ORBIS Dear Prospective Client Investing With Orbis Thank you for choosing to invest with Orbis. To open your investment account and make an investment is a five step process. Step 1: Orbis Account Opening package Please complete the Orbis Account Opening package ensuring the Account Opening, Subscription and W-8BEN forms are signed by authorised signatories. The terms and conditions establish the basis upon which you invest in the Orbis Funds. Step 2: Anti-Money Laundering (AML) documentation Orbis is required by law to obtain AML documentation from our prospective clients prior to accepting subscriptions. You should contact the Allan Gray Orbis Service Team to establish the AML documents required for your account opening. Step 3: Original documentation Please post or courier the original Orbis Account Opening package and all relevant AML documentation to the Allan Gray Orbis Service Team at the following address: Attention: The Allan Gray Orbis Service Team Allan Gray Proprietary Limited V&A Waterfront PO Box 51605 Cape Town, 8002 South Africa Step 4: Client Identification Number Once your original Orbis Account Opening package has been received in good order and approved, the Allan Gray Orbis Service Team will send you written confirmation of your Orbis client identification number. Please quote this number in all future correspondence with the Allan Gray Orbis Service Team. Step 5: Send monies for your subscription Guidance on sending your subscription monies, including Orbis subscription account details, bank currency routing information and subscription cut-off times are included with the Subscription Form. If you have any questions, please contact the Allan Gray Orbis Service Team on 0860 000 654 (international +27 21 415 2301) or offshore_direct@allangray.co.za. Yours sincerely Allan Gray Orbis Service Team
Orbis Funds Account Opening Form Please complete the form in BLOCK capitals 1. Investor details Registered name This is the name of the applicant (the individual that will directly hold the interests in an Orbis Fund(s)). The name should be printed exactly as it should appear on the Orbis Funds share register. For all purposes of this Account Opening Form, an individual is a natural person. Address Physical address of the applicant PO boxes and c/o addresses cannot be used. Documentation regarding the applicant s account will be mailed to this address unless a preferred mailing address is provided below. City/town Province/state/county Country Post code/zip code Preferred mailing address of the applicant 1 PO Boxes or c/o addresses may be used. City/town Province/state/county Country Post code/zip code Primary contact details Correspondence will be for the attention of this contact. Title First name(s) Surname Primary email 2 Additional email 2 Business number Mobile/cell number Home number 1 For investments in the Orbis SICAV Funds, regulations require Orbis to post annual and special general meeting notices, annual reports and all other proxy materials to the applicant. 2 By providing an email address, the applicant agrees to receive emailed documentation from Orbis and Citi, and receive a copy of the contract note via email. If an email address is not provided, the contract note will be sent to the applicable mailing address. Read the electronic communications terms in section 11.e. 2. Reporting and Online Services Preferences Reporting preferences Summary of investments Tick for the applicant to receive a monthly statement via email. To automatically receive our Fund reports and news updates, please register for an online account at www.orbis.com. Once registered, simply select Your Account at the top right-hand side of the homepage, navigate to Your Report Preferences under Your Settings, and confirm which reports you would like to receive by email. Online services preferences Online Services - Instruct and View 1 The applicant agrees that the individual identified under Primary contact details in section 1 will be an authorised user for the applicant s account. Instruct and View access provides authority to view account information, submit transactions and make changes to static data (such as email or registered address) online. The primary email address provided for that authorised user will act as their username. The terms of online services are described in section 11.e. Online Services - View Only The applicant agrees that the individual identified under Primary contact details in section 1 will be an authorised user for the applicant s account. View Only access provides authority to view account information online only and not submit transaction or make changes to static data (such as email or registered address) online. The primary email address provided for that authorised user will act as their username. The terms of online services are described in section 11.e. 1 Please note that the Online Services - Instruct and View option is only available to eligible applicants and may require additional anti-money laundering documentation. For this option the primary contact must be a named individual and not a group or team name. The Allan Gray Orbis Service Team will contact the applicant if this affects them. 3. Electronic communications The applicant would like to be able to fax future instructions to Citi and fax other communications to Orbis. The ability to submit instructions and other communications by fax may be limited as specified to the applicant at the time of opening an Orbis investment account. Please read the electronic communications terms in section 11.e. Yes No 4. Dividend preferences Tick for the applicant to receive cash dividends paid by the Funds. If not selected, dividends will be reinvested 1. 1 Certain applicant jurisdictions prohibit the reinvestment of dividends. The Allan Gray Orbis Service Team will contact the applicant if this affects them. Account Opening Form_AGL - 1 Jan 2016 Page 1 of 6
5. Banking details Orbis Funds Account Opening Form Complete the authorised banking details to be used for redemption and dividend payments. Bank name and address Account number Account currency SWIFT/BIC Account name The bank account must be in the registered name shown in section 1. IBAN number Sort code ABA/FED code Other bank code Please specify. 6. Additional contacts Please complete this section if the applicant wants to authorise additional contacts to receive specific information, or grant online services, for this account. The terms of online services are described in section 11.e. Online Services - Instruct and View: provides authority to view account information, submit transactions and make changes to static data (such as email or registered address) online. Online Services - View Only: provides authority to view account information only and not submit transactions or make changes to static data (such as email or registered address) online. To automatically receive our Fund reports and news updates, please register for an online account at www.orbis.com. Once registered, simply select Your Account at the top right-hand side of the homepage, navigate to Your Report Preferences under Your Settings, and confirm which reports you would like to receive by email. Contact Details Reports and Online Services Title Email 1 Full name Contract notes Summary of investments Online Services - Instruct and View 2 Online Services - View Only Title Email 1 Full name Contract notes Summary of investments Online Services - Instruct and View 2 Online Services - View Only Title Email 1 Full name Contract notes Summary of investments Online Services - Instruct and View 2 Online Services - View Only Title Email 1 Full name Contract notes Summary of investments Online Services - Instruct and View 2 Online Services - View Only 1 The provision of an email address constitutes the contact s agreement to the receipt of documents terms in section 11.e. Please note that the contact s email address will act as the username for their online account when requesting online services. If the contact has an existing online account, the username will be updated to match the email address provided above. 2 Please note that the Online Services - Instruct and View option is only available to eligible applicants and may require additional anti-money laundering documentation. For this option a named individual must be associated with the username. The Allan Gray Orbis Service Team will contact the applicant if this affects them. Account Opening Form_AGL - 1 Jan 2016 Page 2 of 6
Orbis Funds Account Opening Form 7. Beneficial ownership Tick the box if the applicant is the beneficial owner of the shares to be held in this account (i.e. the applicant is the legal owner of the shares and the only individual(s) who will derive the economic benefit of the shares owned). 8. Confirmation of compliance The following information is required as part of our compliance obligations under (i) the U.S. Foreign Account Tax Compliance Act ( FATCA ), (ii) the OECD Common Reporting Standard ( CRS ), (iii) for the Luxembourg SICAV funds only, the EU Directive on Administrative Cooperation ( DAC ) and (iv) for the Bermuda funds only, the Agreement between the Government of the United Kingdom of Great Britain and Northern Ireland and the Government of Bermuda to Improve International Tax Compliance (the UK-Bermuda IGA ). The applicant will also be asked to provide an IRS Form W-8 (non-us persons) or W-9 (US persons), on which the applicant will be asked to certify its tax status. Failure to complete this form, or to provide the requested documentation, could indefinitely delay or prevent us from opening the account. Tax Residency Please provide us with tax residency information for the applicant: Please list below all of the countries in which the applicant is considered to be tax-resident, and the associated tax identification number (or its functional equivalent, such as a National Insurance or Social Security Number) in each of those countries. If you are not considered tax-resident in any country or are unable to provide a tax identification number, please specify N/A and provide an explanation as to why in the Tax Identification Number column. Name Country Tax Identification Number (where applicable) Consent to Reporting Under FATCA, accounts that are considered to be owned by US persons or by persons who fail to comply with FATCA-related documentation or information requests ( Recalcitrant Account Holders ), may be required to be reported to the US Internal Revenue Service ( IRS ), as are certain payments to Recalcitrant Account Holders. From 2017, withholding tax at a rate of 30% may also apply to these payments. Additionally, information on reportable account holders invested in the Orbis SICAV Funds will be collected and transferred in accordance with the Inter-Governmental Agreement between Luxembourg and the US. Under similar rules proposed by the OECD (referred to as the Common Reporting Standard or CRS ), accounts that are considered to be owned by persons that are tax-resident in one or more jurisdictions that have opted to participate in the CRS will be required to be reported to the tax authorities in those jurisdictions. Additionally, to the extent that any account is considered to be owned by a UK tax-resident individual, information relating to that person which is required to be reported under UK regulation 6 will be reported to HMRC, and may be transferred to the government of another territory in accordance with a relevant agreement. The information required to be reported under each of these regimes includes: Name, address and taxpayer identification number (or its functional equivalent); Account number; Year-end account balance or value; and Gross payments on the account. By ticking this box, the applicant hereby consents to such reporting. Please note that we will not be required to report an account to the applicable tax authorities if the applicant provides all requested information and documentation, and the account is not, and does not become, owned by a person that is considered to be a US person, or tax-resident in the UK or any other country participating in the DAC or CRS. Please note that if the applicant does not tick this box, the account may not be opened. Changes in Circumstance Notification Obligation Under FATCA, CRS, DAC and the UK-Bermuda IGA, the applicant is obligated to notify us of any change in circumstances that affects any information provided in these account opening documents or on a Form W-8 or W-9 (or any related documentation) submitted in connection with the Orbis account(s) (including the FATCA status indicated therein). The applicant is required to notify us within 30 days of any such change in circumstances, and to provide updated documentation. By signing this Account Opening form, the applicant will be considered to acknowledge and agree to this notification requirement. Legal Disclaimer The information given in this section does not constitute legal or tax advice. Also, any discussion of tax matters in this document is not intended or written to be used, and cannot be used, for the purpose of avoiding any tax penalties that may be imposed. Accordingly, each applicant should seek advice based on its particular circumstances from an independent tax advisor. 9. confirmation of eligible investor status Please tick the box beside the applicable statements, as confirmation of the applicant s eligibility to invest in the Orbis Funds. Must be completed by all applicants The applicant has reviewed the eligible investor status terms in section 11.c and meets the applicable eligibility criteria. The applicant has a single investment decision maker. Investment decision maker means an individual or group of individuals who control the applicant s decision to invest into, or divest from, the Orbis Funds. The investment decision maker s location is the country where the applicant is ordinarily resident. If the investment decision maker is a group of individuals, then the investment decision maker s location is the country where that group of individuals principally makes its investment decisions. The investment decision maker s location is (the applicant must select only one): The same country as the physical address provided in section 1. The following country:. Account Opening Form_AGL - 1 Jan 2016 Page 3 of 6
Orbis Funds Account Opening Form 10. Authorisation The applicant confirms that all information provided in this form is accurate and understands that if there are any changes to this information, this must be communicated in writing to Citi. The applicant accepts that their account and investment in the Orbis Funds will be governed by the terms of this form, the current prospectus for the invested Orbis Fund(s), the articles of incorporation, and the memorandum and articles of association and/or bye-laws of the invested Orbis Fund(s). The applicant confirms they have had the opportunity to receive, read, and understand these documents. If the applicant needs copies of any of these documents, please contact the Allan Gray Orbis Service Team. The undersigned individual(s) confirm that they have full power and authority to execute this form in the capacity in which they are doing so and to bind the applicant and elect any additional contacts as agreed herein. Only undersigned individual(s) will be authorised to issue future instructions for the account unless the undersigned individual(s) provide a power of attorney to add another signatory with this form. The applicant agrees to notify Citi within five business days if the representations, warranties and confirmations in this form cease to be true and accurate and understands that the Orbis Funds reserve the right to redeem the applicant s entire holdings if the representations, warranties and confirmations are or become untrue. The applicant has read and accepts the obligations in the terms and conditions of this form and consents to the disclosure of the applicant s personal data in accordance with data protection terms and conditions. Applicant s signature(s) Print signatory s name Day Month Year Send original completed and signed Account Opening Form to the Allan Gray Orbis Service Team: Attention: The Allan Gray Orbis Service Team Allan Gray Proprietary Limited V&A Waterfront PO Box 51605 Cape Town, 8002 South Africa 11. Terms and conditions a. General subscription terms For further assistance, contact the Allan Gray Orbis Service Team: Email: offshore_direct@allangray.co.za Phone: 0860 000 654 (international +27 21 415 2301) Website: www.orbis.com 1. The rights and obligations of applicants and shareholders of the Funds (including any non-contractual obligations) shall be governed by the laws of the jurisdiction of the applicable Fund regardless of where the account is opened or the citizenship, domicile or residency of the applicant(s) or shareholder(s). If any Orbis form is not dated in the space provided, it is deemed to bear the date on which it is first received by Citi. Citi s record of such date shall be conclusive. 2. Dividends from a Fund will automatically be reinvested in additional shares of the Fund unless (a) the applicant completes section 4 of this form (b) sends subsequent written instructions to Citi to receive a cash dividend or (c) the applicant s jurisdiction prohibits the reinvestment of dividends. If the applicant chooses to receive cash dividends, they will be paid by wire transfer. 3. Subscriptions will only be processed after Citi has received an original signed Subscription Form. Applicants who have elected to communicate via electronic communications in this form may send their Subscription Forms by fax to the number indicated in section 4 of the Subscription Form. The applicant should contact Citi to ensure that their faxed communication has been properly received. b. Data protection terms 1. In accordance with the Luxembourg law of 2 August 2002 on the protection of persons with regard to the processing of personal data, Orbis SICAV, the data controller, collects, stores and processes the data the applicant supplies, as well as data relating to the applicant s transactions with the Orbis Group and others. The processed data includes the applicant s name, contact details, banking details and the amount invested. The processing of the data is necessary to service Orbis SICAV shareholders. 2. The applicant s personal data is processed for the purposes of (a) maintaining the register of shareholders (b) processing share subscriptions, redemptions, conversions and dividend payments (c) maintaining controls in respect of late trading and market-timing practices and (d) complying with applicable antimoney laundering rules. 3. By signing this form, the applicant consents to personal data being transferred to employees and consultants responsible for client service and/or relationship management of Orbis Investment Advisory (Pty) Limited in Australia, Orbis Investment Advisory Limited and Orbis Portfolio Management (Europe) LLP in the United Kingdom, Orbis Investments (Canada) Limited and Orbis Investment Advisory (Canada) Limited in Canada, Orbis Investment Management Limited and Orbis Investment Management (B.V.I) Limited in Bermuda, Orbis Investment Management (Luxembourg) S.A. in Luxembourg and Orbis Investment Management (U.S.), LLC in the USA, as well as to Citi entities and affiliates based in India, Ireland, Luxembourg, the United Kingdom and the United States, and any of their successors carrying out their functions, which persons may be outside those jurisdictions. The data comprises the information which the applicant provides on the original Account Opening Form, Subscription Forms, Switch Forms, Redemption Forms and Transfer Forms, identification documentation and on the applicant s transaction and account related instructions such as address changes, contract notes and trade confirmations. Such transfers take place to provide the applicant with the requested services or information efficiently and to comply with legal requirements. Orbis SICAV will not transfer the applicant s personal data to any third parties other than those mentioned above, except to comply with legal requirements or with the applicant s prior consent. Wherever the applicant s personal data is processed, it will be kept confidential and secure. Orbis SICAV will not sell the applicant s data to anyone. Personal data will not be retained for periods longer than those required for the purposes of its processing, subject to any limitation periods imposed by law. Account Opening Form_AGL - 1 Jan 2016 Page 4 of 6
Orbis Funds Account Opening Form 4. The applicant has the right to access their personal data. To do this, the applicant may contact the Allan Gray Orbis Service Team by telephone on 0860 000 654 (international +27 21 415 2301), by email at offshore_direct@allangray.co.za or by mail to the Allan Gray Orbis Service Team, PO Box 51605, V&A Waterfront, Cape Town 8002, South Africa. 5. Personal information of applicants who are not investors in the Orbis SICAV will be processed in compliance with Orbis privacy policy which is available from Orbis or which may be downloaded from the website www.orbis.com. This may include disclosure to other Orbis companies and non-affiliated parties in certain circumstances. c. Eligible investor status terms 1. This application is not being made by any person under the age of 18 years. If this is an application for shares in an Investor Share Class, this application is not being made by, on behalf of or for the benefit of, directly or indirectly, a US Person. 2. A US person includes (a) a US person for purposes of US Federal income tax (b) a US Person under Rule 902 under the US Securities Act of 1933, as amended (c) any discretionary account that is managed by another person for the benefit of a person resident in the United States and (d) any person who does not meet the definition of non-united States person as defined in Rule 4.7 under the US Commodity Exchange Act, as amended. A false statement or misrepresentation of tax status by a US person could lead to penalties under US law. If the applicant s tax status changes and the applicant becomes a US citizen or a resident, the applicant must notify Orbis and Citi within 30 days. d. Release of client specific information terms 1. Orbis policy is to disclose information on an applicant s investments only to those authorised to receive it. 2. Orbis will release information to: the applicant s current authorised signatories individuals who have been given permission to receive client specific information in section 1 and section 6 of this form, via an Orbis Standing Authorisation Form or other acceptable authorisation letter signed by current authorised signatories. 3. Orbis shall have no duty or obligation to enquire into (a) the authenticity of any oral or written request to release information that Orbis believes to be genuine or (b) the authority of any person purporting to represent or act as an agent for any authorised recipient, provided that Orbis has no reasonable basis to believe that such authority does not exist. 4. The applicant may at any time (a) change the list of authorised recipients or (b) limit an authorised recipient s authority. Orbis shall not be deemed to have notice of any change of authorised recipient or limitation of authority until it receives written notice of the change signed by the applicant s authorised signatories (as reflected in Orbis records immediately prior to receiving such notice). e. Electronic communications terms 1. Request for electronic communications capability and acceptance of risks. The applicant requests the ability to send instructions for trading in the Orbis Funds (subscriptions, switches, transfers and redemptions) to Citi and other instructions to Citi and Orbis (e.g. requests for reports, change of address notices) in the form of electronic communications (including via fax and/or via the Orbis website) and to have them acted upon instead of the usual requirement of physically delivering original signed instructions. The applicant authorises Citi and Orbis to rely on instructions contained in electronic communications on these terms. The applicant understands that they may still elect at any time to physically deliver originals. The applicant understands and accepts that using and relying on electronic communications involves increased risk of fraud and of miscommunications including those due to a telecommunications system or equipment failure, misdirected communications or illegibility of the instructions or documents. 2. Right of Citi or Orbis to not act on electronic communications and copies. The applicant understands and agrees that Citi or Orbis or both may choose not to rely on electronic communications. If this is the case, Citi and Orbis agree that, whichever of them elects not to act upon the electronic communications, they will try to contact the applicant on the same day to advise the applicant of their decision. The applicant will not hold Citi or Orbis (and they will not be) responsible if they choose not to act on electronic communications. 3. Receipt of documents. The applicant acknowledges that the applicant and any additional contacts that the applicant has authorised may receive electronic information on their investment in, or correspondence regarding, the Fund(s). All correspondence from Citi or Orbis may be sent without encryption unless the applicant requests otherwise. The applicant understands and accepts that receiving and relying on electronic communications involves increased risk of fraud and of miscommunications including those due to a telecommunications system or equipment failure, unauthorised interception, misdirected communications or infections with viruses or corruption in any other manner. 4. Allocation of risk. The applicant agrees to bear the risks associated with using and relying on electronic communications or copies of documents except where Citi or Orbis is grossly negligent or wilfully default in undertaking their respective responsibilities. The applicant agrees that, except where Citi or Orbis is grossly negligent or wilfully default, they will not be responsible for any loss or liability the applicant incurs due to an electronic communications transmission error or due to Citi or Orbis relying on an instruction sent by electronic communications which they believe in good faith to be genuine. 5. Online services terms. In addition to the foregoing, with respect to the use of online services, the applicant agrees to abide by the terms and conditions of its Orbis account and the website terms of use in effect from time to time as posted on the website at www.orbis.com. In the event of any conflict between the terms in this form and the website terms of use then in effect, the website terms of use shall govern. The applicant acknowledges that use of the services by them or their authorised users constitutes acceptance of the terms and conditions in effect at that time. Orbis will, as soon as possible, cancel access to the services if a request is sent to Orbis. In the event that online services (including online transacting) is not available for any reason, the applicant and additional contacts that have access to online services will not be able to view account information, submit transactions or make changes to static data. However, this does not affect authorised signatories who may otherwise transact by submitting a completed form, as described in the applicable Fund s prospectus. Account Opening Form_AGL - 1 Jan 2016 Page 5 of 6
f. Investment threshold terms Orbis Funds Account Opening Form Please visit www.orbis.com to view the minimum investment amount required to open an account with Orbis and the minimum holding requirement per Orbis Fund. Future redemptions and transfers of Orbis Fund shares which would cause the applicant s holdings to drop below any individual Orbis Fund or share class minimum holding threshold will be declined. This will not restrict the applicant from redeeming or transferring their entire Orbis holdings. g. Interpretation In these Terms and Conditions: Citi means each of Citibank International Limited, Luxembourg Branch, Citi Fund Services Ohio, Inc. and Citigroup Pty Ltd., their respective subsidiaries or affiliates from time to time and any successor to any of them. Electronic communications means any communications sent via an electronic communications network or carrier or other existing or subsequently developed remote communications methods. Orbis means any collective investment scheme managed by a member of the Orbis Group and any member of the Orbis Group. Orbis Group means the Orbis group of companies and entities from time to time in existence and including but not restricted to Orbis Holdings Limited, Orbis Investment Management Limited, Orbis Investment Management (B.V.I.) Limited, Orbis Investment Advisory Limited, Orbis Asset Management Limited, Orbis Investments (Canada) Limited, Orbis Investment Advisory (Canada) Limited, Orbis Portfolio Management (Europe) LLP, Orbis Investment Management (Luxembourg) S.A., Orbis Investment Management (U.S.), LLC, their subsidiaries and affiliates and any successors to any of them. Account Opening Form_AGL - 1 Jan 2016 Page 6 of 6
Orbis Funds Subscription Form For clients serviced by Allan Gray Proprietary Limited only Investors who are not currently registered Orbis Fund shareholders must complete an Orbis Account Opening Form Please complete the form in BLOCK capitals 1. Account details Client identification number Insert the client identification number as it appears on the investor s most recent contract note or welcome letter. Registered name Print the registered name as it appears on the investor s most recent contract note. If this is the investor s initial investment, print name as it appears on the Account Opening Form. 2. Subscription instructions Subscription details Print the full Fund name(s) and share class(es) (if applicable) the investor would like to invest in, including the currency and amount that will be remitted. Orbis Fund 1 Insert full Orbis Fund name and share class (if applicable) Currency Remitted 2 Amount Desired dealing day The Orbis Funds dealing day is Thursday. The subscription will be processed on the next available dealing day unless a specific Thursday is noted in the date box below. The Subscription Form 1 and subscription proceeds 2 must be received and validated by Citi before the applicable cut-off times. Day Month Year 1 See sections 5, 6 and 7 for the full Orbis Fund names, investment minimums, form cut-off times, representations and other important information. 2 See section 8 for the cut-off times for receipt of subscription proceeds. This differs by currency. 3. Source of wealth Select the source of the wealth for the investor s subscription by ticking the applicable box(es) below. This is required for anti-money laundering compliance. Salary or bonus Loan Profit from sale of property Profit from sale of investment Savings Inheritance or gift Profit from sale of business Investment income (e.g. dividends, interest) Other (please specify) 4. Authorisation The investor accepts that this subscription will be governed by the terms of this form, the current prospectus, articles of incorporation, memorandum and articles of association and/or bye-laws of the invested Orbis Fund(s). Orbis SICAV investors specifically consent (i) to the provision of the current prospectus and Key Investor Information documents on the Orbis website, and (ii) if subscribing in the capacity of an Institutional Investor, that they are eligible to do so pursuant to the definition provided under Appendix I of the General Information document. The investor confirms they have had the opportunity to receive, read and understand these documents. If the Investor needs copies of any of these documents, please contact the Allan Gray Orbis Service Team. The investor confirms there has been no change in the beneficial ownership of the shares held in the Orbis Fund(s) and that the representations, warranties and confirmations in the Account Opening Form (or where the investor has not completed an Account Opening Form, the investor s most recently submitted Subscription Agreement or form) remain true and accurate. The investor (a) confirms that the applicable representations in section 6 are true and accurate and (b) acknowledges the notes in section 7. Authorised signature(s) Print signatory s name and title Day Month Year Fax the completed form to the Allan Gray Orbis Service Team: 021 415 4950 (international +27 21 415 4950), or if the investor has not elected to transact via electronic communications the original must be sent to: Attention: The Allan Gray Orbis Service Team Allan Gray Proprietary Limited V&A Waterfront PO Box 51605 Cape Town, 8002 South Africa For further assistance, contact the Allan Gray Orbis Service Team: Email: offshore_direct@allangray.co.za Phone: 0860 000 654 (international +27 21 415 2301) Website: www.allangray.co.za Subscription Form _AGL- 1 Jan 2016 Page 1 of 4
Orbis Funds Subscription Form 5. Information table Please note that not all Funds and share classes are available to all investors in all jurisdictions. Please visit www.orbis.com to view the Funds and share classes available in your jurisdiction and the applicable minimum investment required to open an account. Persons will only be permitted to subscribe for shares in the Orbis Funds under certain circumstances as determined by, and in compliance with, applicable law. Investor Share Class Funds Non-SICAV (Bermuda domiciled) SICAV (Luxembourg domiciled) Orbis Global Equity Fund Orbis SICAV Asia ex-japan Equity Fund Orbis Optimal SA (Euro) Fund Orbis SICAV Japan Equity (Euro) Fund Orbis Optimal SA (US$) Fund Orbis SICAV Japan Equity (Yen) Fund Orbis SICAV Global Balanced Fund Minimum investment amount: USD50,000 per Fund or equivalent. Subsequent subscriptions: USD1,000 per Fund or equivalent, but does not need to be in multiples of USD1,000. Dealing day: Thursdays. Subscription Form Cut-off Times The Allan Gray Orbis Service Team must send your signed and completed forms to Citi before the below cut-off times. As such, please send your forms to the Allan Gray Orbis Service Team at least two hours in advance of the form cut-off time. Alternatively, if you have elected to transact via electronic communications, you can fax your forms directly to Citi at +35 316 22 4034 by the below cut-off times. Non-SICAV (Bermuda domiciled) SICAV (Luxembourg domiciled) 5.00pm (Bermuda time) 5.30pm (Bermuda time) 10.30pm Luxembourg time on the dealing day (or 9.30 pm Luxembourg time on any dealing days that fall in between the time Bermuda and Luxembourg adopt daylight savings time) 6. Representations The investor represents that the following statements are true and accurate for each fund into which they are subscribing as set forth in section 2. As used in the representations below, investment decision maker means an individual or group of individuals who control the applicant s decision to invest into, or divest from, the Orbis Funds. This includes, but is not limited to, trustees, investment committees and advisors. This excludes discretionary platforms that aggregate assets that are sourced from individual underlying investors when such investors have the ability to choose to invest in (or divest from) the Orbis Funds. If the investment decision maker is an individual, then the investment decision maker s location is the country where that individual is ordinarily resident. If the investment decision maker is a group of individuals, then the investment decision maker s location is the country where that group of individuals principally makes its investment decisions. Fund Orbis Global Equity Fund Orbis Optimal SA (Euro) Fund Orbis Optimal SA (US$) Fund Orbis SICAV Asia ex-japan Equity Fund Orbis SICAV Japan Equity Fund Orbis SICAV Global Balanced Fund Representation Either: (a) the investment decision maker is not located in any country of the EEA or (b) the investment decision maker is, or is acting on behalf of a beneficial owner who is, currently invested in the Fund. Either: (a) the investment decision maker is a person or entity that is regarded as a resident of Africa under applicable taxation laws or (b) the investment decision maker is, or is acting on behalf of a beneficial owner who is, currently invested in the Fund. Either: (a) the investment decision maker is not located in any country of the EEA other than Sweden, Ireland, Luxembourg, the Netherlands, Norway or the United Kingdom, or (b) the investment decision maker is, or is acting on behalf of a beneficial owner who is, currently invested in the Fund. 7. Notes to Subscription Form Investment This form must be used for initial and subsequent subscriptions in the Orbis Funds. Additional copies of this Subscription Form, the Orbis Funds prospectuses and the Orbis SICAV Key Investor Information documents may be found at www.orbis.com/investingwithus/forms or requested from the Allan Gray Orbis Service Team free of charge. Citi reserves the right to request additional information to verify the identity of the investor, source of payment and source of funds. Citi will not accept a subscription until the investor provides originals of the requested information. Funds received without requested original documents will be held for two dealing days then returned. Investors will be informed by the Allan Gray Service Team of the supporting documents required. For a subscription to be considered acceptable on a dealing day, a correctly completed Subscription Form together with the requisite payment confirmation must be received at Citi by the applicable cut-off time. The Subscription Form cut-off times and other important Fund information can be found in section 5. The cut-off time for the currency being remitted can be found in section 9 of this form. The cut-off time for the form and receipt of subscription proceeds can be different depending on the currency remitted. Payment The investor must wire funds to Citi by the cut-off times shown in section 9 of this form. Orbis subscription accounts and bank currency routing information may be found in sections 8 and 9 of this form. The subscription must be in accordance with the terms of the prospectus of the Fund shares being acquired in order for the subscription to be accepted on that dealing day. All payments must include a reference to the registered name and Orbis client identification number provided in section 1. Subscription funds Subscription Form _AGL- 1 Jan 2016 Page 2 of 4
Orbis Funds Subscription Form received that cannot be applied to the Orbis Funds subscription account using straight through processing due to errors in wire formatting will be repaired and applied to the subscription account on a best efforts basis. There is no guarantee that the monies will be repaired and applied to the Orbis Funds subscriptions account prior to the cut-off time, in which event the investor s subscription will be delayed. Citi and Orbis reserve the right to request anti-money laundering documentation when subscription proceeds are not sent from an account held in the name of the investor shown in section 1 (registered name). Where subscription proceeds are sent from a person or entity other than the registered investor and Orbis and Citi do not have anti-money laundering documentation for the third party there may be a delay in the matching of the subscription proceeds. This could result in the investor missing their desired dealing day. The investor should contact the Allan Gray Service Team if sending subscription proceeds from a bank account that is not in their name. South Africa Investment If (a) the investor is subscribing for shares of one or more of the following funds: Orbis Global Equity Fund, Orbis Optimal SA Fund (Euro or US$), Orbis SICAV Asia ex-japan Fund, Orbis SICAV Japan Equity Fund (Euro or Yen) or Orbis SICAV Global Balanced Fund and (b) the investor and/or the investor s investment decision maker is located in South Africa, then the investor acknowledges receiving (via the www.orbis.com website) and understanding the Minimum Disclosure Document that relates to said Fund(s). The investor further agrees to the delivery of said document(s) via the website. Subscription Form _AGL- 1 Jan 2016 Page 3 of 4
Orbis Funds Subscription Form 8. Important guidance on sending subscription monies You should select the relevant currency details from section 8 for the currency in which you will be sending funds. All money transfer instructions need to include: 1. Beneficiary account name: Orbis Funds [Cur] Subscriptions 2. Payment details line: [Your Orbis registered name] 3. Payment details line: [Your Orbis client identification number] Sample instruction: Currency: Account number: Beneficiary bank: SWIFT: Routing code: Beneficiary account name: Payment details line 1: Payment details line 2: USD 30722012 Citibank New York CITIUS33 ABA 021 000 089 Orbis Funds USD Subscriptions [Your Orbis registered name] [Your Orbis client identification number] Matching: Anti-money laundering rules require funds be sent from an account in the name of the registered shareholder. If this is not possible, you should contact the Allan Gray Service Team prior to sending funds. Timing: Instruct your bank to remit funds in time to be received by the beneficiary bank for credit to the beneficiary account name PRIOR to the relevant cut-off time for receipt of funds or acceptable form of payment on the Orbis Fund dealing day on which you intend to subscribe. 9. Orbis subscription accounts and bank currency routing information Australian Dollar - AUD Canadian Dollar - CAD Swiss Franc - CHF Bank: Citibank N.A. London Swift: CITIGB2L A/C Name: Orbis Funds AUD Subscriptions A/C Number: 11809849 IBAN: GB98CITI18500811809849 AUD subscription proceeds by 4.00pm (GMT) on the day PRIOR to the dealing day. If the dealing day and/ or one of the days leading up to it is a public holiday in Australia and/or the United Kingdom you may have to remit your funds earlier. Please check with your bank on how this may affect you. Bank: Citibank Canada Swift: CITICATT A/C Name: Orbis Funds CAD Subscriptions A/C Number: 2015277033 CAD subscription proceeds by the form cut-off time on the dealing day. If the dealing day and/or one of the days leading up to it is a public holiday in Canada you may have to remit your funds earlier. Please check with your bank on how this may affect you. Euro - EUR British Pound - GBP Japanese Yen - JPY Bank: Citibank N.A. London Swift: CITIGB2L A/C Name: Orbis Funds EUR Subscriptions A/C Number: 11809784 IBAN: GB10CITI18500811809784 EUR subscription proceeds by 3.00pm (GMT) on the dealing day. If the dealing day and/or one of the days leading up to it is a public holiday in Europe and/or the United Kingdom you may have to remit your funds earlier. Please check with your bank on how this may affect you. Bank: Citibank N.A. London Swift: CITIGB2L Sort Code: 18-50-08 A/C Name: Orbis Funds GBP Subscriptions A/C Number: 11809865 IBAN: GB54CITI18500811809865 GBP subscription proceeds by 3.00pm (GMT) on the dealing day. If the dealing day and/or one of the days leading up to it is a public holiday in the United Kingdom you may have to remit your funds earlier. Please check with your bank on how this may affect you. Bank: Citibank N.A. London Swift: CITIGB2L BC: 89095 A/C Name: Orbis Funds CHF Subscriptions A/C Number: 11809881 IBAN: CH9289095000011809881 CHF subscription proceeds by 12 noon (GMT) on the dealing day. If the dealing day and/or one of the days leading up to it is a public holiday in Switzerland and/or the United Kingdom you may have to remit your funds earlier. Please check with your bank on how this may affect you. Bank: Citibank N.A. London Swift: CITIGB2L A/C Name: Orbis Funds JPY Subscriptions A/C Number: 11809806 IBAN: GB95CITI18500811809806 JPY subscription proceeds by 4.00pm (GMT) on the day PRIOR to the dealing day. If the dealing day and/or one of the days leading up to it is a public holiday in Japan and/or the United Kingdom you may have to remit your funds earlier. Please check with your bank on how this may affect you. US Dollar USD Bank: Citibank New York Swift: CITIUS33 ABA: 021 000 089 A/C Name: Orbis Funds USD Subscriptions A/C Number: 30722012 USD subscription proceeds by the form cut-off time on the dealing day. If the dealing day and/or one of the days leading up to it is a public holiday in the United States you may have to remit your funds earlier. Please check with your bank on how this may affect you. Subscription Form _AGL- 1 Jan 2016 South African Rand - ZAR Bank: Citibank N.A. London Swift: CITIGB2L A/C Name: Orbis Funds ZAR Subscriptions A/C Number: 11809822 IBAN: GB51CITI18500811809822 ZAR subscription proceeds by 8.30am (GMT) on the dealing day. If the dealing day and/or one of the days leading up to it is a public holiday in South Africa and/or the United Kingdom you may have to remit your funds earlier. Please check with your bank on how this may affect you. Page 4 of 4
Form W-8BEN (Rev. February 2014) Department of the Treasury Internal Revenue Service Do NOT use this form if: Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) For use by individuals. Entities must use Form W-8BEN-E. Information about Form W-8BEN and its separate instructions is at www.irs.gov/formw8ben. Give this form to the withholding agent or payer. Do not send to the IRS. OMB No. 1545-1621 Instead, use Form: You are NOT an individual................................. W-8BEN-E You are a U.S. citizen or other U.S. person, including a resident alien individual................... W-9 You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the U.S. (other than personal services)................................. W-8ECI You are a beneficial owner who is receiving compensation for personal services performed in the United States....... 8233 or W-4 A person acting as an intermediary............................... W-8IMY Part I Identification of Beneficial Owner (see instructions) 1 Name of individual who is the beneficial owner 2 Country of citizenship 3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address. City or town, state or province. Include postal code where appropriate. Country 4 Mailing address (if different from above) City or town, state or province. Include postal code where appropriate. Country 5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions) 6 Foreign tax identifying number (see instructions) 7 Reference number(s) (see instructions) 8 Date of birth (MM-DD-YYYY) (see instructions) Part II Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions) 9 I certify that the beneficial owner is a resident of within the meaning of the income tax treaty between the United States and that country. 10 Special rates and conditions (if applicable see instructions): The beneficial owner is claiming the provisions of Article of the treaty identified on line 9 above to claim a % rate of withholding on (specify type of income): Explain the reasons the beneficial owner meets the terms of the treaty article:. Part III Certification Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that: I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or am using this form to document myself as an individual that is an owner or account holder of a foreign financial institution, The person named on line 1 of this form is not a U.S. person, The income to which this form relates is: (a) not effectively connected with the conduct of a trade or business in the United States, (b) effectively connected but is not subject to tax under an applicable income tax treaty, or (c) the partner s share of a partnership's effectively connected income, The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty between the United States and that country, and For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions. Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner. I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect. Sign Here Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY) Print name of signer Capacity in which acting (if form is not signed by beneficial owner) For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25047Z Form W-8BEN (Rev. 2-2014)