addendum is signed in conjunction with my investment/additional contribution into the Private Wealth Portfolio and I understand that it forms part of my application for investment and my contract with Hollard;.. I further confirm my understanding of, and acknowledge, the fact that this is a combination of five linked endowment policies issued by Hollard Life and that all instructions from this point forward must be made on a sub policy level. Applicant Signature ate of Signature Capacity: Hollard is a licensed Financial Services Provider FSP o Registration o. 1993/00140/06 Page 11 of 11