PAGE 1 Voluntary Investment Plan Application Form 1. IMPORTANT INFORMATION • Please read the Terms and Conditions booklet which apply to this investment. This is available from your Financial Adviser, the Client Services Centre at 0860 774 774 or at www.psg.co.za. • PSG Invest (Pty) Ltd, an authorised administrative financial services provider, is the Administrator of this product. • PSG Invest allows investors to access a range of portfolios from a number of managers through one administrative platform. • Please complete all relevant sections of this application form in order to process this investment. • Please submit instructions for processing to [email protected]or fax to 011 996 5499. • For enquiries, please email [email protected]or contact one of our consultants on 0860 774 774. • The Administrator will only process this application form when all required documentation is received and once the money reflects in the Administrator’s bank account. 2. INVESTOR DETAILS Personal details Contact details Title Initials Home phone First names Work phone Surname (or registered name of entity) Fax Cellphone ID number (or registration number) Email address Date of birth Marital status Income tax number Tax status Gender Nationality Physical address Postal address Line 1 Line 1 Line 2 Line 2 Suburb Suburb City City Region Region Area code Area code Are you exempt from Dividend withholding Tax (‘DWT’), or qualify for a reduced withholding tax rate? If ‘yes’, please request the relevant form from your Financial Adviser, or the Client Service department. Yes No Do you or any controlling persons associated with this investment, have a tax number, tax residency or nationality in a country other than South Africa? Yes No If ‘Yes’, please complete and submit the CRS and FATCA Individual Self Certification Form available from your Financial Adviser or from the Client Service department. If investing as an entity, please also complete and submit the CRS and FATCA Entity Self-Certification Form. A politically exposed person (‘PEP’) is a person who is, or has in the past, been entrusted with prominent public functions in a particular country, whether performed locally or abroad. It includes Heads of State/Government, cabinet ministers, senior and/or influential officials like judges, political and military leaders, members of ruling or royal families, municipal managers etc. If a family member, close associate or beneficiary of an investor is a PEP, the investor is also considered to be a PEP. Are you a PEP? Yes No Where the application is made on behalf of a legal entity, trust or unincorporated entity; is the contact person or any stakeholder in the applicant a PEP? Yes No 3. SECURE ONLINE ACCESS AND INVESTMENT NAME You can specify a unique investment name for your investment, which will be displayed both online and when you receive any communication specific to your investment. Investment name I want secure website access to my investments If yes, an online account will be activated via our Client Services Centre. Yes No VERSION 1 – APRIL 2018
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PAGE 1
Voluntary Investment Plan Application Form
1. IMPORTANT INFORMATION• Please read the Terms and Conditions booklet which apply to this investment. This is available from your Financial Adviser, the Client Services
Centre at 0860 774 774 or at www.psg.co.za. • PSG Invest (Pty) Ltd, an authorised administrative financial services provider, is the Administrator of this product.• PSG Invest allows investors to access a range of portfolios from a number of managers through one administrative platform.• Please complete all relevant sections of this application form in order to process this investment.• Please submit instructions for processing to [email protected] or fax to 011 996 5499. • For enquiries, please email [email protected] or contact one of our consultants on 0860 774 774. • The Administrator will only process this application form when all required documentation is received and once the money reflects in the
Administrator’s bank account.
2. INVESTOR DETAILS
Personal details Contact details
Title Initials Home phone
First names Work phone
Surname (or registered name of entity)
Fax
Cellphone
ID number (or registration number)
Email address
Date of birth Marital status
Income tax number Tax status
Gender Nationality
Physical address Postal address
Line 1 Line 1
Line 2 Line 2
Suburb Suburb
City City
Region Region
Area code Area code
Are you exempt from Dividend withholding Tax (‘DWT’), or qualify for a reduced withholding tax rate? If ‘yes’, please request the relevant form from your Financial Adviser, or the Client Service department.
Yes No
Do you or any controlling persons associated with this investment, have a tax number, tax residency or nationality in a country other than South Africa?
Yes No
If ‘Yes’, please complete and submit the CRS and FATCA Individual Self Certification Form available from your Financial Adviser or from the Client Service department. If investing as an entity, please also complete and submit the CRS and FATCA Entity Self-Certification Form.
A politically exposed person (‘PEP’) is a person who is, or has in the past, been entrusted with prominent public functions in a particular country, whether performed locally or abroad. It includes Heads of State/Government, cabinet ministers, senior and/or influential officials like judges, political and military leaders, members of ruling or royal families, municipal managers etc. If a family member, close associate or beneficiary of an investor is a PEP, the investor is also considered to be a PEP.
Are you a PEP? Yes No
Where the application is made on behalf of a legal entity, trust or unincorporated entity; is the contact person or any stakeholder in the applicant a PEP?
Yes No
3. SECURE ONLINE ACCESS AND INVESTMENT NAME
You can specify a unique investment name for your investment, which will be displayed both online and when you receive any communication specific to your investment.
Investment name
I want secure website access to my investments If yes, an online account will be activated via our Client Services Centre.
Electronic collection from existing bank account Electronic collection from other account (complete section below)
If collected by the Administrator - Collection Date (if not completed, collection will be done immediately, subject to cut off times)
Account holder name Account Current Transmission Savings
Bank name Branch code
Branch name Account number
Method of Payment
Cheque deposit
All cheques must be endorsed as non-transferable and deposited directly into the PSG Invest Voluntary Investment Account. In accordance with the regulation set by the Payment Association of South Africa (‘PASA’) and the South African Reserve Bank (‘SARB’), the maximum cheque deposit amount that the Administrator may accept per client is R500 000 per day. For investments in excess of this amount, payment may be made via electronic fund transfer (maximum of R5 million per day) into the bank account stated on the Application Form relevant to the product.
Electronic/Internet transfer Electronic/internet transfers may take up to two days to appear in the PSG Invest Voluntary Investment Account.
Electronic collection by the Administrator
In accordance with the regulation set by the Payment Association of South Africa (‘PASA’) and the South African Reserve Bank (‘SARB’), the maximum once-off collection amount that the Administrator may accept per client is R1 000 000 per day for debit orders. For investments in excess of this amount, payment may be made via electronic fund transfer (maximum of R5 million per day), into the bank account stated on the Fees – Appendix 1 form.
Debit order Please complete the Bank account details of Investor and debit order authority section below.
Transfer of Units In Please complete the ‘Transfer of Units In’ form
5. SINGLE CONTRIBUTION INVESTMENT DETAILS
Single contribution amount (R 20 000 minimum) R
What is the source of the funds?
Savings Inheritance Bonus Dividend pay-out Other
If ‘other’, please provide details
Please indicate your fund class clearly. If you do not indicate your fund class, we will default to the clean fee class of the particular fund that is available on our platform. A 'clean class' is the class of a fund in which only the fund manager’s fee is deducted from the unit price. There is no deduction for administration fees within the unit price.
DESTINATION FUND NAME(S) FOR INITIAL INVESTMENT FUND CLASS PERCENTAGE
%
%
%
%
%
%
%
%
%
%
Total 100%
Cut-off time for transactional requests is 10h30 for that day. For Money Market Funds, the cut-off time is 08h30 for that day. Instructions received after cut-off will be processed the following business day.
6. PHASE-IN
Please note that a phase-in can only be started from one or more of the funds stipulated for the Initial Investment above. Should the phase-in commencement date be prior to settlement of the Initial Investment above, the phase-in will then commence once funds in the Initial Investment have settled. Please indicate your fund class clearly. If you do not indicate your fund class, we will default to the clean fee class of the particular fund that is available on our platform.
VERSION 1 – APRIL 2018
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Voluntary Investment Plan Application Form
SOURCE FUND FUND CLASS PERCENTAGE OR AMOUNT
DESTINATION FUND(S) FOR PHASE IN INSTRUCTION FUND CLASS PERCENTAGE
%
%
%
%
%
%
%
%
%
%
Total 100%
Phase-in commencement date
Number of phase-in transactions Phase-in frequency Weekly Monthly
7. RECURRING CONTRIBUTION INVESTMENT DETAILS
Recurring investment amount via Debit order (R500 monthly minimum) R
Debit order start date
Frequency Monthly Quarterly Half-yearly Yearly
Escalation (per year) %
What is the source of the funds?
Savings Inheritance Bonus Dividend pay-out Other
If ‘other’, please provide details
Please indicate your fund class clearly. If you do not indicate your fund class, we will default to the clean fee class of the particular fund that is available on our platform.
DESTINATION FUND NAME(S) FOR RECURRING CONTRIBUTION FUND CLASS PERCENTAGE
%
%
%
%
%
%
%
%
%
%
Total 100%
8. INVESTOR BANK ACCOUNT DETAILS
The investor must keep the Administrator informed of any changes in the bank account details.
Account holder name Account Current Transmission Savings
Bank name Branch code
Branch name Account number
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Voluntary Investment Plan Application Form
• Please attach a cancelled or certified copy of a cheque not older than three months or a certified copy of a recent bank statement not older than three months for verification purposes.
• Payments can only be made into or from the above bank account types and not into a credit card, bond or money market account.• Should the Investor and account holder not be the same person, a certified copy of the account holder’s Identity Document as well as physical address
(not older than three months) will be required.
9. DEBIT ORDER AUTHORISATION (FOR ALL COLLECTIONS AND/OR RECURRING CONTRIBUTIONS)
I authorise the Administrator to draw direct debits or the specified once-off debit amount against the bank account specified. Direct debits can only be processed from a South African bank account. Units bought with a direct debit can only be redeemed after 45 calendar days. If the bank account holder is not the same as the investor (3rd party contribution) then the actual account holder must sign below as authority to debit their bank account and must provide full FICA documentation as per our FICA requirements available on our website. If the bank account holder is not the investor, he/she acknowledges that the Administrator does not make third party payments, payment will only be made to the investor. The Administrator will debit the specified bank account within 2 business days of receiving a valid and complete application and supporting documents or on the date specified on the application form. If the collection day falls on a weekend or a recognised South African public holiday, the collection day will automatically be the next ordinary business day. The Administrator must receive the instruction three working days before the required date of payment for payment to take place on that day. Where the Third Party Premium Payer is an organisation, please note that we require a resolution on a letterhead, signed by the directors of the premium paying entity, confirming the authorised signatory of the premium paying entity. Cut-off time for transactional requests (excluding Money Market Funds) is 10h30 for that day. Money Market Funds are 08h30 for that day.
I/we, the undersigned account holder/authorised signatory, acknowledge that this account belongs to the premium paying entity, and hereby request and authorise the Administrator to draw due and payable premiums against the account stated above.
I understand that the details of each withdrawal will be reflected on the premium payer’s bank statement. I agree to pay fees relating to this debit order that may be levied by the bank, and will include debit order rejection fees.
Signed at (place) this day of 20
Signature of bank account holder/authorised signatory Signature of parent or guardian (if applicable)
10. PREFERRED FEE FUNDYou may choose to have your ongoing Investment Administration fee and Financial Adviser fee for all portfolios in your investment deducted from a specific fund instead of proportionately from each fund. This will be known as your Preferred Fee Fund.
Do you require a Preferred Fee Fund? Yes No
FUND NAME FUND CLASS
• If the balance in the Preferred Fee Fund is insufficient, the Administrator will deduct the fees proportionally from the remaining portfolio.
11. RECURRING WITHDRAWAL DETAILS
Withdrawal amount R Escalation (per year) %
Withdrawal frequency Monthly Quarterly Half-yearly Yearly
Income payment date
Please note that we cannot guarantee payments on specific dates, but will endeavour to pay the income as close to this date as possible.
SOURCE FUNDS FOR WITHDRAWAL
FUND NAME FUND CLASS AMOUNT PERCENTAGE
%
%
%
%
%
Total 100%
• If the selected day falls on a weekend or public holiday it will be effective on the preceding business day.• The Administrator must receive the instruction 7 working days before the required date of payment for payment to take place on that day.• Cut-off time for transactional requests (excluding Money Market Funds) is 10h30 for that day. Money Market Funds are 08h30 for that day. • All payments are made electronically to the bank account of the registered investor only.• No payments will be made to credit card accounts or market linked accounts.
VERSION 1 – APRIL 2018
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Voluntary Investment Plan Application Form
12. FINANCIAL ADVISER (FSP DETAILS)
Title Initials Surname
Full names
FSP name FSP code
FSP license number Financial Adviser code
Investment Specialist name
Discretionary Mandate You may authorise the above FSP to submit instructions for this investment on your behalf. The FSP needs to hold a ‘Category II’ licence with the Financial Services Board to do this and will need an investment mandate from you.
Has such an investment mandate been signed by you? Yes No
If ‘yes’, indicate whether this investment mandate provides for full or limited discretion. Full discretion means that the FSP has an unlimited mandate to act on your behalf in order to achieve the investment objectives without it being necessary to obtain further authority or consent from you to effect any investment transactions in terms of the mandate.
Full discretion Limited discretion
If the FSP was appointed with limited discretion, indicate transactions which the FSP may execute on your behalf:
Withdrawal instructions Switch instructions Rebalance instructions Additional investments Other
If ‘other’, provide details
Financial Adviser declaration • I hereby confirm that I am appropriately registered in terms of Financial Advisory and Intermediary Services Act 37 of 2002 (‘FAIS’) to act as the
Investor’s Financial Adviser of record, in terms of a duly signed mandate.• I hereby confirm that I represent an accountable institution as defined in the Financial Intelligence Centre Act, no. 38 of 2001 (‘the Act’). I furthermore
confirm that the independent financial services provider which I represent is the primary accountable institution in respect of the Investors on whose behalf I establish business relationships or conclude single transactions with the Administrator (the secondary accountable institution).
• I have explained the necessary disclosures required, in terms of FAIS Act 37 of 2002.• I hereby confirm that in terms of my internal rules and procedures I will comply with all requirements of Section 21 and 22 of the Act in respect of
identifying and verifying Investors and record holding.I acknowledge that I’m in no way absolved of my abovementioned duties to identify, verify and keep records as primary accountable institution or act
with due care and diligence towards the Investor.
Signed at (place) this day of 20
Signature of Financial Adviser
13. DECLARATION AND ACCEPTANCE BY INVESTOR
The Investor agrees and declares that:
• I confirm that the Effective Annual Cost (‘EAC’) of my financial product was available to me by means of a calculator at http://tools.psg.co.za/EAC/ManualCalculator.
• I confirm that the calculator provided the charges that impact the investment returns of my financial product, and allows me to compare these charges with other financial products.
• I confirm that the welcome pack documentation will include the EAC of my financial product; and • I confirm that the EAC will be disclosed to me on an annual basis.• I confirm that I have read and understand the terms and conditions applicable to this investment as set out in the Terms and Conditions Booklet.• I accept these terms and conditions as being applicable to my investment.• I have provided the necessary FICA documentation and/or such other documentation as required to process this application form.• I declare that any and all information provided by me herein or in another document is true and correct and I agree to supply the Administrator with
any updated information within 7 days of such change taking place.• I understand that I am responsible for the accuracy and completeness of all answers, statements of other information provided by me or on my behalf.• I confirm that the Administrator may accept instructions from my appointed financial adviser only if appointed and authorised by me in writing.• I confirm that the Administrator may accept signed instructions by fax or via other electronic means. As a result I hereby waive any claim that I may
have against the Administrator and indemnify the Administrator against any loss incurred as a result of the Administrator receiving and/or acting upon such communication. Furthermore, the Administrator will not be held responsible for any failure, malfunction or delay of any network or electronic or mechanical device or any other form of communication used in the submission, acceptance and processing of application form and/or transactions. The Administrator will not be liable to make good or compensate any investor or third party for any damages (whether direct or consequential), losses, claims or expenses resulting there from. The investor and any third party indemnifies the Administrator accordingly.
• I confirm that I have made an informed decision to purchase the product indicated in this application form and I am aware of the financial and tax consequences, if any, of such a purchase.
• I confirm that the Financial Adviser mentioned above, is my appointed Financial Adviser.• Balances that remain in a fund following a 100% switch out/rebalance out/withdrawal from this fund will not automatically follow the original
transaction to the required destination fund or bank account. Such residual balances may be caused by reinvested distributions or the release of unitsthat were reserved for another transaction at time of instruction.
14. FEES• This investment is subject to certain fees. For an explanation of these fees please refer to Fees – Appendix 1 • Please acknowledge acceptance of the fees by signing where indicated. This application will not be processed should the Administrator not receive the
signed Appendix 1.
15. COMMUNICATION PREFERENCESThe Administrator will communicate to you via email. If no email address has been supplied, communication will be done via post. If you have a Financial Adviser, you may choose to have your communication sent to you, your Financial Adviser or to you both:
• Send transaction confirmation to:
Me My Financial Adviser Both
If no selection is made, we will send transaction confirmations to both you and your Financial Adviser.
• Send my statements and other communication to:
Me My Financial Adviser Both
If no selection is made, we will send these communications to you only.
16. SIGNATURESI/We, the undersigned, confirm that I/we have completed this application form and acknowledge and accept the terms and conditions relevant to this investment and accept the implications thereof.
The Investor understands that in terms of the Financial Advisory and Intermediary Services Act, 2002 (‘FAIS’), his Financial Adviser must be mandated by a licensed Financial Services Provider (‘FSP’) as a representative with the necessary FAIS subcategories to act on the Investor's behalf and that it is also the Investor's responsibility to determine whether his Financial Adviser has the necessary authorisation. (FSB toll free number: 0800 110443). The Investor understands and confirms that the Administrator is entitled to act on his Financial Adviser's instructions, whether in written or electronic format, as if they were the Investor's own instructions. The Investor hereby indemnifies the Administrator against all losses or damage, which he may sustain, as a result of transactions entered into on the basis of this delegation of authority by the Investor to the Financial Adviser. If a Financial Adviser is not mandated as required by the Financial Services Board, the Administrator is obliged by law to decline any instructions from such Financial Adviser. The Administrator may and will accept instructions on the strength of the Investor’s signature. The Investor hereby authorises the Administrator to obtain information from the appointed FSP, Financial Adviser or administrative assistant where the Investor has failed to include such information in the application or transaction form. This authorisation is subject to the Administrator obtaining documentary proof where necessary.
Signed at (place) this day of 20
Signature of Investor/Authorised signatory Signature of parent or guardian (if applicable)
Official capacity (if other than Investor)
17. COMPLAINTS• If you are not satisfied with this investment, or the services rendered, you can write to the Compliance Officer at [email protected]. Remember to
include all supporting documents. The Compliance Officer will acknowledge the complaint in writing, and provide you with the contact details of the person that is most likely to resolve it.
• Should you have a complaint about the Administrator or advice given by a financial adviser relating to this investment, you can write to the Ombud for Financial Service Providers at:
* Please note that this fee is only applicable when investing in a PSG Multi-Management Fund or PSG Single Manager Fund.
Where applicable, the full rebate received from the fund manager will be used to reduce the yearly Investment Administration Fee. Excess rebates will be allocated to the investment in the following month, in the form of purchased units. Other Fees
EVENT FEE
Switching fee None
Debit order returning fee None
These fees, their frequency and the investment minimums may be adjusted from time to time subject to prior notice.
INITIAL FINANCIAL ADVISORY FEE (EXCL. VAT)
For Initial Single Contribution % (Maximum of 5.0% excl. VAT)
For Additional Contributions % (Maximum of 5.0% excl. VAT)
For Recurring Contributions % (Maximum of 5.0% excl. VAT)
ONGOING FINANCIAL ADVISORY FEE (EXCL. VAT)
The Financial Adviser will be paid an ongoing Financial Advisory fee of between 0% and 1.00% per year (excl. VAT). These fees are calculated on the value of your investment portfolios, and deducted monthly. Ongoing Financial Advisory Fee % (excl. VAT)
MODEL PORTFOLIO MANAGER FEE (EXCL. VAT)
The model portfolio manager will be paid an ongoing fee. These fees are calculated on the value of your investment portfolios, and deducted monthly.
Ongoing fee % (excl. VAT)
Should the fee blocks above not be completed, the fee will default to 0%.
BANKING DETAILS
Please ensure that all contributions are deposited into the following bank account:
