APPLICATION FORM PROFESSIONAL PROVIDENT SOCIETY INVESTMENTS PROPRIETARY LIMITED ( PPS INVESTMENTS ) CLIENT SERVICE CENTRE CONTACT DETAILS TEL: 0860 468 777 (0860 INV PPS) FAX: 021 680 3680 EMAIL: admin@ppsinvestments.co.za WEBSITE: www.ppsinvestments.co.za Please complete the form in BLOCK LETTERS Please indicate all options selected with a [X] Please initial any amendments made to this application form Please note, Investment Option(s) refer to the underlying unit trusts within your portfolio FICA requirements are available on the PPS Investments website The daily cut-off for receipt of instructions is 14:00 General Terms, Conditions and Declarations are available on the PPS Investments website Please note, this is a fillable form. Please print, sign where required and send to the details above for processing. All fields in red are compulsory. A CONTACT PERSON FOR OUTSTANDING REQUIREMENTS Name and surname Telephone number Email Capacity B D IMPORTANT INFORMATION REGARDING THE You must make sure your annual payments across all approved tax-free savings accounts with all product providers do not exceed the annual and life time contribution limits. The limits apply with regards to total contributions across all product providers and not on a per product provider basis. If you exceed your annual contribution limit of R30 000 (as stipulated in the Income Tax Act) this will lead to a penalty tax of 40% on the over contributed amount. This penalty will be imposed by the South African Revenue Service ( SARS ) at the end of the tax year. If you contribute more than the lifetime contribution limit of R500 000 (as stipulated in the Income Tax Act), this will lead to a penalty tax of 40% on the over contributed amount. This penalty will be imposed by the South African Revenue Service ( SARS ) at the end of the tax year. C PERSONALISED INVESTMENT NAME You have the opportunity to name your investment (e.g. My Holiday Fund ). Name my investment Please note that the product does not guarantee performance in line with your personalised investment name. PERSONAL DETAILS OF INVESTOR (only natural persons who are resident in South Africa for tax purposes) New investor Existing investor Client number (if existing investor) PPS member number Title Surname First name(s) Date of birth Identity or passport number Country of passport issued Gender Male Female Home language English Other (please specify) Country of citizenship South African Other (please specify) Nationality South African Other (please specify) Are you a registered tax payer? Yes No If yes, please complete the tax information on the following page. PAGE 1 OF 7 January 2016
Country / Countries of Tax Residence Tax reference number Physical address Postal code Postal address Postal code Please note, at least one contact number is required. Telephone number (home) Telephone number (work) Cellphone number Email Preferred communication method Email Post Source of funds for this investment (compulsory) Professional / Liquidation of Property Gift / Donation Savings Business investment disposal inheritance Other (specify) E ACTING ON BEHALF OF THE INVESTOR E1. Guardian / persons with Power of Attorney acting on behalf of the investor. Proof to be sent to PPS Investments. Title Surname First name(s) Identity or passport number Relationship to the investor E2. Mandate for dealing with the administrative FSP acting on behalf of the investor. Proof to be sent to PPS Investments. I have entered into a full / limited discretion mandate with the Advisory Practice (FSP) captured in Section O. Yes No I authorise PPS Investments to accept instructions submitted by the FSP on my behalf. Yes No Please send us a copy of the signed mandate. F LUMP SUM INVESTMENT DETAILS Lump sum contribution (minimum R2,000) (May not exceed R30 000 per tax year) Phasing-in details Lump sum investments can be made directly into the Investment Option(s) of your choice or can be phased in over a period of time. If this option is selected, all monies should be invested in the PPS Enhanced Yield Fund and will be phased into your selected Investment Option(s). Investment to be phased in Yes No If Yes, please select phase-in period 3 months 6 months 12 months Phase-ins will be generated on the 9 th of the month, and priced on the 10 th. Should either of these days fall on a weekend or public holiday, the process will take place on the following business day. PAGE 2 OF 7
G DEBIT ORDER INVESTMENT DETAILS Please note that your first debit order payment must be deducted from your bank account and may not be paid in cash. Debit order investment amount (Minimum R500 and maximum R2 500 per month) Commencement month Collection date 1 st 7 th 15 th 28 th (Not within 14 days of investment date) Frequency Monthly Quarterly Half-yearly Yearly Annual escalation rate 5% 10% 15% % Please note that your selected escalation rate might be capped to ensure that the escalation rate does not lead to a breach of the annual and lifetime contribution limits. Should the cut-off for my selected debit order date be missed, please commence on the same day of the following month; or as soon as possible, on the next collection date. H BANK DETAILS Bank details of investor The following bank details will be used for all payments. A cancelled cheque or recent bank statement (not older than three (3) months and clearly displaying your name and the bank s logo) must accompany this application form as confirmation of these details. Any changes to your banking details in future must be forwarded in writing to PPS Investments together with proof thereof. Title Initials Surname Identity or passport number Name of bank Account number Branch name Branch code Type of account Current Savings Transmission I, the undersigned, request and authorise PPS Investments to arrange to collect / deposit any monies payable from / to the bank account specified above. Use the bank details below for the recovery of my debit order and / or lump sum investment, as the payer differs from the investor (please provide proof of bank details such as a cancelled cheque or a bank statement not older than three (3) months, a copy of the ID of the payer and a specimen signature of the payer). Collection requests from a third party legal entity s account must be accompanied by a resolution, copies of the ID documents and signatures of the signatories of the third party as well as all supporting documents. PAGE 3 OF 7
Bank details of third party Title Initials Surname / Name of entity Identity or passport number / Registration number of entity Name of bank Account number Branch name Branch code Type of account Current Savings Transmission I, the undersigned, request and authorise PPS Investments to arrange to collect the monies payable from the bank account specified above. Signature of account holder / Signatory Date I METHOD OF PAYMENT Cheque deposit* All cheques must be endorsed as Non Transferable and deposited directly into the product s bank account. Electronic / Internet transfers* Electronic transfers may not reflect immediately and may take a few days to appear in the product s bank account. Regular debit order Please ensure that the bank account details are completed in section H if you select this option. The reference on your bank account will be a combination of the abbreviated product name (PPS INV1) and a 16-digit investment number e.g. PPS INV1 POL1234567890123. Electronic collection by the Administrator The reference on your bank account will be a combination of the abbreviated product name (PPS INV1) and a 12-digit client number e.g. PPS INV1 123456789012. Please do the electronic collection on (date) J * The Administrator requires proof of deposit or transfer, together with receipt of the applicable documentation as set out in this form, before the application can be processed. Please reference your deposit using your contact number, followed by your name and surname. For example, 0825554444 John Smith. INVESTMENT OPTION(S) I hereby apply to invest in the Investment Option(s) indicated below. These are made available by PPS Investments as unit trusts that comply with the Collective Investment Schemes Control Act Board Notice 90 of 2014. These unit trusts may not have a performance fee structure or invest in any vehicles that charge a performance fee. If the chosen Investment Option(s) introduce performance fees in future, PPS Investments might switch your Investment Option(s) on your behalf should you not switch to appropriate unit trusts yourself. For a comprehensive list of available Investment Option(s), please refer to the Investment Option Schedule for the PPS Tax Free Investment Account within the Select Range available on www.ppsinvestments.co.za or from the PPS Investments Client Service Centre and indicate your selection in the table below. The available Investment Option(s) may change from time to time. Please ensure that the percentages are completed for the lump sum and debit order investment column, where applicable. Investment Option Lump sum investment % Debit order investment % 1 2 3 4 5 6 7 8 9 10 Total 100% 100% PAGE 4 OF 7
L K TERMS, CONDITIONS AND DECLARATIONS I understand and agree to be bound by the provisions of this application form. If on the date of signature of this application form an updated application form exists and fees and General Terms, Conditions and Declarations differ, the updated application form, fees and General Terms, Conditions and Declarations will apply. I understand and agree that: It is my responsibility to ensure that my personal and contact particulars are correct. If this is not the case, or in the event that my personal and / or contact particulars change, it is my responsibility to inform PPS Investments in writing of the incorrect particulars or the change in particulars. I will notify PPS Investments immediately if my residency of Foreign Account Tax Compliance Act (FATCA) or equivalent classification changes in the future, or if there are any changes in circumstances that may impact my tax residency status or FATCA classification. PPS Investments may use all personal and contact information I have provided to PPS Investments in order to facilitate my tracing in respect of any unclaimed benefits. I also agree that PPS Investments may share all personal and contact information with any third party, or obtain any contact and personal information from any third party, in order to facilitate my tracing in respect of any unclaimed benefits. The information contained herein is correct. If this application form is signed in a representative capacity, I have the necessary authority to do so and this transaction is within my powers. I will have fourteen [14] days after receipt of the investment confirmation to report any errors to PPS Investments. I am acting for my own account. I have considered the suitability of this product and have made my decision to enter into this investment without relying on any communication from PPS Investments, whether written, oral or implied, as investment advice or a recommendation to enter into the investment. I understand that information and explanations relating to the terms of an investment are not to be considered investment advice or a recommendation to enter into any transaction. PPS Investments will not be responsible for any failure, malfunction or delay of any networks, electronic or mechanical device or any other form of communication used in the submission, acceptance and processing of applications and / or transactions. PPS Investments will not be liable to make good or compensate any investor or third party for any related damages, losses, claims or expenses. I am aware of the Investment Option Schedule for the PPS Tax Free Investment Account within the Select Range (available on www.ppsinvestments.co.za), which details the Investment Option(s) available on the PPS Investments platform and sets out the fees which maybe applicable to my investment (including administration fees and asset management fees of the respective Investment Option(s)). The General Terms, Conditions and Declarations (available on www.ppsinvestments.co.za or on request from the PPS Investments Client Service Centre on 0860 468 777 or at clientservices@ppsinvestments.co.za) have been clearly understood by me. I understand the PPS Investments Investment Option Schedule which details the unit trust funds and fee information and is available on www.ppsinvestments.co.za. Application The current Administrator is PPS Investment Administrators Proprietary Limited ( the Administrator ), which is a licensed administrative Financial Services Provider and may change from time to time. I hereby apply for a PPS Tax Free Investment Account and agree to be bound by the Terms, Conditions and Declarations contained in this application form as well as PPS Investments General Terms, Conditions and Declarations (as amended from time to time). This application does not create any obligation for PPS Investments until it has been accepted in writing by PPS Investments. Product Terms and Declarations I confirm that I have noted the following: PPS Investments does not guarantee the performance of any investment. The value of my investment will increase or decrease as the market values of the underlying securities in my chosen Investment Option(s) fluctuate. Investment Options are generally medium- to long-term investments. The value of the units in these Investment Option(s) may increase or decrease and past performance is not necessarily a guide to future performance. I am aware of the impact that a downturn in the market will have on my capital. I am aware that the Administrator of the PPS Tax Free Investment Account appoints a nominee company which is responsible for holding and protecting my investments. The current nominee company is Source Nominees, and it can change from time to time. The PPS Tax Free Investment Account is a tax free investment by virtue of section 12T of the Income Tax Act. Only natural persons may invest in the PPS Tax Free Investment Account. No tax is payable on interest, dividends or realised capital gains or losses that is earned on my investment. I am responsible for ensuring that no contribution exceeds the prescribed limits, currently a maximum of R30 000 per tax year, with an overall lifetime limit of R500 000 in respect of all my tax free investment accounts with various providers. Should these limits at any time be breached penalties will occur in the form of a tax equal to 40%. Should the contributions received exceed the maximum prescribed limits, I will have an option to invest the excess contributions into the PPS Investment Account upon receipt of a signed application form by PPS Investments or the excess contribution will be refunded to my bank account. The transfer of any tax free investment to or from another provider is currently not allowed. PAGE 5 OF 7
Security cessions will be allowed but no outright cessions or loans will be allowed. Full and partial withdrawals will be allowed. All withdrawals must be requested in writing and will be disinvested following receipt and acceptance of such written instruction and subject to the requirements of the Administrator and the management company of the selected Investment Option(s) having been met. Repurchases will take place at the Net Asset Value (NAV) price calculated in accordance with the requirements of the Collective Investments Schemes Control Act and the relevant deed of the selected Investment Option(s). The proceeds from withdrawals may only be paid into a bank account held in the name of the investor. Withdrawal instructions that include a change in banking details must be accompanied by a copy of a cancelled cheque or bank statement not older than three (3) months. All death benefits will be paid into the name of the Estate Late, therefore account ownership will not be passed on to a beneficiary. L CLIENT DECLARATION I hereby confirm that I,, have read and understood: The General Terms, Conditions and Declarations; The MDD of the chosen fund(s), are included but not limited to the Total Expense Ratio (TER) and Transaction Cost (TC) applicable to my investment available on the PPS Investments website www.ppsinvestments.co.za. I also certify that the information provided in terms of FATCA is correct and that unless stated otherwise, I am not a tax resident of the United States of America. Signature of investor Date ML FINANCIAL ADVICE FEES I acknowledge that I did not receive any financial advice. I will be noted as a PPS Investments No Financial Adviser investor. I acknowledge that I have received financial advice from the financial adviser whose details are completed in the section below. This is my appointed financial adviser and I agree to the payment of advice fees as follows: Initial lump sum fee Initial debit order fee Ongoing fees per annum Max. 3% (excl. VAT) Max. 3% (excl. VAT) Max. 1% (excl. VAT) Fees must be paid from A specific Investment Option All Investment Option(s) proportionally The Administrator will pay ongoing advice fees to your financial adviser on your behalf and will recover these fees from your investment. NL FINANCIAL ADVISER DETAIL AND DECLARATION Financial adviser name Financial adviser institution Financial adviser code Contact number FSP licence number VAT status Registered Not registered VAT number I declare that I am a licensed Financial Services Provider and have made the disclosures required in terms of the Collective Investment Schemes Control Act, No. 45 of 2002; the Financial Advisory and Intermediary Services Act, No. 37 of 2002; and all subordinate legislation to the investor. I acknowledge and confirm that, in my capacity as the primary accountable institution (with the Administrator being the secondary accountable institution), I have established and verified the identity of the investor in accordance with section 21 of the Financial Intelligence Act, 2001 ( the Act ) and will keep records of such identification and verification according to the provisions of section 22 of the Act. I warrant that I have explained all fees that relate to this investment to the investor and I understand and accept that the investor may withdraw his / her authority for the payment of advice fees in writing to PPS Investments. Signature of financial adviser Date PAGE 6 OF 7
OL DETAILS OF THE AND SUPPORTING DOCUMENTATION PPS Tax-Free Investment Account bank account details Account name Professional Provident Society Investment Administrators (Pty) Ltd - PPS Tax-Free Investment Account Bank FNB Branch RMB Corporate Banking - Cape Town Branch code 204-109 Account number 625 741 690 51 Reference Contact number first, followed by your name and surname For example: 082 555 4444 John Smith Supporting documentation Copy of a bar-coded ID bearing ID number and photograph Proof of residential address (e.g. bank statement, utility bill or telephone account not older than six (6) months) Proof of bank details (e.g. bank statement or cancelled cheque not older than three (3) months) Compliance department PPS Investments Tel: 0860 468 777 (0860 INV PPS) Ground Floor, Travers House Fax: 021 680 3680 Boundary Terraces Website: www.ppsinvestments.co.za 1 Mariendahl Lane Email: compliance@ppsinvestments.co.za Newlands 7700 Please do not hesitate to contact us if you are not satisfied with this investment or the services from PPS Investments. A complaint must be submitted to the Compliance Officer. The contact address of the Compliance Officer is the same as the address above. PPS Investments will acknowledge the complaint in writing and will inform you of the contact details of the person addressing your complaint. The Ombud for Financial Services Providers If you are not satisfied with the response from PPS Investments or if you have a complaint about the advice given by your financial adviser, you have the right to address your complaint in writing to the Ombud for Financial Services Providers. The Ombud for Financial Services Providers PO Box 7451 Lynwood Ridge 0040 Email: info@faisombud.co.za The Ombud is legally empowered to investigate and adjudicate complaints in a procedurally fair, economical and expeditious manner. PPS Investments (Pty) Ltd, PPS Multi-Managers (Pty) Ltd and PPS Investment Administrators (Pty) Ltd are licensed financial services providers. PPS Management Company (Pty) Ltd (RF) is a licensed collective investment scheme manager. Ground Floor, Travers House, Boundary Terraces, 1 Mariendahl Lane, Newlands, 7700 Website: www.ppsinvestments.co.za Email: clientservices@ppsinvestments.co.za PAGE 7 OF 7