1 of 22. Received and / or Accrued (conitinued) Other foreign income (excl. income listed above)

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1 Information Have the banking, contact and trustee details of the trust been verified and confirmed as correct? (efer to guide) Is the declaration made by a tax practitioner? Did the trust enter into any reportable arrangement in terms of s34-39 of the Tax Administration Act? Specify the number of reportable arrangements Was any local income received by and / or accrued to the trust during the year of assessment? Indicate the type of local income received / accrued to the trust: emuneration Annuities Interest Capital Gain / Loss ental Income Farming Income Other local income (excluding income listed above) Interest Programme Does any declaration in this return relate to an application made under the SAS Voluntary Disclosure Programme? eceived and / or Accrued Business, trade or professional income (excluding ental and Farming) Did the trust participate in any local farming partnership operations? How many farming partnership operations did the trust participate in? eceived and / or Accrued Was any foreign income received by and / or accrued to the trust during the year of assessment? Indicate the type of foreign income received / accrued to the trust: IFOMATIO TO CEATE THE ICOME TAX ETU FO A TUST Dividends Capital Gain / Loss Other foreign income (excl. income listed above) Credits Information Is the trust a partner in a partnership? How many partnerships? eceived and / or Accrued (conitinued) Did the trust receive any amounts considered non-taxable? Will the trust be claiming any PAE credits reflected on an IP5 tax certificate? Specify the number of IP5 tax certificates Will the trust be claiming any foreign tax credits in terms of s6quin? Were any foreign tax credits refunded / discharged during the year of assessment for which a rebate was allowed during a previous year of assessment? elated Persons Specify the number of distinct persons or beneficiaries to whom any of the following transactions were applicable during the year of assessment: Taxable on income distributed to / vested in beneficiaries or taxable i.t.o s7 or par of the Eighth schedule eceived a distribution / vesting of non-taxable income from this trust eceived a distribution / vesting of capital or assets from this trust Has outstanding loan(s) granted to this trust Holds outstanding loan(s) from this trust Made / eceived donation(s) / contribution(s) to / from this trust eceived distributions from other trusts or foundations eceived refund(s) on contribution(s) made to this trust Granted the right of use of asset(s) retained in this trust IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX Farming XXXX 1 of 22 This page allows you to customise the IT12T return for the trust. elated Persons (continued) Specify the number of distinct persons or beneficiaries to whom the highest of the total of the following transactions were in excess of during the year of assessment (the number should not exceed 50): Taxable on income distributed to / vested in beneficiaries or taxable i.t.o s7 or par of the Eighth schedule eceived a distribution / vesting of non-taxable income from this trust eceived a distribution / vesting of capital or assets from this trust Has outstanding loan(s) granted to this trust Holds outstanding loan(s) from this trust Made / eceived donation(s) / contribution(s) to / from this trust eceived distributions from other trusts or foundations eceived refund(s) on contribution(s) made to this trust Granted the right of use of asset(s) retained in this trust Distribute / vest capital or assets from this trust IT12T Were any of the following transactions applicable to the trust during the year of assessment: Distribute / vest taxable income / capital gain(s) from this trust Distribute / vest non-taxable income from this trust Hold outstanding loan(s) granted Hold a liability for outstanding loan(s) Make donation(s) Make contribution(s) eceive donation(s) eceive contribution(s) eceive distributions from other trusts or foundations efund contribution(s) Grant the right of use of asset(s) retained in this trust

2 egistered ame Trust eg o. egistration o. Address Particulars Details Special Trust par. (a) Please indicate the VDP application no. issued by SAS Specify the reportable arrangement number: Details (if applicable) Is the trust party to any arrangements which has the following features: ound trip financing (s80d)? Special Trust par. (b) Is the trust a Personal Service Provider as defined in the Fourth Schedule to the Income Tax Act? Elements that have the effect of offsetting or cancelling each other? Presence of an accommodating or tax-indifferent party (s80e)? Income Tax eturn for Trusts (Income Tax Act, o. 58 of 1962, as amended) Inter vivos ote: If no VDP application was made, change your VDP answer to o on the first page of this return Testamentary Tel o. I declare that: Taxpayer ef o. Date registered at Master s Office (CCMMDD) Collective Investment Scheme Information ear of Assessment I am the duly appointed epresentative of the trust The information furnished in this return is to the best of my knowledge both true and correct I have disclosed the gross amounts of all income received and / or accrued to this trust during the period covered by this return I have the necessary financial records and supporting schedules to support all declarations on this return which I will retain for audit purposes. Date (CCMMDD) Vested i.t.o Income Is the trust registered in the epublic of South Africa or is the place of effective management in the epublic? Did the trust, together with any connected person in relation to the trust, hold at least 10% of the participation rights in any controlled foreign company (CFC)? If es, complete the applicable schedule (IT10) (refer to guide). Indicate whether the trust was engaged in mining or mining operations as defined in s1 of the Income Tax Act. If es, complete the applicable schedules (Schedules A and B) (refer to guide). Were any changes made during the year of assessment to the trustees? IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX 2 of 22 Discretionary i.t.o Income For enquiries go to or call SAS (7277) esidency for income tax purposes (e.g. South Africa = ZAF) Master s office of trust registration Main Income Vested i.t.o Capital IT12T Discretionary i.t.o Capital Mark here with an X if you declare that you do not have an address Information (Continued) Were any changes made during the year of assessment to the beneficiaries? Were any changes made during the year of assessment to the the trust deed? If es, where beneficiaries have a vested right to the trust s asset(s), has the change in the trust deed affected any of the beneficiaries vested interest in the trust s asset(s)? Did any amounts distributed by the trust or retained in the trust arise by reason of a donation, settlement or other disposition to this trust? Is this trust a beneficiary of another trust or are other trust(s) beneficiaries of this trust? XXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXX Please ensure you sign over the 2 lines of X s above

3 3 of 22 of Assets and Liabilities Statement of Local Assets and Liabilities (ands only) Assets (at cost) (Continued) Assets (at cost) Fixed property and all improvements to property Shares in private companies or member s interest in Close Corporation Loan accounts Financial instruments listed (shares, unit trusts, etc.) et capital of business, trade, profession or farming Equipment, machinery, implements Motor vehicles, caravans, boats Debtors Stock Livestock elected value(s) Cash on hand, in bank and other similar institutions Personal effects, (jewellery, paintings, furniture, etc.) Other assets Please provide descriptions relating to other listed above Total Local Assets Mortgage bonds Loan accounts Creditors Bank overdraft Other liabilities Liabilities Please provide descriptions relating to other listed above IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX Total Local Liabilities Total foreign assets Total foreign liabilities Liabilities (Continued) Statement of Foreign Assets and Liabilities ote: For foreign assets, the foreign currency value must be translated using the spot rate as at the end of the year of assessment in which the asset was acquired. For foreign liabilities, the foreign currency value must be translated using the spot rate as at the end of this year of assessment. Total profit / loss taxable in trust

4 Gross receipts and accruals Less: Expenses Taxable amount available for distribution / assessed loss retained in trust Less: Amount distributed to / vested in beneficiaries or taxable i.t.o. of s7 Taxable in Trust Gross receipts and accruals Less: Amount distributed to / vested in beneficiaries or taxable i.t.o s7 Taxable in Trust IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX 4 of 22 Gross receipts and accruals Less: Expenses Taxable amount available for distribution/ assessed loss retained in trust Less: Amount distributed to / vested in beneficiaries or taxable i.t.o s7 Taxable in Trust

5 Schedule of 5 of 22 in respect of the disposal of assets Proceeds Base Cost Capital Gain / Loss Please refer to the guide with regards to the main asset type source code list Even numbered codes refer to gains and uneven numbered codes refer to losses Please note the inclusion rate will be applied by SAS Add: Adjustment for clogged losses included in amounts listed above to be carried forward (par. 39 of the Eighth Schedule) Less: Allowable deduction i.r.o. prior year clogged losses carried forward on capital gain(s) to connected person(s) (par. 39 of the Eighth Schedule) Capital Gain available for distribution / Capital Loss retained in trust Less: Amount distributed to / vested in beneficiaries or taxable i.t.o par of the Eighth schedule Taxable in Trust (vested in foreign beneficiaries) Taxable in Trust (not vested in beneficiaries) IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX umber of transactions Main Asset Type

6 Local ental Income 6 of 22 and Trading Income (excluding ental and Farming Income) Gross receipts and accruals (Continued) Turnover / Sales Lease payments Less: Expenses Cost of sales Legal cost Add: Expenses incurred i.r.o right of use of trust assets by beneficiaries / other persons Gross Profit/ Loss ental Sub-total according to Income Statement Income other than turnover epairs / Maintenance Add: on-taxable items and amounts claimed for accounting purposes oyalties and licence fees Less: Tax deductions and special allowances i.t.o the Income Tax Act Accounting / Consulting / Trustee fees Salaries and wages Taxable amount available for distribution/ assessed loss retained in trust Bad / Doubtful debts Travel costs Less: Amount distributed to / vested in beneficiaries or taxable i.t.o s7 Capital allowances / Depreciation Other expenditure Taxable in Trust Electricity / ates and Taxes Please provide descriptions relating to other listed above Entertainment Insurance (Business related) Interest / Finance charges Total expenses IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX Accounting Profit/ Loss

7 Other Please provide descriptions relating to other listed above Control Total 7 of 22 and Trading Income (excluding ental and Farming Income) (Continued) Debit Adjustments (decrease net profit / increase net loss) on-taxable Amounts Credited to the Income Statement Please select / de-select the non - taxable amounts not credited to the Income Statement Accounting interest received / receivable Accounting profit on disposal of fixed and / or other assets Amounts previously taxed as received in advance eceipts and / or accruals of a capital nature eversal of provisions Special Allowances ot Claimed in the Income Statement Please select / de-select the special allowances not caimed in the Income Statement estraint of trade (s11(ca)) Amortisation of lump sum contributed to retirement / benefit funds (s11(l)) Depreciable asset allowance (s11(o)) Expenditure before commencing trade (s11a) esearch and development deduction (s11b) esearch and development deduction (s11d) Machinery, plant, implements, utensils and articles deduction (s12b) Manufacturers, hotelkeepers, aircraft, ship, storage and packing of agricultural products deduction (s12c) Pipelines, transmission and rail deduction (s12d) olling stock (s12da) IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX Airport and port assets (s12f) Wear and tear allowance (s11(e)) and Trading Income (excluding ental and Farming Income) egistered learnership agreements completed in current year (s12h) Doubtful debt allowance (s11(j)) XXXX Special Allowances ot Claimed in the Income Statement (Continued) Learnership agreements registered / in effect (s12h) Deduction in respect of Venture Capital Company shares (s12j) Certified Emission eductions Exemption (s12k) Allowance for energy efficiency savings (s12l) Exemption in respect of films (s12o) Deduction for building(s) used in a manufacturing process (s13) Hotel building deduction (s13bis) esidential building deduction (s13ter) UDZ (s13quat) - erection of a new building this year UDZ (s13quat) - improvements this year

8 Commercial building deduction (s13quin) esidential unit deduction (s13sex) Low cost residential unit deduction (s13sept) Prepaid expenditure not limited by s23h Allowance for future expenditure (s24c) Credit agreement and debtors allowance (hire-purchase) (s24) Interest incurred (s24j) Film allowance (s24f) Environmental asset deduction (s37b) Environmental conservation and maintenance deduction (s37c) Other 8 of 22 and Trading Income (excluding ental and Farming Income) (Continued) Debit Adjustments (decrease net profit / increase net loss) (Continued) Special Allowances ot Claimed in the Income Statement (Continued) Debit Adjustments (decrease net profit / increase net loss) continued Special Allowances ot Claimed in the Income Statement (Continued) Please provide descriptions relating to other listed above Control Total on-deductible Amounts Debited to the Income Statement Accounting interest paid / payable Accounting loss on disposal of fixed and / or other assets Credit Adjustments (increase net profit / decrease net loss) Please select / de-select the non-deductible amounts debited to the Income Statement Amortisation of lease premiums and improvements to leasehold premises Capital expenditure and / or losses Depreciation according to financial statements Expenses not actually incurred in the production of income (s11(a)) Financial assistance (s31) IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX Credit Adjustments (increase net profit / decrease net loss) on-deductible Amounts Debited to the Income Statement (Continued) Interest paid in respect of capitalised leased assets Interest, penalties paid in respect of taxes (s23(d)) Lump sum contributions to retirement and / or benefit funds Prepaid expenditure not allowed under s23h Provision for doubtful debt not deductible in current year Provisions not deductible current year (excluding doubtful debt) Transfer pricing adjustments Other Please provide descriptions relating to other listed above Control Total

9 Amounts received in advance Amounts accrued but not received 9 of 22 and Trading Income (excluding ental and Farming Income) (Continued) Allowances / Deductions Granted in Previous ears of Assessment and now eversed Please select / de-select the allowances / deductions granted in previous years of assessment and now reversed Allowance for future expenditure (s24c) Credit agreements and debtors allowance (hire-purchase) (s24) Doubtful debt allowance (s11(j)) Other Please provide descriptions relating to other listed above Control Total Amounts not Credited to the Income Statement Please select / de-select the amounts not credited to the income statement Closing value of consumable stock and spare parts Closing balance of stock values of work in progress - (s22(2a)) Interest accrued (s24j) Loans / advances granted by an insurer (par. (m) of def. of gross income ) Transfer pricing adjustment Amounts not Credited to the Income Statement (Continued) Expenses incurred i.r.o right of use of trust assets by beneficiaries / other persons Other Please provide descriptions relating to other listed above Control Total ecoupment of Allowances Previously Granted Please select / de-select the previously granted allowances that are subject to recoupment Bad debts Lease charges (s8(5)) IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX Wear and tear (s8(4)) Other Please provide descriptions relating to other listed above Control Total ecoupment of Allowances Previously Granted (Continued) ote: If partnership applicable, only enter the amount applicable to the share % of the trust below. Taxable profit available for distribution / Assessed Loss retained in trust Less: Amount distributed to / vested in beneficiaries or taxable i.t.o s7 Taxable in Trust

10 esearch and Development information s11d Was the research and development approved by the Minister of Science and Technology for the purposes of obtaining the allowance contained in s11d? Urban Development Zone S13 Is the building(s) for which the trust is claiming an allowance in an approved demarcated zone? Did the trust receive certificate(s) issued by the municipality confirming that the buildings(s) for which the trust is claiming an allowance is in an urban development zone? Did the trust erect, extend, add to or improve the building(s) for which the trust is claiming an allowance with the sole purpose of disposing thereof directly on completion? If o, state the total amount incurred for the erection, extension, addition or improvement of the building(s) Did the trust purchase the building(s) or part thereof from a developer? If es, state the purchase price of the building(s) or part thereof State the amount of the purchase price deemed to be cost incurred by the trust in terms of s13quat(3b) Did the trust use the building(s) erected, extended, improved or added on to solely for the trade of the trust during the year of assessment? Did the trust incur costs for the erection, extension or addition relating to low cost housing (s13quat(3a))? Is the trust a developer as envisaged in s13quat? Did the trust submit the necessary forms as prescribed in s13quat (10A)? Did the trust submit the necessary forms as prescribed in s13quat (4)? Energy Efficiency Savings s12l Has the trust obtained a certificate issued by SAEDI in respect of energy efficiency savings for the purposes of claiming a s12l allowance? IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX 10 of 22

11 Income from Local (ands only) Gross receipts and accruals (Including private usage) Partnership income (Add profit / Deduct loss) Plus: Livestock on hand at the end of the current year of assessment Plus: Produce on hand at the end of the current year of assessment Livestock on hand at the end of the preceding year of assessment Livestock purchased and received in exchange Balance of livestock not allowed in the preceding year of assessment Less: Amount deducted [Sub-Total (ii) limited to Sub-Total (i)] Less: Balance carried forward to the following year of assessment (This amount may not create or increase a loss) Less: Expenses Sub-Total (ii) Less: Produce on hand at the end of the preceding year of assessment Less: Special depreciation Equalisation rate selection: 3 year one (IT48) Mark here with an X if Par 13, 13A, 15, 17 or 20 of the First Schedule to the Income Tax Act applies. Excluding market value of livestock and produce acquired otherwise than by purchase, natural increase or in the ordinary course of farming operations (e.g. donations and inheritance) et Profit / Loss Less: Amount of improvements Sub-Total (i) Sub-Total Add: Expenses incurred i.r.o right of use of trust assets by beneficiaries / other persons Taxable profit available for distribution/ assessed loss retained in trust Less: Amount distributed to / vested in beneficiaries or taxable i.t.o s7 Taxable in Trust IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX 11 of 22

12 Income from Local Special Depreciation Information - ands only, no cents Balance b/f previous year Purchases current year Deductions in respect of purchases current year Deductions added back in respect of assets sold Amount allowable current year Information on Balance brought forward from previous year Less: ecoupments Plus: Purchases current year Plus: Total brought forward from partnership IT48V s Total improvements Less: Allowable deductions current year Balance carried forward to subsequent year ands only, no cents (IT48) (Continued) IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX Current ear Subsequent ear ear Following Subsequent ear 12 of 22

13 Income from Local Partnership Farming Operations (IT48V) Partnership name Gross receipts and accruals (Including private uasage) Plus: Livestock on hand at the end of the current year of assessment Plus: Produce on hand at the end of the current year of assessment Livestock on hand at the end of the preceding year of assessment Livestock purchased and received in exchange Balance of livestock not allowed in the preceding year of assessment Less: Amount deducted [Sub-Total (ii) limited to Sub-Total (i)] Sub-Total (ii) Less: Balance carried forward to the following year of assessment (This amount may not create or increase a loss) Less: Expenses Less: Produce on hand at the end of the preceding year of assessment Less: Special depreciation ands only, no cents Excluding market value of livestock and produce acquired otherwise than by purchase, natural increase or in the ordinary course of farming operations (e.g. donations and inheritance) Sub-Total (i) Sub-Total et Profit / Loss Trust share % of Taxable Income / Loss from partnership farming operations (Carry this amount to the IT48) IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX 13 of 22

14 Income from Local Partnership Farming Operations (IT48V) Special Depreciation Information - ands only, no cents Balance b/f previous year Purchases current year Deductions in respect of purchases Deductions added back in respect of assets sold Amount allowable current year Information on Purchases current year Surname / Trading ame Initials (if applicable) Surname / Trading ame Initials (if applicable) Surname / Trading ame Initials (if applicable) Surname / Trading ame Initials (if applicable) Surname / Trading ame Initials (if applicable) ands only, no cents for Share Distribution (Farming) 5 Share % Share % Share % Share % Share % Current ear Subsequent ear ear Following Subsequent ear, %, %, %, %, % ote: eflect Trust % share of this amount on the IT48. Profit / Loss Profit / Loss Profit / Loss Profit / Loss Profit / Loss 14 of 22 ands only, no cents (Continued) ote: If more than 5 partners, indicate 4 partners with highest share percentage. In last partner field indicate other in trading name with remaining share percentage. IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX Improvements Improvements Improvements Improvements Improvements Taxpayer ef o. Taxpayer ef o. Taxpayer ef o. Taxpayer ef o. Taxpayer ef o.

15 Other Local Income Other Local Income excluding local income from emuneration, Annuities, Interest, ental, Capital Gains/ Losses, Farming and Business/ Trade/ Professional. Gross receipts and accruals Less: Expenses Add: Expenses incurred i.r.o right of use of trust assets by beneficiaries / other persons Sub-total according to Income Statement Add: on-taxable items and amounts claimed for accounting purposes Less: Tax deductions and special allowances i.t.o the Income Tax Act Taxable amount available for distribution/ assessed loss retained in trust Less: Amount distributed to / vested in beneficiaries or taxable i.t.o s7 Taxable in Trust 15 of 22 Foreign Interest Income Gross receipts and accruals Less: Expenses Taxable amount available for distribution/ assessed loss Less: Amount distributed to / vested in beneficiaries or taxable i.t.o s7 Taxable in Trust Foreign tax credits on foreign interest distributed / vested in beneficiaries Foreign tax credits on foreign interest retained in trust IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX 4113 Foreign Dividend Income Gross foreign dividends subject to SA normal tax Less: Expenses Taxable amount available for distribution/ assessed loss retained in trust Less: Amount distributed to / vested in beneficiaries or taxable i.t.o s7 Taxable in Trust Foreign tax credits on foreign dividends distributed / vested in beneficiaries Foreign tax credits on foreign dividends retained in trust ote: The exemption i.to. s10b(3) will be applied programmatically by SAS 4112

16 Schedule of 16 of 22 in respect of the disposal of assets Proceeds Base Cost Capital Gain / Loss Please refer to the guide with regards to the main asset type source code list Even numbered codes refer to gains and uneven numbered codes refer to losses Please note the inclusion rate will be applied by SAS Add: Adjustment for clogged losses included in amounts listed above to be carried forward (par. 39 of the Eighth Schedule) Less: Allowable deduction i.r.o. prior year clogged losses carried forward on capital gain(s) to connected person(s) (par. 39 of the Eighth Schedule) Capital Gain available for distribution / Capital Loss retained in trust Less: Amount distributed to / vested in beneficiaries or taxable i.t.o par of the Eighth schedule Taxable in Trust (vested in foreign beneficiaries) Taxable in Trust (not vested in beneficiaries) Foreign tax credits for capital gains distributed / vested in beneficiaries (rand value only) Foreign tax credits for capital gains / loss retained in trust (rand value only) IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX 4114 umber of transactions 4114 Main Asset Type

17 17 of 22 Foreign Farming Income Other Foreign Income Gross receipts and accruals Gross receipts and accruals Less: Expenses Other Foreign Income excl. Dividends, Interest, Capital Gains and Farming Less: Expenses Add: Expenses incurred i.r.o right of use of trust assets by beneficiaries / other persons Other on-taxable income Add: Expenses incurred i.r.o right of use of trust assets by beneficiaries / other persons Less: Amount distributed to / vested in beneficiaries or taxable i.t.o s7 IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX Amounts Considered non-taxable Local Dividends Exempt foreign dividends (excl. s10b(3) exemption) Sub-total according to Income Statement Please provide descriptions relating to other listed above Add: on-taxable items and amounts claimed for accounting purposes Sub-total according to Income Statement Add: on-taxable items and amounts claimed for accounting purposes Less: Tax deductions and special allowances i.t.o the Income Tax Act Less: Tax deductions and special allowances i.t.o the Income Tax Act Taxable amount available for distribution/ assessed loss Taxable amount available for distribution/ assessed loss Less: Amount distributed to / vested in beneficiaries or taxable i.t.o s7 Taxable in Trust Taxable in Trust Foreign tax credits on foreign Farming income distributed / vested in beneficiaries Foreign tax credits on foreign Farming income retained in trust Foreign tax credits on other foreign income distributed / vested in beneficiaries 4119 Foreign tax credits on other foreign income retained in trust 4110

18 Available (excluding provisional tax) South African Sourced Income (already elsewhere included in this return) s6quin (ands only, unless specified) Taxable income from services rendered in South Africa taxed outside the SA Was the declaration of foreign tax withheld (FTW01) submitted to the Commissioner within 60 days? Please confirm that this amount was not claimed as a deduction in terms of s6quat(1c)? Foreign Tax Credits certificate number, IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX 7456 efunded / Discharged by the government of a Foreign Country in respect of a rebate allowed by SAS in a previous year s6quin Specify the portion of the amount so refunded / discharged as was previously allowed by SAS as a rebate XXXX 18 of 22, Credit, 4102

19 Trusts with more than 50 beneficiaries Partnership ame Specify the trust s profit / loss sharing % during the year of assessment: of Consolidated Transactions for Trust How many persons received capital distribution(s) from this trust during the year of assessment? % Indicate if the trust derived a profit / loss from this partnership during the year of assessment: Profit Loss Amount o of persons to whom non-taxable income was distributed, ote: Any Capital or Income (Taxable / on taxable) distributed as an annuity must be declared in this section of the return under the source code Local Dividends IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX Exempt foreign dividends (excl. s10b(3) exemption) Total value of capital distributed by the trust during the year of assessment XXXX 19 of 22 ote: The details of consolidated transactions must be provided where more than 50 distinct persons or beneficiaries were indicated in the Information to Create the Income Tax return for a Trust page. Indicate if this information is in respect of a local or a foreign partnership: Local Foreign + - Other on-taxable income

20 Trusts with more than 50 beneficiaries How many outstanding loans is the trust liable for? How many outstanding loans have been granted by the trust? How many persons received donation(s) from this trust during the year of assessment? How many persons received contribution(s) from this trust during the year of assessment? How many persons made donation(s) to this trust during the year of assessment? How many persons made contribution(s) to this trust during the year of assessment? How many trusts / foundations made distribution(s) to this trust during the year of assessment? How many persons received refunds for contribution(s) made to this trust during the year of assessment? How many persons enjoyed the right of use of assets retained in this trust? Total value of outstanding loans the trust is liable for Total value of outstanding loans granted by the trust IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX Total value donated by the trust during the year of assessment Total value contributed by the trust during the year of assessment Total value donated to the trust during the year of assessment Total value contributed to the trust during the year of assessment Total value distributed to the trust during the year of assessment Total value of contributions refunded by the trust during the year of assessment Was any waiver or compromise exercised in respect of these loans? Was any waiver or compromise exercised in respect of these loans? Total expenses incurred by this trust in respect of right of use of trust assets during the year of assessment 20 of 22 Was security provided for all of these loans? Was security provided for all of these loans?

21 Is this person / beneficiary: Taxpayer ef o. Surname First ame Other ame Initials Passport o. of Person / Beneficiary of Person / Beneficiary where Total Transactions exceed A connected person in relation to this trust? A beneficiary of this trust? A settlor of this trust? A natural person? A donor of this trust? Individual - Taxpayer ef o. Company / CC / Trust eg o. egistered ame Date of Birth (CCMMDD) ID o. Passport Country (e.g. South Africa = ZAF) Mark Transactions applicable to this person/beneficiary during the year of assessment with an X. This person/beneficiary: Was taxable on amounts distributed to / vested in beneficiaries or taxable i.t.o s7 or par of the Eighth schedule eceived / accrued non-taxable amounts from this trust Holds outstanding loan(s) granted to this trust Made contribution(s) to this trust Made distribution(s) to this trust (only applicable if the related party is a trust or foundation) Holds outstanding loan(s) from this trust eceived donation(s) from this trust eceived refund(s) on contribution(s) to this trust IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX 21 of 22 Passport Issue Date (CCMMDD) eceived / accrued a capital or asset distribution from this trust Made donation(s) to this trust eceived contribution(s) from this trust Enjoyed the right of use of asset(s) retained in this trust

22 ote: Any Capital or Income (Taxable / on taxable) distributed as an annuity must be declared in this section of the return under the source code Total value of capital distributed to this person during the year of assessment, %, % Total value donated by this person to the trust during the year of assesment Total value donated by the trust to this person during the year of assessment Total value distributed by this person to the trust during the year of assessment IT12T L XX FV V2014.XX.XX SV XXXX CT XX O XXXXXXXXXX XXXX 22 of 22 Total expenses incurred by this trust in respect of right of use of trust assets by this person during the year of assessment Total value contributed by this person to the trust during the year of assessment Total value contributed by the trust to this person during the year of assessment Total value of contribution(s) refunded by the trust to this person during the year of assessment BFCA01