Investec Bond Application Form – Fill Out and Use This PDF

InvestecBond

Application form

Please print clearly in block letters

Please fax this application form (pages 1 - 9), the required documentation and the proof of deposit to 0861 500 300 or + 27 11 263 6061 (international fax no.). Alternatively fi nancial advisors can upload this instruction via our secure website at https://www.secure.sso.za.investec.com

No instruction will be processed unless all pages of the form and all required documentation have been completed and received by Investec Investment Management Services (Pty) Ltd (IMS).

This application form and the terms contained in the IMS Combined Terms Document will form the agreement between the investor and IMS. The contents of the IMS Combined Terms Document may be changed from time to time, and it is the responsibility of the investor to consult the most updated IMS Combined Terms Document, to determine the terms applicable to the relationship between the investor and IMS, and the terms relevant to IMS products. This document can be viewed on www.investecassetmanagement.com, alternatively a copy is available from your FSP or IMS.

For a copy of the fund’s Minimum Disclosure Document, please contact the relevant investment fund manager.

A. Investor details

Name(s) of investor/authorised contact person

Residential address (principal place of business)

		Code	Country
Postal address
		Code	Country
Tel (home) (country code) (	)	Tel (work) (country code) (	)
Fax (country code) (	)	Tel (cell) (country code) (	)
Email

Please note: If no preference is selected and an email address is provided, the default method of communication will be email.

Country of issue (passport)		Date of expiry (passport)	DD	/ MM	/ YYYY
Date of birth	DD / MM / YYYY	Place of birth
Nationality		Married in community of property	Yes	No	N/a

Occupation/nature of business activities (if an entity)

Are you an existing IMS investor Yes

No

N/a

If yes, existing investment no.

–

–

–

Dividend withholding tax

If yes, please complete the “Dividends Tax Declaration and undertaking for exemption” available on www.investecassetmanagement.com . Failure to do so will result in dividends tax being withheld/payable.

Interest withholding tax for non-South African residents

If you are a non-South African taxpayer, do you qualify for interest withholding tax reduction or exemption under section 50D/50E of the Income

If yes, please complete the “Interest Withholding Tax Declaration for non-South African residents” available on www.investecassetmanagement.com . Failure to do so will result in interest withholding tax being withheld/payable on applicable interest.

FATCA1

Tax Regulations2 require us to collect information about each investor’s tax residency. In certain circumstances (including if we do not receive a valid self-certifi cation from you) we may be obliged to share information on your account with SARS. If you have any questions about your tax residency, please contact your tax advisor. Should any information provided change in the future, please ensure you advise us of the changes promptly.

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Please indicate all countries in which you are resident for tax purposes and the associated tax reference numbers in the table below.

Country / countries of tax residency (including South Africa)	Tax reference no. (for US citizen / resident TIN3)

Legal entity self-certification

For all legal entities, a legal entity self-certifi cation form must be completed and submitted with the application form.

Should you be a Passive Non-Financial Entity you will be required to submit individual self-certifi cation forms for any Controlling Persons. The legal entity self-certifi cation form and the individual self-certifi cation form are available on www.investecassetmanagement.com

Please note: Should your tax details change please notify IMS.

1The term “FATCA” refers to The Foreign Account Tax Compliance provisions contained in the US HIRE Act 2010.

2The term “tax regulations” refers to regulations created to enable automatic exchange of information and include FATCA1, and the OECD Common Reporting Standard for Automatic Exchange of Financial Account Information.

3 The term “TIN” refers to the US Tax Identifi cation No.

C. Bank details of the investor

Please supply proof of bank details (a cancelled cheque or bank statement)

Name of bank			Branch country
Branch name			Branch code
Name of account holder(s)
Account no.			Type of account	Current	Savings
Universal branch codes will be used for the following banks:
ABSA	632005	Nedbank	198765	Capitec	470010
Standard	51001	First National Bank	250655	Investec	580105

D. Parent / legal guardian acting on behalf of a minor (if applicable)

Title	Surname
Name
Residential address
		Code	Country
Contact no. (country code) (	)
Email
ID no. / passport no. (non-residents only)		Relationship to investor

E. Investment details

				Tick relevant options
Product platform				Sections to be completed and notes
	iSelect				Should neither platform be selected the default,
	FundSelect/FundChoice				iSelect will be applied
Investment type	Lump sum	Electronic funds			Section E, E1, E2, E3 - attach proof of deposit
		transfer
		Once-off debit			Section E, E1, E2, E3 and F - Please note this amount is restricted to
					R500 000 and the bank details in Section C will be debited
	Recurring investments (debit order)				Section G
	Transfer	Unit transfer			Section H (a) and H (d)
		Cash transfer			Section H (b) and H (d)
		Share portfolio			Section H (c) and H (d)
		transfer
Deals (for multiple sources)	Combine into a single deal
					Should no selection be made, a new deal will be created
	Separate deals

2/10 (03/2015 InvBond)

1.Please refer to the IMS Combined Terms Document for minimum investment amounts and debit order terms.

2.The investor is required to hold a minimum of 3% (in addition to the amount required to provide an income) in investment instruments (section E1). A maximum of 97% of the total investment amount may be invested in a share portfolio (Section E2).

3.Where the investor requires an income withdrawal from the investment, the amount will be withdrawn from the investment portfolio (E1) portion of the investment. The investor must ensure that a suffi cient percentage of the total investment is invested in investment instruments to provide for the income withdrawal.

Bank details for InvestecBond

IMS does not accept cash deposits.

Please state either South African ID no./passport no., company or trust registration no. as per the application form, to reference your deposit.

Name of account	Grayston Nominees (Pty) Ltd Investec Investor Bond
Name of Bank	Standard Bank
Branch	Killarney	Branch code	007205
Account no.	001668609	ReferenceID no./registration no. (if applicable)

E1. Source of funds for investment (where the funds for investment are coming from):

E2. Lump sum

Investment type

E3. Investment portfolio details (lump sum - not applicable to transfers from other MANCOS or LISPS and debit orders)

Investment instruments	*FundSelect		% of Investment
(excluding share portfolios)	(tick)		amount
			%
			%
			%
			%
			%
			%
			%
			%
			%
			100%

*Investors without fi nancial advisors or invested through the iSelect product platform may not select FundSelect in the tick boxes above.

Please note: If the investor is investing into the iSelect or FundSelect/FundChoice product, then the investor will be placed in the default class applicable to the associated fi nancial advisor.

1.If the investor wishes to invest a portion of the above investment into a Capital Gains Tax (CGT) expense account, the Money Market Expense Account instrument must be included in the portfolio details above, failing which annual fees and charges will be recovered by redeeming units proportionately from the investment instruments.

2.The minimum phasing-in term is 3 months and the maximum is 24 months. The fi rst phase-in or subsequent phase-in shall commence at the end of the month in which the investment is made, provided the investment takes place on or before the 20th day of the month. Where the investment takes place after the 20th day of any month, the phasing-in shall commence at the end of the following month.

3.No phasing-in is permitted into the offshore funds or in respect of share portfolios.

4.Please indicate if the nominated instrument is a FundSelect instrument, failing which the non-FundSelect class of the same instrument will be nominated where relevant.

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E4. Share portfolio
Name of stockbroker		Name of share portfolio
Mandate type	Discretionary (stockbroker managed)	Non-discretionary (IFA managed)

1.Please ensure that the relevant stockbroker addendum is completed.

2.*Where the share portfolio is IFA managed the IFA must enter into an agreement with IMS. IMS cannot process this instruction unless the agreement with the IFA has been signed.

F. Once-off debit authority

I/We, the undersigned, request IMS to draw against my/our bank account in any manner agreed on between IMS and my/our bank the amount necessary for payment of the amount indicated in Section E above.

Once-off electronic collection is restricted to a maximum of R500 000. The alternative payment method for amounts exceeding R500 000 is an electronic fund transfer into the relevant product bank account.

Please note: This instruction is only possible providing the following criteria are met:

–The date the account is to be debited is a business day and all requirements have been met. The investor’s account will be debited within two business days.

–This instruction form may only be signed by the investor who must also be the account holder.

–In the event that the investor is not a natural person, a resolution from the legal entity (trust, company, close corporation or partnership) giving the signatory(ies) authority to sign on behalf of the legal entity, may be required. IMS shall not be liable or responsible, for any reason, in the event that the signatory(ies) is/are not duly authorised and the signatory(ies) indemnifi es IMS against any and all damages and/or loss arising from such event.

Signature of bank account holder

Date DD / MM / YYYY

G. Recurring investments (debit order)

I hereby request, instruct and authorise IMS or its assignees to draw against my account with the bank noted in section B (or any other bank or

branch to which I may transfer my account), the sum of R	(amount in words)
	being my contribution commencing on (date) 01 / MM / YYYY

Thereafter IMS or its assignees will endeavour to draw the amount on the 1st business day of each month in which such instalment becomes payable. I understand that all such withdrawals from my bank account shall be treated as though they had been signed by me personally.

Debit order fund selection

Investment instruments	*FundSelect		% of debit
	(tick)		order amount

%

%

%

%

%

%

%

%

*Investors without fi nancial advisors or invested through the iSelect product platform may not select FundSelect in the tick boxes above.

Please note: If the investor is investing into the iSelect or FundSelect/FundChoice product, then the investor will be placed in the default class applicable to the associated fi nancial advisor.

4/10 (03/2015 InvBond)

Third party details

Personal details for FICA purposes

TitleSurname/corporate/entity name

Name(s) of authorised contact person

Residential address (principal place of business)

CodeCountry

ID no. / passport no. (non-residents only) / registration no.

Please note: FICA declaration signed by the advisor is only applicable to the investor and not to the third party. Please provide the required FICA documentation.

Third party bank account details

Please supply proof of bank details (a cancelled cheque or bank statement)

Name of bank	Branch country
Branch name	Branch code
Name of account holder(s)
Account no.	Type of account Current	Savings

–I agree to pay any bank charges and costs relating to the debit order authority.

–I acknowledge that I may cancel this authority by giving IMS not less than 30 calendar days’ written notice.

–I agree that receipt of this instruction by IMS shall be regarded as receipt thereof by my bank.

–I agree that if IMS receives any of the information or required documentation relevant to this application after the monthly cut-off date for debit order business (usually around the 20th of the month), then the debit order will only commence in the following month.

Authorised signature of third party bank account holder

Date DD / MM / YYYY

Initial and surname of signatory

H. Transfer of units, cash or share portfolios

1.This instruction must be used where the investor holds existing unit trusts with another management company (MANCO) or Linked Investment Service Provider (LISP) and would like to transfer to the InvestecBond.

2.Either a unit, cash or share transfer may be done per application form submitted. Please complete the relevant section a), b) or c) below.

3.Please attach a statement from the MANCO/LISP or stockbroker not older than one month.

4.Please state the names of the transferring company(s) in the space provided below.

5.Fees:

5.1No initial fees will apply to any of the below transfers.

5.2Consequently no initial fees will be paid to your Financial Services Provider (FSP), unless a FSP fee is indicated in the Financial Services Provider appointment section.

a) Unit transfers

I/We hereby authorise the abovementioned unit trust manager(s) and/or LISP to transfer the specific units from my/our accounts detailed below into the InvestecBond.

Name of MANCO/LISP

Investment instrument name

Account no.	Number of units
Name of MANCO/LISP
Investment instrument name
Account no.	Number of units

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Name of MANCO/LISP

Investment instrument name

Account no.	Number of units
Name of MANCO/LISP
Investment instrument name
Account no.	Number of units
Name of MANCO/LISP
Investment instrument name
Account no.	Number of units

b) Cash transfers (if allowed by Transferring Companies)

I/We hereby authorise the abovementioned unit trust manager(s) and/or LISP to convert the specific units/funds from my/our accounts detailed below to cash and transfer the proceeds to the following bank account:

Name of account:	Grayston Nominees (Pty) Ltd Investec Investor Bond
Name of Bank:	Standard Bank
Branch:	Killarney
Branch code:	007205
Account no:	001668609

Name of MANCO/LISP

Investment instrument name

Account no.	Amount R
Name of MANCO/LISP
Investment instrument name
Account no.	Amount R
Name of MANCO/LISP
Investment instrument name
Account no.	Amount R

c) Share portfolio transfers

I/We hereby confirm that I/we have instructed the transferring stockbroker to transfer my/our share portfolio to the transferee stockbroker.

Name of transferring stockbroker

Account no.

*Investors without fi nancial advisors or invested through the iSelect product platform may not select FundSelect in the tick boxes above.

Please note: – If the investor is investing into the iSelect or FundSelect/FundChoice product, then the investor will be placed in the default class applicable to the associated fi nancial advisor.

– The destination fund selection above must be aligned to the product platform

6/10 (03/2015 InvBond)

L. Financial Services Provider appointment

To be completed by the investor
1. I/We appoint		as my/our fi nancial advisor(s) as
	the authorised representative of
	[Financial Services Provider (FSP)]; FSP no.	.

2.In the case where my/our FSP is an approved investment manager/discretionary fi nancial services provider, I/we agree and understand that he/she may give IMS investment instructions directly, and I/we herewith authorise IMS to adhere to this fi nancial advisor’s instructions on my/ our behalf.

M. Financial advisor fee

Fee type		Percentage
		(excluding VAT)
Initial fees
Initial lump sum fee in respect of FundChoice, iSelect and FundSelect funds	%
Initial debit order fee in respect of FundChoice, iSelect and FundSelect funds	%
Initial fee in respect of transfer indicated in Section G	%
Annual fees
Annual fee for FundChoice and iSelect funds (annual fees in respect of FundSelect instruments are set out in the IMS	%
Combined Terms Document)
Annual fee in respect of the share portfolio	%

Please note: – Should a fee percentage not be indicated above, the fee will default to zero.

–Only fees applicable to this application form and corresponding to the relevant completed section should be indicated in the table above.

Signature of investor

Date DD / MM / YYYY

Name of investor

Signature of authorised signatory / guardian of investor

Date DD / MM / YYYY

Name of authorised signatory

Capacity of authorised signatory

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N. Declarations by FSP

Name of FSP					Code
Name of fi nancial advisor(s)					Code
Tel
Fax
Email
Name of alternate contact person at FSP
Tel
Fax
Email
					% will be re-invested into the investor’s investment reducing the fi nancial advisor fee in the case of
A fi nancial advisor fee rebate of

FundSelect instruments. The FundSelect fee rebate does not include VAT. VAT on the original fee is applied.

Please tick the applicable declaration(s)

FAIS declaration – I/We confi rm that I am/we are an authorised FSP in terms of FAIS.

FICA declaration – I/We hereby confi rm that the independent FSP, is the primary accountable institution (as described in the regulations to FICA) in respect of the investors on whose behalf I/we establish business relationships or conclude single transactions with IMS (the secondary accountable institution), and that I/we will have established and verifi ed the identity of each such investor in terms of section 21 of FICA. I/We confi rm that I/we will keep a record of the investors’ records as is required in terms of section 22 of FICA.

Please note: Should the FSP not wish to make use of the FICA declaration please refer to the FICA documentation checklist available on www.investecassetmanagement.com and attach all the relevant FICA documents to the application form.

Share portfolio declaration – I/We confi rm that we are appropriately licensed in terms of FAIS to provide advice and/or intermediary services in respect of and/or manage a share portfolio on behalf of the investor.

Signature of appointed representative of FSP

Date DD / MM / YYYY

Initial and surname of appointed representative of FSP

O. Complaints procedure

For information regarding our complaints procedure please go to our website at:

http://www.investecassetmanagement.com/south-africa/footer-menu/complaints/.

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INVESTOR DOCUMENTATION CHECKLIST

Please note:	– Investors are obliged to submit the following documentation to IMS, together with their signed application
	forms
	– Additional documentation may be requested to satisfy FICA requirements. The FICA requirements are detailed
	on a separate FICA documentation checklist on www.investecassetmanagement.com
	– Investors must notify IMS of any changes to their details and fax updated documentation to
	0861 500 300 or +27 (11) 263 6061 (international fax no.).

Individual investor/sole proprietors/partners to a partnership agreement

copy of ID of each individual investor/sole proprietor/partner (+ one specimen signature), or copy of passport (if non-resident), and

cancelled cheque/bank statement bearing the logo of the bank as proof of the bank details in the name of the individual/partnership, and dividends tax declaration (if applicable) and

power of attorney (if applicable) and

unabridged birth certifi cate/court order appointing legal guardian (if minor investor)

Close Corporations

copy of CK1 (certifi cate of registration), and a copy of CK 2A where applicable (name change certifi cate), and

resolution of members appointing authorised signatories to act on behalf of the close corporation in respect of this investment, and cancelled cheque/bank statement bearing the logo of the bank as proof of bank details in the name of the CC, and

copy of ID for each authorised signatory (+ one specimen signature), and dividends tax declaration

Companies

copy of CM1 or CoR 14.3 (certifi cate of incorporation), and copy of CM29 or Form CoR 39 (list of directors), and

resolution of directors appointing authorised signatories to act on behalf of the company in respect of this investment, and cancelled cheque/bank statement bearing the logo of the bank as proof of bank details in the name of the company, and copy of ID for each authorised signatory (+ one specimen signature), and

dividends tax declaration

Trusts

copy of trust deed or copy of other document by which trust is created, and letters of authority (as issued by the Master of the High Court), and

resolution of trustees appointing authorised signatories to act on behalf of the trust in respect of this investment, and cancelled cheque/bank statement bearing the logo of the bank as proof of bank details in the name of the trust, and copy of ID for each of the authorised signatories only (+ one specimen signature), and

list of names of benefi ciaries, and dividends tax declaration (if applicable)

Retirement funds

copy of proof of Financial Services Board (FSB) registration number (copy of registration certifi cate/letter from the FSB confi rming / containing registration number), and

resolution of trustees appointing authorised signatories in respect of this investment, and signatory list (this could sometimes form part of the resolution), and

cancelled cheque/bank statement bearing the logo of the bank as proof of bank details of the Retirement Fund, and copy of ID’s for each authorised signatory (+ one specimen signature), and

dividends tax declaration

Other entities

copy of document by which the entity is founded, and

resolution appointing authorised signatories to act on behalf of the entity in respect of this investment, and cancelled cheque/bank statement bearing the logo of the bank as proof of bank details in the name of the entity, and copy of ID for each authorised signatory (+ one specimen signature), and

dividends tax declaration (if applicable)

10/10 (03/2015 InvBond)

CLIENT SERVICE CENTRE

100 Grayston Drive Sandown Sandton 2196 PO Box 785700 Sandton 2146 Telephone: 0860 500 100

Fax: 0861 500 300 or (2711) 263-6061

email: comcentre@investecmail.com

www.investecassetmanagement.com

Investec Investment Management Services (Pty) Ltd

(Reg. No. 1992/003608/07)

Investec Asset Management and Investec Investment Management
Services are authorised fi nancial services providers	InvBond
	Inv/72378 (03/2015)

03/2015 InvBond