Application Form. Account Number (if any) For office use CT:

Transcription

1 Application Form Account Number (if any) For office use CT: A. General Investment Procedures: You are referred to the terms and conditions applicable to this investment, as set out in the deed and supplemental deeds of the IP Collective Investment Scheme prior to completing this application form. Complete the relevant forms and attach the necessary documentation before forwarding them to the Fund Manager, MitonOptimal South AFrica (Pty) Ltd. An investment statement, confirming the purchase of participatory interest in the portfolio/s, will be forwarded to the investor as soon as possible. B. Documents to be submitted: Proper identification (see requirements below) Application form, which is to be co-signed by the broker/financial intermediary, if any. If the applicant is acting as an agent or representative of another, a copy of the power of attorney or other written authorisation signed by the principal. C. The submission of documents: The application form and all supporting documentation are to be transmitted via to dealing@mitonoptimal.co.za or by facsimile to: (021) D. Additional information: In order to comply with international Know Your Client (KYC) and Anti-Money Laundering (AML) legislation, it is essential to provide the required information and documents in respect of all applicants. E. Administrative Process: In the event that this application form, or any other written instruction is faxed or ed to MitonOptimal South Africa (Pty) Limited, the responsibility for ensuring that the instruction has been received and actioned, will lie with the instructor (investor or financial advisor). If you wish to confirm receipt of an instruction, please contact our Client Service team on (021) F. Supporting Documentation: The Financial Intelligence Centre Act, 38 of 2001, ( FICA ) compels MitonOptimal South Africa (Pty) Limited to establish and verify the identity of a client prior to transacting. To facilitate compliance with FICA and ensure seamless transacting with yourself, we kindly ask that you attach copies of the relevant supporting documentation set out in this below to your completed Application Form. IP Management Company (RF) Pty Ltd will only place investments once all the supporting documentation set out below has been supplied. Note: All copies are to be notarised or certified by a notary public. 1. Individuals 1.1 SA Citizen/Resident Certified or notarised copy of a valid I.D document containing a photo, full names, date of birth & ID number. * A cancelled cheque or bank statement (less than 3 months old) as proof of bank details Document(s) less than 3 months old (at the date of this application) showing residential address (e.g. utility bill, telephone account, bank statement, municiple services invoice). * A passport /driver s licence containing the above information will only be accepted with a written reason for the unavailability of the ID document. 1.2 Foreign Nationals Copy of passport containing a photo, full names, date of birth and passport number Document(s) less than 3 months old (at the date of this application) showing residential address (e.g. utility bill, telephone account, bank statement, municiple services invoice). 1.3 Legal Incapacity Document(s) set out above iro both parties. (1.1.1 or 1.2.1) Copy of minor s bar-coded ID containing a verifiable photo, full names, date of birth, ID number; birth certificate (only if ID has not been issued); copy of bar-coded ID or passport in respect of parents or guardian(s) containing a verifiable photo, full names, date of birth and ID number; proof of residential address in respect of parents or guardian(s) (less than 3 months old) and proof of guardianship (if applicable) Proof of authority to act (e.g. power of attorney, mandate, resolution, court order) Document(s) less than 3 months old (at the date of this application) showing residential address (e.g. utility bill, telephone account, bank statement, municiple services invoice). 1 Fund Manager Details: MitonOptimal South Africa (Pty) Ltd Suite 202, South Wing, Great Westerford, 240 Main Road, Rondebosch, Cape Town, 7700, South Africa Tel: (+27) Fa x: (+27) dealing@mitonoptimal.co.za Version: PO Box 144, Rondebosch Cape Town, 7701 South Africa

2 2. Institutions 2.1 SA Companies Certificate of Incorporation (CM1) Notice of registered Office and Postal Address (CM22) containing registrars stamp and signed by the Company Secretary or equivalent documents (CoR14.3 and CoR21.1) List of Directors (CM29) Certificate of name change (CM9) if applicable Copy of document(s) issued by SARS bearing income tax and VAT registration numbers Resolution by the board of directors authorising representative(s) to act on behalf of the company Document (less than 3 months old) showing residential address (e.g. utility bill, bank statement, tax invoice, Telkom account, payslip or municipal rates) for all authorised representatives Certified copy of a valid ID document/passport as set out in and respectively, iro the manager, all authorised representatives and all individuals holding 25% or more of the voting rights at a general meeting Applicable documentation refer to in / or / or /2.3.2 iro institutions holding 25% or more of the voting rights at a general meeting Cancelled cheque or bank statement (less than 3 months old). 2.2 SA Close Corporations Founding Statement and Certificate of Incorporation (CK1) Amended Founding Statement (CK2) if applicable, containing registrars stamp and signed by authorised representative/employee Document (less than 3 months old) containing trade name and business address (e.g. utility bill, bank statement, tax invoice, Telkom account, municipal rates) Resolution by the board of members authorising representative(s) to act on behalf of the CC Certified copy of a valid ID document/passport as set out in and respectively, iro each member and all authorised representatives Document (less than 3 months old) showing residential address (e.g. utility bill, bank statement, tax invoice, Telkom account, payslip or municipal rates) for all authorised representatives Cancelled cheque or bank statement (less than 3 months old). 2.3 Foreign Companies Official document from foreign regulators witnessing incorporation, bearing the name, number and the address Document (less than 3 months old) containing trade name and business address (e.g. utility bill, bank statement, tax invoice, Telkom account, payslip or municipal rates) Certified copy of a valid ID document/passport as set out in and respectively, iro the manager, all authorised representatives, all individuals holding 25% or more of the voting rights at a general meeting Resolution by the board of members authorising representative(s) to act on behalf of the company Applicable documentation refer to in / or / or / iro institutions holding 25% or more of the voting rights at a general meeting Cancelled cheque or bank statement (less than 3 months old). 2.4 Other Legal Persons (i.e. club, association, body corporate) Constitution or other founding documents in terms of which legal person is created Certified copy of a valid ID document/passport as set out in and respectively iro each member and all authorised representatives Resolution by the authorised body authorising representative(s) to act on behalf of the legal person Document (less than 3 months old) showing residential address (e.g. utility bill, bank statement, tax invoice, Telkom account, payslip or municipal rates) for all authorised representatives Cancelled cheque or bank statement (less than 3 months old). 2.5 Partnership Partnership agreement Certified copy of a valid ID document/passport as set out in and respectively, iro to any individual partners, an individual exercising executive control and all authorised representatives Resolution by the partners authorising a representative(s) to act on behalf of the partnership Document (less than 3 months old) showing residential address (e.g. utility bill, bank statement, tax invoice, Telkom account, payslip or municipal rates) for all authorised representatives Applicable documentation refer to in / or / or / iro any institutional partners or an institutional exercising executive control Cancelled cheque or bank statement (less than 3 months old). 2.6 Retirement Fund FSB number and proof of registration Copy of letterhead, utility bill or bank statement Documentation/resolution authorising person(s) to act on behalf of retirement fund. 2.7 Trust The trust deed or other founding document (i.e. a will) Letters of authority from Master (SA trust) or foreign regulator (foreign trust) to trustees Certified copy of a valid ID document/passport as set out in and respectively, iro an individual founder of the trust, each individual trustee, each individual beneficiary, all authorised representatives details on determination of beneficiaries if not specified A death certificate or certificate of de-registration where founder died or ceased to exist Document (less than 3 months old) showing residential address (e.g. utility bill, bank statement, tax invoice, Telkom account, payslip or municipal rates) for individual founder of the trust, each individual trustee, each individual beneficiary, all authorised representatives Applicable documentation refer to in / or / or / or / or or any institutional beneficiaries, any institutional trustees or institutional founder of the trust, details on determination of beneficiaries if not specified Cancelled cheque or bank statement (less than 3 months old). 2

3 3. Personal Details (Please tick were appropriate) Title First names of investor/registered name of legal entity Surname Physical address (Residential / registered address) Initials Postal Code: Postal address (Residential / place of business) Postal Code: Income Tax reference number (mandatory) Income office (mandatory) ID number (mandatory) Registration number (CC / Company / Trust) (mandatory) Date of incorporation for legal entity (mandatory) Date of birth Country of birth Method of Identification (e.g. identity number, passport [non-resident only]) (mandatory) Passport number (mandatory - for non-residents) Nationality (mandatory) Are you a resident for Tax purposes in South Africa (mandatory) Tax Office (mandatory) Yes No Country of issue (mandatory) OR are you a resident for Tax purposes anywhere else other than South Africa (mandatory) Tax number Yes No Does the Company have any shareholders with more than 25% of the voting rights at a general meeting (not applicable to companies listed on the JSE) If YES please complete Annexure A for each individual/institution holding more than 25%. Yes No Telephone number (Home) Telephone number (Work) Cell phone number Mandatory Fields Resident Country of residence Non-resident SA emigrant Fax number Source of income (e.g.salary, savings etc. If you have indicated above that you are a resident for Tax purposes anywhere else other than South Africa- please list the country or countries in which you are a resident for tax purposes, where the United States of America is indicated the tax number is required. For other nations, provision of tax number is optional. Country Tax Number Marital Status Single Married Other If Other - please specify Confirmation of tax status for Dividend Withholding Tax (Please consult a tax adviser if you are unsure about your tax status) Dividend Withholding Tax (All investors) SARS requires IP Management Company (RF) Pty Ltd to pay over Dividend Withholding Tax (DWT) on your behalf where applicable. We will deduct this tax before we pay any dividends to you or re-invest into your account. Certain investors may qualify for an exemption or reduced tax rate. Should this be applicable to you, please complete the relevant DWT exemption or reduced tax rate forms and submit with your application. Unless we receive information from you indicating otherwise, we will be obliged to withhold the default DWT of 15%. Please refer to Apendix B and C. Dividends Withholding Tax on Real Estate Investment Trust (REIT) Income (South African tax residents only) Even if you do not qualify for any other exemption, South African tax resident investors should tick the para (l) exemption box below in order to qualify for exemption from DWT on REIT income. Para (l) any person insofar as the dividend constitutes income of that person (i.e. falls into normal tax system) 3

4 3. Personal Details (Cont.) DECLARATION in terms of sections 64FA(1)(a)(i), 64G(2)(a)(aa) or 64H(2)(a)(aa) of the Income Tax Act of 1962 (ACT Number 58 of 1962) and UNDERTAKING in terms of sections 64FA(1)(a)(ii), 64G(2)(a)(bb) or 64H(2)(a)(bb) of theincome Tax Act of 1962 (ACT Number 58 of 1962): I the undersigned hereby declare that dividends paid to the beneficial owner is exempt, or would have been exempt had it not been a distribution of an asset in specie, from the dividends tax in terms of the paragraph of section 64F of the Act indicated above and undertake to forthwith inform the Withholding Agent in writing should the circumstances of the beneficial owner referred to in the declaration above change. Signature: Date: DD / MM / YYYY Withholding Tax on Interest (Non South African tax residents only) Please note that IP Management Company (RF) Pty Ltd will withhold Withholding Tax on Interest at the applicable rate stipulated in legislation until we are in possession of your correctly completed and signed declaration form which stipulates exemption or reduced tax rates claimed. To claim the exemption or claim the reduced rate of tax please complete and sign the Withholding Tax on Interest Declaration form Appendix D. FATCA self-certification form for entities IP Management Company (RF) Pty Ltd is required by law to ask for information from all clients on their international citizenship and tax residency status. I/we will notify IP Management Company (RF) Pty Limited immediately if my/our tax residency or Foreign Account Tax Compliance Act (FATCA) or equivalent classifications changes in the future. Or if there are any changes in circumstances that may impact on my/out tax residency status and/or FATCA classification. Kindly note that the Entity Tax Declaration form must be completed if you are investing on behalf of an entity (ie a juristic person, not an individual). It is important to please advise us immediately should any of the information (once completed) change in the future, or if there are any changes in circumstances that you believe could affect your tax residency or FATCA classification. Kindly request this form from MitonOptimal South Africa (Pty) Ltd. Phone (021) or dealing@mitonoptimal.co.za. Type of investor (applicable to all investors) Instititutional Investors Retail Investors Definition Definition Retirement Funds Individuals Long-term Insurers Companies and Close Corporations Collective Investment Scheme Management Companies Trusts and Partnerships Investment Managers who are registered with Financial Medical Aid Schemes and Intermediaries * Surveillance Department as Institutional Investors * Intermediaries include linked investment service providers (LISPs), nominee companies or investment managers not registered as institutional investors with the South African Reserve Bank. Where assets are sourced from an intermediary, the intermediary must provide identification of the assets as either institutional assets or retail assets. 4. Bank Details Account to be used for repurchases (No payments will be made by cheque or to a third party) The details specified below must be in the investor's name (no third party payments will be permitted) and will be used for all future banking transactions until such time as we are notified in writing of any changes. Account holder Name of bank Branch code Branch Account number Account type Current Savings Other A cancelled cheque or relevant bank statement less than 3 months old must accompany this application form as confirmation of banking details. Payments will only be made to the bank account in the name of the registered investor. We are unable to facilitate payment to credit cards or market-linked accounts. All payments are instructed electronically. No payments will be made by cheque. 4

5 5. Investment Plan I/we select the following investment plan(s): Multi-Asset Portfolio Name Minimum Lump Sum Minimum Monthly Lump Sum 1 Monthly Standard Bank Branch Code ( ) MitonOptimal IP Diversified Income Fund of Funds : B2 R5,000 R500 R R Acc. No * MitonOptimal IP Prudential Fund of Funds: B2 R5,000 R500 R R Acc. No * MitonOptimal IP Flexible Fund of Funds: B2 R5,000 R500 R R Acc. No * MitonOptimal IP Worldwide Flexible Fund of Funds: B2 R10,000 R500 R R Acc. No * MitonOptimal IP Foreign Flexible Feeder Fund: A R5,000 R500 R R Acc. No * 1 Please note that no cash will be accepted. Cash can be paid directly into the bank account provided. * Please make cheques payable to IP Management Comp Op Tr Acc. Standard Bank, Thibault Square Branch, Branch code , current account number Cheques can be deposited directly into the above bank account of the portfolio. In case of lump sums, please fax through copy of bank deposit slip and post original or certified copy with the application form. Single-Manager Portfolio Name Minimum Lump Sum Minimum Monthly Lump Sum 1 Monthly Standard Bank Branch Code ( ) MitonOptimal IP Interest Plus Fund: A R10,000 R500 R R Acc. No * MitonOptimal IP SA Inflation Linked Index Fund: A R10,000 R500 R R Acc. No * MitonOptimal IP Defended Beta Fund: A R10,000 R500 R R Acc. No * MitonOptimal IP Active Beta Fund: A R10,000 R500 R R Acc. No * MitonOptimal IP Smart Equity Fund: A R10,000 R500 R R Acc. No * MitonOptimal IP High Conviction Equity Fund: A R10,000 R500 R R Acc. No * 1 Please note that no cash will be accepted. Cash can be paid directly into the bank account provided. * Please make cheques payable to IP Management Comp Op Tr Acc. Standard Bank, Thibault Square Branch, Branch code , current account number Cheques can be deposited directly into the above bank account of the portfolio. In case of lump sums, please fax through copy of bank deposit slip and post original or certified copy with the application form. Method of payment (tick relevant box) Cheque deposit Electronic transfer Once off debit Regular debit order Once-off debit instructions will be actioned provided the following criteria are met: The date the account is to be debited is a business day and all requirements have been fulfilled. Your account will be debited within 2 business days of receipt of completed application and supporting documents. Once-off electronic collection is restricted to maximum if R500,000 per bank account per day. Amounts exceeding R500,000 must be actioned by electronic transfer (EFT) directly into our bank account specified above. I / We the under signed, hereby instruct and authorise IP to draw against the nominated bank account, the investment amounts in terms of this application on the day specified above for the investment at the ruling price on that day. All such withdrawals from my / our bank account by IP will be treated as though they have been signed by me / us personally, and I / we request the bank to debit my/our account with these drawings. Debits can only be processed from a South African Bank Account. I / We acknowledge that cheque deposits are subject to a 14 day clearance period. Any changes to debit order details must be communicated 5 business days before the debit day. Source of funds 6. Income Instruction Please select one option. If no selection is made, income will automatically be re-invested Reinvest my income in further units Pay my income into my bank account - detailed in section 4. Bank Details 5

6 7. Debit Order Authority (The minimum debit order is R500 per month / per account / per Fund. Debit orders are restricted to a maximum of R500,000 per bank account / per day.) Must be 5 working days prior to 1st working day of the month in which debit order is to commence. Debit Order frequency (tick relevant box) Monthly Quarterly Bi-annually Annually commencing on (DD / MM / YYYY) and thereafter on the 1st OR 25th day of every month until further notice. Tick as appropriate. Account holder Name of bank Branch code Branch Account number Account type Optional annual automatic increase % 8. Income Plan If applicable You may schedule a regular monthly income plan providing that the instruction is received 5 business days before the scheduled withdrawal payment date for the payment to be effective on that day. If not, the first withdrawal payment will be scheduled to take place the next month. Regular withdrawal payments are scheduled for the 25th of each month and if this falls on a weekend or public holiday it will be effective on the next business day. The minimum regular withdrawal amount is R1, per month per account / fund. I/We, the undersigned, hereby authorise IP Management Company (RF) Pty Ltd to transfer from my investment account R ON THE DAY OF EACH MONTH TO MY BANK ACCOUNT LISTED ABOVE. EFFECTIVE FROM DATE 9. Facsimile Instruction I wish the following authorisation to apply: (If NO is selected, only original instructions received will be acted upon) Yes No I/We, the undersigned hereby authorise IP Management Company (RF) Pty Ltd to act upon instruction by facsimile with regard to my investment in collective investments without liability in respect of any transfer, payment or other act done in accordance with such instructions and notwithstanding the absence of proof that the same was signed or sent by me. Communication from IP Management Company (RF) Pty Limited or MitonOptimal South Africa (Pty) Limited: All your correspondence will be sent to your address provided on page 3 under point 3 (confirm by ticking relevant box): If no please advise of alternative address or correspondence instruction: Yes No DD / MM / YYYY Dated Signature of the Investor DD / MM / YYYY Dated Authorised Signature (If different to the investor and warrant to have power of authority to act on the investor s behalf) Full name of authorised signatory Capacity of authorised signatory 6

7 10. Agreement with Investor 1. This application form and the Supplemental Deed(s) of the MitonOptimal IP Funds will form the agreement between the investor and IP Management Company (RF) Pty Ltd, an authorized Manager of a Collective Investment Scheme in Securities in terms of the Collective Investment Schemes Control Act, 45 of 2002 ( the Act ). The Deed is available for viewing at the registered office of the Manager. 2. Collective Investment Schemes in Securities (CIS) are generally medium to long term investments. The value of units may go down as well as up and past performance is not necessarily a guide to the future. CIS are traded at ruling prices and can engage in borrowing and scrip lending. Commission and incentives may be paid and if so, would be included in the overall costs. Please refer to the fund summary at the back of this application form for a list of the initial fees and annual management fees applicable to each collective investment portfolio. 3. All IP collective investment portfolios are valued and priced using forward pricing at 15h00 each business day with the exception of quarter end when valuation is at 17h00 and 20h00 for fund of funds and certain funds with significant investments in CIS. 4. Collective investment prices are calculated on a net asset value basis by determining the total market value of all assets in the collective investment portfolio scheme, including any income accruals, less any permissible deductions from the portfolio namely: brokerage fees, marketable securities tax, Value Added Tax, auditors fees, bank charges, trustee and custodian fees, and the service charges of the manager. Please refer to the fund summary at the back of the application form. 5. Units will be repurchased by the manager at the ruling price calculated in accordance with the requirements of the Act and the relevant deeds and paid to the investor only. Subject to occurrences beyond the control of IP, transaction requests received by IP before 14h30 will be actioned at that day s price. Monies from the repurchase of units will not be paid to third party bank accounts. 6. Fluctuations or movements in exchange rates may cause the value of underlying international investments to go up or down. 7. The manager may borrow up to 10% of the market value of the collective investment scheme portfolio to ensure liquidity. 8. The fund(s) may engage in scrip-lending activities, subject to the limits and conditions imposed by the Act. 9. The IP collective investments portfolios may at any stage be closed to enable the portfolios to be managed in accordance with their mandates. 10. IP reserves the right to repurchase unit balances with a market value less than the minimum monthly investment amount and close the investment account. Investors will be notified beforehand should this be contemplated. 11. If the investor requests a unit certificate, IP reserves the right to repurchase units from the investor in order to pay for the stamp duty payable in respect of the unit certificate and the net number of units will be certified. 12. The clearance period on investments made by debit order is 10 (ten) days. 13. In the event that this application form is faxed or ed to IP, the responsibility of ensuring that the instruction has been received and actioned by IP will lie with the instructor. A fax confirmation in the hands of the sender will not be regarded as proof that IP received a specific document. IP does not accept any liability and responsibility for having acted on a faxed document that on the face of it appears valid and the investor consequently bears the risk of fraud and/or forgery. 14. IP reserves the right to only process instructions that are submitted on IP standard transaction forms. 15. IP reserves the right to withhold processing of any unclear, incomplete or ambiguous requests forwarded by the investor / financial advisor. IP will not be liable for any damages or losses of whatsoever nature arising out of IP s failure to action this instruction due to occurrences beyond the control of IP. IP will not be liable for any loss incurred due to incorrect information being supplied by the investor or his/her financial advisor. This includes, but is not limited to, IP being unable to identify a deposit or transfer made to the respective IP bank account, for any reason whatsoever. Proof of payment and copies of all verification documentation requested must accompany this application form. IP will not be obliged to process this application form until it has received proof of payment and the verification documentation and IP will not be liable for any loss or damage of whatsoever nature arising from the inability of IP to process this application form due to the fact that the requirements of the Financial Intelligence Centre Act, 38 of 2001 ( FICA ) have not been complied with. The investor indemnifies and holds IP harmless against any loss or damage which the investor may suffer as a result of any commission or omission by IP which is a result of an obligation imposed on IP by FICA. 16. SARS requires us to pay over Dividend Withholding Tax (DWT) on your behalf where applicable. We will deduct this tax before we pay any dividends to you or reinvest into your account. Unless we receive information from you indicating otherwise, we will be obliged to withhold the default DWT of 15%. 17. The Manager does not provide any guarantee either with respect to the capital or the return of a portfolio. Fund of funds and feeder funds invest in portfolios of other Collective Investment Schemes that levy their own charges, which could result in a higher fee structure for the fund of funds. The Manager retains full legal responsibility for the Fund, regardless of Co-Naming arrangements. Prices are published daily and available in newspapers countrywide, as well as on request from the Manager. IP Management Company (RF) Pty Ltd is the authorised Manager of the Scheme contact or clientservices@ipmc.co.za. Standard Bank is the trustee / custodian contact compliance-ip@standardbank.co.za. Additional information including the annual report of the Manager and detailed holdings of the portfolio as at the last quarter end are available, free of charge, from clientservices@ipmc.co.za 18. IP Management Company (RF) (Pty) Ltd is a member of Association for Savings & Investment SA (ASISA). 19. Complaints should be in writing and clearly marked for the attention of the Compliance Officer and should be sent to clientservices@ipmc.co.za or faxed to

8 11. Declaration I/we certify that I/we have noted and understood the information provided and to confirm that I/we received the minimum disclosure document MDD I/We understand and/or warrant that: I/we have read and understand and agree to be bound by the provisions of this application form. If, on the date of signature of this application form, an updated application form exists and the fees and / or terms and conditions are different on that form, the fees and / or terms and conditions on the updated application form will apply; the information contained in this application form is true and correct. IP shall have the right to make any enquiries from any source to verify the information disclosed in this application form; where this application form is signed in a representative capacity I/we have the necessary authority to sign; IP reserves the right to request any additional evidence to identify the source or the investment amount prior to processing this application; and any amounts received by IP by debit order or Electronic Funds Transfer (EFT) will be deemed not to have been received and no transaction(s) in respect of such application may be made until the amount has been unconditionally credited to the IP Management Comp OP TR bank account. I/We indemnify and hold IP harmless against any claim of whatsoever nature, which I/we may have resulting from conducting business by telephone, facsimile, , website or any other electronic means. I/We hereby consent to IP taking any security precautions it may deem necessary to proceed with my/our application. IP shall, at its discretion, have the option to pay or collect any amounts (provided that I/we owe the amount to IP), via the Automated Clearing Bureau or EFT. DD / MM / YYYY Dated Signature of the Investor DD / MM / YYYY Dated Authorised Signature (If different to the investor and warrant to have power of authority to act on the investor s behalf) Full name of authorised signatory Capacity of authorised signatory 8

9 12. Introducer s Details To be completed by the investor 1. I/WE DO NOT APPOINT A FINANCIAL ADVISOR OR I APPOINT AS MY FINANCIAL ADVISOR. I hereby confirm that the individuals whose details are completed above, is my appointed Financial Advisor and I agree to the payment of fees as indicated in point 5 below. 2. I confirm that my financial advisor(s) is an approved investment manager/discretionary financial service provider, in terms of the Financial Advisory and Intermediary Services Act, 37 of 2002 ( FAIS ), with full discretion to manage my investments. I instruct IP Management Company (RF) Pty Ltd ( IP ) to accept instructions given by my financial advisor(s) on my behalf. 3. I instruct IP Management Company (RF) Pty Ltd to provide my financial advisor(s) with a copy of my valuation statements. 4. In consideration for the execution of the financial advisors duties in respect of the investment(s), I acknowledge that the financial advisor(s) shall receive payment of such fees as are reflected in the application form or any variations thereof, which fees shall be charged against the investment(s). 5. Financial Advisor Fees. I hereby confirm the financial advisor, whose details are completed below, to be my introductory financial advisor and agree to the payment of fees as follows: Please specify the percentage (excluding VAT) Initial Advice Fee Ongoing Advice Fee * (in increments of 0.25% to a max of 2%. Please refer to schedule of fees / charges) (per annum of the investment portfolio, charged and paid monthly in arrears - max 0.75%) * Ongoing Advice Fee: This is a negotiated fee agreed upon by yourself and your financial advisor for ongoing services. It is calculated as a percentage of the value of investment. The fee is calculated and paid monthly, and is included in the service charge of the Manager. 6. I expressly agree that I will have no claim or cause of action IP Management Company (RF) Pty Ltd in connection with my relationship with my financial advisor(s), this mandate, or for any other reason including the advice given to me by the financial advisor(s). I/we opt for options indicated above. I/we agree that participatory interest to the value of the indicated options ongoing fee plus VAT be redeemed from my account on a monthly basis to be paid as an ongoing advisory fee to the financial advisor stated below. ED AT PLACE ON THIS DAY DAY OF MONTH, YEAR Signature of investor NAME OF LEGAL GUARDIAN (Where applicable) 13. Financial Advisor Details & Declaration Contact name Company Brokerage Code Registration number FSP licence number Telephone number Advisor Code Fax number I/We declare that I/we have made the disclosures required in terms of the Financial Advisory and Intermediary Services Act 37 of 2002 and subordinate legislation thereto, to the investor(s). declare that I/we have fully explained the meaning and implications of replacement (if applicable) to the investor(s) and that I am fully aware of the possible detrimental consequences of replacement. warrant that I/we have explained all fees that relate to this investment to the investor and I/we understand and accept that the Investor may withdraw his/her authority for payment to me/us in writing to IP. Financial Advisor Declaration (FICA) warrant that I/we have established and verified the identity of the investor(s) (and persons acting on behalf of the investor) in accordance with the Financial Intelligence Centre Act 38 of 2001 (FICA) and subordinate legislation thereto, and I/we will keep records of such identification and verification according to the provisions of FICA. I confirm that I have identified the investor, including any person acting on behalf of the investor, premium payer and cessionary, where applicable, and verified his/her details on this investment under the requirements set out in section 21 of the Financial Intelligence Centre Act, No 38 of I further confirm that I have stored all the verification documents in terms of section 22 of the same act. (effective from 30 June 2003.) Signed at PLACE on this DAY day of MONTH, YEAR ATURE OF FINANCIAL ADVISOR (Who accepts his/her appointment) 9

10 13. Maximum Costs and Charges Service Charge An ongoing service charge is levied daily on the market value of the portfolios Portfolio Name Manager s Charge Ongoing Service Charge (Incl. VAT) Risk Multi-Asset Funds MitonOptimal IP Diversified Income Fund of Funds: B2 1 0% 0.86% Low MitonOptimal IP Prudential Fund of Funds: B2 0% 0.86% Low to Moderate MitonOptimal IP Flexible Fund of Funds: B2 0% 0.86% Moderate MitonOptimal IP Worldwide Flexible Fund of Funds: B2 2 0% 0.86% Moderate to High MitonOptimal IP Foreign Flexible Feeder Fund: A 0% 0.46% Moderate to High Single Asset Funds MitonOptimal IP Interest Plus Fund: A 0% 0.68% Low MitonOptimal IP SA Inflation-Linked Index Fund: A 0% 0.51% Low to Moderate MitonOptimal IP Defended Beta Fund: A 3 0% 0.74% Moderate to High MitonOptimal IP Active Beta Fund: A 0% 0.46% Moderate to High MitonOptimal IP Smart Equity Fund: A 4 0% 0.57% High MitonOptimal IP High Conviction Equity Fund: A 5 0% 0.86% High The investor pays for the value of the ruling underlying investments as on the day the investment deposit is received after deduction of the following manager s charges, where applicable: (refer note 9.1). Refer to Terms and Conditions Section 9.2 regarding pricing times for the various above mentioned funds. 1 10% (sharing rate) of the out-performance above the hurdle rate on a high water mark principle. Fees capped at 1.75% p.a. The fees are accrued on a daily basis and paid out on a monthly basis. Any shortfall in the hurdle rate and the high water mark is carried forward to set-off against future positive out performances. Fee example, 0% performance fee if portfolio performance is in line with its hurdle rate (SA repo rate). 2 15% (sharing rate) of the out-performance above the hurdle rate on a high water mark principle. Fees capped at 2.5% p.a. The fees are accrued on a daily basis and paid out on a monthly basis. Any shortfall in the hurdle rate (CPI +6% p.a.) and the high water mark is carried forward to set-off against future positive out performances. Fee example, 0% performance fee if portfolio performance is in line with its hurdle rate. Performance Fee per Fund 3 5% (sharing rate) on a high water mark principle. The fees are accrued on a daily basis and paid out on a monthly basis and will be recovered from the portiolio as part of the service fee. Fee example, 0% performance fee if portfolio performance is less than or equal to the high watermark. 4 When the fund performs better than the FTSE/JSE Top 40 Index plus 1.5% p.a., 30% of the outperformance to a total maximum fee of 1% p.a. is payable as a performance fee. Performance is measured over a 12 month period and reset every 12 months. The fees are accrued on a daily basis and paid out on a monthly basis, with 1/12th of the annual fee cap applied every monthend. 5 20% of out-performance of the benchmark, capped at 1.25% p.a. Performance is measured over a 12 month period and reset every 12 months. The fees are accrued on a daily basis and paid out on a monthly basis, with 1/12th of the annual fee cap applied every month-end. If you have any questions about this Application Form, please contact our Client Service Team on for assistance Collective Investment Schemes are generally medium to long term investments. The value of participatory interests or the investment may go down as well as up. We advise that you consult a Qualified Independent Financial Advisor to ensure that the fund is appropriate in terms of the investor s risk tolerance and appetite. Past performance is not necessarily a guide to future performance. Collective investment schemes are traded at ruling prices and can engage in borrowing and scrip lending. A schedule of fees and charges and maximum commissions is available on request from the manager. The Manager does not provide any guarantee either with respect to the capital or the return of a portfolio. Fund of Funds and Feeder Funds invest in portfolios of other Collective Investment Schemes that levy their own charges, which could result in a higher fee structure for the fund of funds. Collective Investment Schemes prices are calculate on a net asset value basis and auditor s fees, bank charges and trustee fees are levied against the portfolio. Graphs and performance figures are sourced from Financial Express for lump sum investments including income distribution, at NAV to NAV basis and do not take any initial fees into account. Income is reinvested on the ex-dividend date. Actual investment performance will differ based on the initial fees applicable, the actual investment date and the date of reinvestment of income. The Manager retains full legal responsibility for the Fund, regardless of Co-Naming arrangements. Transaction cut-off time is 14:30 daily. Valuation time is 15:00 (17h00 at quarter end) and 20:00 for fund of funds and certain funds with significant investments in Collective Investment Schemes. Prices are published and calculated daily, they are available in newspapers countrywide, as well as on request from the Manager. IP Management Company (RF) Pty Ltd is the authorised Collective Investment Scheme Manager of the Scheme contact or clientservices@ipmc.co.za. Standard Bank is the trustee / custodian contact compliance- IP@standardbank.co.za. Additional information including application forms, the annual report of the Manager and detailed holdings of the portfolio as at the last quarter end are available, free of charge, from clientservices@ipmc.co.za. MitonOptimal South Africa (Pty) Limited is the Fund Manager and is regulated by the Financial Services Board, FSP MitonOptimal South Africa (Pty) Limited is authorised to act as a Fund Manager in terms of FAIS. IPMC is owned by the following licensed Financial Services Providers: MiPlan (Pty) Ltd, (FSP 9383) 37%, Flagship Asset Management (Pty) Ltd (FSP 577) 16%, MitonOptimal Holdings (Pty) Ltd, holding company for MitonOptimal Asset Management (Pty) Ltd (FSP 28160) 16%, FirstGlobal Asset Management (Pty) Ltd (FSP 20987) 25%. 10 Member of the Association for Savings & Investment SA

11 Appendix A (Not required for individual investors) Please complete a separate Annexure A form for each authorised representative, founder/donor, trustee, beneficiary, member, partner, executive, manager and shareholder of each entity. Investor Details NAME OF INVESTING ENTITY Designation Authorised representative Founder Trustee Beneficiary Partner Executive Manager Shareholder Title Full names Surname Physical address Postal address Postal Code: Postal Code: Please tick relevant box for method of identification: Identity document OR Passport ID/Passport number Date of birth (DD / MM / YYYY) Signature of investor 11

12 Appendix B Dividend Withholding Tax: Declaration for Exemption Notes on completion of this form: This form is to be completed by the beneficial owner of dividends (including dividends in specie) in order to apply for exemption from dividends tax. To qualify for an exemption, this declaration and undertaking should be submitted at least three days before payment of a dividend - failure to do so will result in the full 15% dividends tax being withheld. Non South African residents seeking to qualify for a reduced rate should not complete this form. A: Withholding Agent: Registered name: IP Management Company (RF) Pty Ltd Dividends tax reference number: 9899/792/14/8 B: Beneficial Owner (Investor) Full names & surname / registered name Nature of person / entity Designation Individual Trust (Anytype) RSA Government, Provincial Administration, Municipalities Listed Company Unlisted Company Retirement Fund (Pension, Provident, Benefit, RA etc) Other if Other selected please provide a description: Identity/passport/registration number South African Income Tax reference number Registered Tax Office Date of Incorporation Physical address Postal Code: Postal address Postal Code: Country in which resident for tax purposes Authorised Contact Person if Beneficial Owner is a Legal Entity Full names & surname South African ID No. or Passport No. (if a foreign national) Telephone number (Home) Telephone number (Work) Cell phone number Fax number 12

13 PART C: EXEMPTION DIVIDENDS: Please indicate the reason why the beneficial owner is exempt from the dividends tax: Par (a) a company which is resident in South Africa Par (b) the Government, provincial government or municipality (of the Republic of South Africa) Par (c) a public benefit organisation (approved by SARS ito section 30(3) of the Act) Par (d) a trust contemplated in section 37A of the Act (mining rehabilitation trusts) Par (e) an institution, body, or board contemplated in section 10(1)(cA) of the Act Par (f) a fund contemplated in section 10(1)(d)(i) or (ii) of the Act (pension fund, pension preservation_fund, provident_fund, provident preservation fund, retirement annuity_fund, beneficiary fund or benefit fund) Par (g) a person contemplated in section 10(1)(t) of the Act (CSIR, SANRAL etc) Par (h) a shareholder in a registered micro business as defined in the Sixth Schedule to the Act to the extent that the aggregate amount of the dividends paid by that registered micro business to its shareholders during the year of assessment in which that dividend is paid does not exceed R200,000 Par (j) a person that is not a resident and the dividend is a dividend contemplated in paragraph (b) of the definition of dividend in section 64D (i.e. a dividend on a foreign company s shares listed in SA, such as dual-listed shares) Par (k) A portfolio of investment schemes in securities Par (n) Fidelity and indemnity funds contemplated in section 10(1)(d)(iii) i.e. only the two, not the other entities mentioned Par (x) Other Par (y) Double Taxation Agreement Par (z) Other international agreement DIVIDEND TAX ON REAL ESTATE INVESTMENT TRUST (REIT) INCOME: Par (l) any person insofar as the dividend constitutes income of that person (i.e. falls into normal tax system) DECLARATION in terms of sections 64FA(1)(a)(i), 64G(2)(a)(aa) or 64H(2)(a)(aa) of the Income Tax Act, 1962 (Act No. 58 of 1962) and UNDERTAKING in terms of sections 64FA(1)(a)(ii), 64G(2)(a)(bb) or 64H(2)(a)(bb) of the Income Tax Act, 1962 (Act No. 58 of 1962): I (full names in print please), the undersigned hereby declare that dividends paid to the beneficial owner is exempt, or would have been exempt had it not been a distribution of an asset in specie, from the dividends tax in terms of the paragraph of section 64F of the Act indicated above and undertake to forthwith inform the Withholding Agent in writing should the circumstances of the beneficial owner referred to in the declaration above change. Signature Date Capacity of Signatory (if not the Beneficial Owner) 13

14 Appendix C Dividend Withholding Tax: Declaration for Reduced Rate Notes on completion of this form: This form is to be completed by the beneficial owner (of dividends, including dividends in specie) in order for the reduced rate of dividends tax, referred to in sections 64FA, 64G or 64H of the Income Tax Act, 1962 (Act No 58 of 1962) (the Act) as well as the provisions of the Agreement for the Avoidance of Double Taxation and Prevention of Fiscal Evasion (DTA) between the Republic of South Africa and the country of residence of the beneficial owner, to apply. In order to qualify for the reduced rate referred to above this declaration and written undertaking should be submitted to the withholding agent (declaring company or regulated intermediary) within the period required by the latter (provided it is before payment of the dividend) - failure to do so will result in the full 15% dividends tax being withheld/payable. Where the beneficial owner is a foreign resident but does not qualify for a reduced rate this form should NOT be completed. A: Withholding Agent: Registered name: IP Management Company (RF) Pty Ltd Dividends tax reference number: 9899/792/14/8 B: Beneficial Owner (Investor) Full names & surname / registered name Nature of person / entity Designation Individual Trust (Anytype) RSA Government, Provincial Administration, Municipalities Listed Company Unlisted Company Retirement Fund (Pension, Provident, Benefit, RA etc) Other if Other selected please provide a description: Identity/passport/registration number South African Income Tax reference number Registered Tax Office Date of Incorporation Physical address Postal Code: Postal address Postal Code: Country in which resident for tax purposes Authorised Contact Person if Beneficial Owner is a Legal Entity Full names & surname South African ID No. or Passport No. (if a foreign national) Telephone number (Home) Telephone number (Work) Cell phone number Fax number 14

15 C: Reduced Rate Please provide an explanation of the reasons the beneficial owner meets the requirements of the DTA. DECLARATION in terms of sections 64FA(2)(a), 64G(3)(i) or 64H(3)(i) of the Income Tax Act, 1962 (Act No. 58 of 1962) and UNDERTAKING in terms of section 64FA(2)(b), 64G(3)(ii) or 64H(3)(ii) of the Income Tax Act, 1962 (Act No. 58 of 1962): I in terms of Article (full names in print please), the undersigned hereby declare that all the relevant requirements of the Agreement for the Avoidance of Double Taxation and Prevention of Fiscal Evasion (DTA) in force on the relevant date between the Republic of South Africa and the country of residence of the beneficial owner specified above, as well as sections 64FA, 64G or 64H of the Act (whichever is applicable), have been met and that dividends paid on the shares specified above are therefore subject to a reduced rate of % and undertake to forthwith inform the Withholding Agent in writing should the circumstances of the beneficial owner referred to in the declaration above change. Signature (Duly authorised to do so) Date Capacity of Signatory (if not the Beneficial Owner) 15

16 Appendix D Withholding Tax on Interest Declaration - Non-RSA Tax Residents Return form by scanning and ing it to clientservices@ipmc.co.za or faxing it to WHO SHOULD COMPLETE THIS FORM? Please complete and sign this form if you are a non-rsa Tax Resident investor subject to a different rate of tax on local interest as a result of a double tax agreement (DTA) or if you represent a legal entity that is exempt from Withholding Tax on Interest (WTI). The owner of the interest must complete and sign all the relevant sections. If you don t complete, sign and return this form to IP Management Company (RF) Pty Ltd (IP), we are obliged to withhold tax on local interest at the applicable rate stipulated in legislation. Individuals who are tax resident in South Africa are not subject to tax at the normal rate of WTI and do not have to complete this form. Individuals who are not tax resident in South Africa are subject to tax and WTI will automatically be withheld and interest paid net of tax. PLEASE NOTE: This declaration is made in respect of all the unit trust funds held within the investor s standard unit trust portfolio, in terms of the Income Tax Act (No. 58 of 1962) (the Act). It applies to all CIS unit trust fund portfolios as managed by IP. Duly completed and signed forms that reach us by 14h30 will be processed on the same day. INSTRUCTIONS Please complete this form using block letters and tick (X) where appropriate. Please complete section 1, and then select the applicable option below. OR I/We hereby apply for exemption. Complete and sign section C. I/We hereby apply for a reduced rate of withholding tax on interest. Complete and sign section D. A: Particulars of Person Paying Interest: Withholding Agent: Company/entity/registered name (if applicable): IP Management Company (RF) Pty Ltd South African income tax number: 9899/792/14/8 Company registration number: 2007/017601/07 Founding/registration/inception date: 28 June 2007 Country of tax residence: South Africa Contact number: Fax number: Preferred method of communication: clientservices@ipmc.co.za Postal address: PO Box 23271, Claremont, 7735 Physical address: 3rd Floor, Letterstedt House, Newlands on-main, Newlands,