UNIT TUST APPLICATION FO LEGAL ENTITIES BEFOE YOU INVEST Make an informed decision: ead our Product ange brochure to make sure you have chosen the right product to suit your needs. efer to our fund factsheets (minimum disclosure documents) and Unit Trust Characteristics and Objectives for information on the Allan Gray unit trusts we offer. Consider getting financial advice: Allan Gray does not provide financial advice. However, we believe in the merits of good independent advice. If you are not comfortable making your own investment decisions, consider using the services of an independent financial adviser (IFA). To locate an IFA in your area, refer to the Find an independent financial adviser section of our website. STEP 1 COMPLETE THE FOM & AGEE TO THE Ts & Cs Make sure you have your tax identification number on hand. Complete all the information on the form to ensure that there is no delay in processing your investment. ead and agree to the Unit Trust Terms and Conditions to understand the rules of your investment. You may need to complete additional forms, depending on the specifics of your investment: Would you like to phase in your investment? Complete the 'Phase-in' form. STEP 2 SEND DOCUMENTS Send us the documents listed below: Email: instructions@allangray.co.za or Fax: 0860 000 655 or +27 (0)21 415 2492 Completed '' form We need the following documents for all representatives acting FICA documents as set out in Annexure A on behalf of, and the contact person for, the legal entity: esolution signed by all authorised signatories Completed Annexure B Proof of bank details (e.g. cancelled cheque or Proof of authority (e.g. power of attorney) bank statement) Copy of South African bar-coded ID or valid passport (if foreign national) STEP 3 MAKE PAYMENT CUT-OFF TIMES Please make payment into the following Allan Gray bank account and send us proof of payment Pre-approved beneficiary: Account name: Bank: Branch code: Account type: Allan Gray Unit Trust Allan Gray Unit Trust Management (F) Proprietary Limited-AG-Trust First National Bank 20-41-09 - Global Transactional Services Cape Town Current Account number: 622 397 733 29 eference number: Swift code: Entity registration number FINZAJJ Please note that if instructions and documents are received: Before 14:00 on a business day, we will start processing on that day. After 14:00 on a business day, we will start processing on the next business day. On a weekend or public holiday, we will start processing on the next business day. The cut-off for debit order processing is three business days before your selected debit order date. Electronic collections occur on the next business day after we begin processing your application. egular withdrawal payments are scheduled for the 27th of each month. The cut-off for regular withdrawal processing is six business days before the scheduled withdrawal payment date. If the instruction is received after the cut-off, the first withdrawal payment will be scheduled to take place the next month. WHAT HAPPENS NEXT? We will process your instruction once we receive the required completed documents and the money reflects in the Allan Gray Unit Trust bank account. You will receive confirmation once your instruction has been processed. You will receive an Allan Gray Online account with this investment and will be contacted to activate your Allan Gray Online account within two business days of your instruction being processed. (Contact us if you need help: Call 0860 000 654 between 07:30-17:30 (Mon - Fri) or Email: info@allangray.co.za
No. 1.0 December 2018 UNIT TUST APPLICATION FO LEGAL ENTITIES Allan Gray Unit Trust Management (F) Proprietary Limited administers the unit trusts. It is authorised to do so as a Manager in terms of the Collective Investment Schemes Control Act. In this form it is referred to as Allan Gray. 1. Please provide us with the legal entity details Type of entity Listed company Unlisted company Partnership etirement fund Non profit organisation Trust Sole proprietor Close corporation Other Details of the legal entity egistered name Trading name egistration number Country of inception VAT number egistered address (head office) Date of inception D D M M Y Y Y Y Business operating address If the same as the registered address (head office), please tick this box Postal code Postal address If the same as the registered address (head office), please tick this box If the same as the business operating address, please tick this box Postal code Postal code Details of the contact person Title Surname First name(s) Nationality Mobile Email Telephone (w) Fax 1 of 9
2. Please provide us with the legal entity s tax information This section applies to all legal entities whether they are registered for tax or not. No. 1.0 December 2018 Please refer to our Tax guide at the end of this form if you need help understanding the terms used in sections 2, 3 and 4. The South African evenue Service (SAS) requires all financial services providers to collect various tax information from their clients. Depending on where the legal entity is a resident for tax purposes, Allan Gray may be required to deduct Dividend Withholding Tax (DWT) and/or Interest Withholding Tax (IWT) on its behalf. Please complete either section 2.1 or 2.2. The completed section determines your DWT/IWT rate. 2.1 If the legal entity is a South African resident for tax purposes, please tick the box below The legal entity is a resident for tax purposes in South Africa. I declare that IWT will not apply to the legal entity s investment and that distributions from eal Estate Investment Trust constitute income that needs to be filed in the legal entity s annual tax return as Allan Gray will not withhold tax on its behalf. Tax Identification Number (TIN) provided to you by SAS If the legal entity is unable to provide a TIN, please complete section 2.3 on the next page. The legal entity s investment may be exempt from DWT. Please tick the appropriate box below to declare the reason for exemption or tick the box to declare that none of the exemptions apply. A company or close corporation registered in South Africa for tax purposes A non profit organisation (approved by SAS in terms of section 30(3) of the Income Tax Act) A pension fund, pension preservation fund, provident fund, provident preservation fund, retirement annuity fund, beneficiary fund or benefit fund registered in terms of the Pension Funds Act, 1956 and approved by SAS A person contemplated in section 10(1)(t) of the Income Tax Act, e.g. SANAL, CSI The South African government, provincial government or municipality An institution, body or board contemplated in section 10(1)(cA) of the Income Tax Act A trust contemplated in section 37A of the Income Tax Act (e.g. mining rehabilitation trusts) Fidelity and indemnity funds contemplated in section 10(1)(d)(iii) of the Income Tax Act - i.e. only the two, not the other entities mentioned A small business funding entity as contemplated in section 10(1)(cQ) of the Income Tax Act Or None of the above exemptions apply, the legal entity will attract the default DWT rate of 20% 2.2 If the legal entity is a non-south African resident for tax purposes, please tick the box below The legal entity is not a resident for tax purposes in South Africa. I have seen and read the Withholding Tax Annexure available on www.allangray.co.za. I declare that the legal entity will be subject to the default DWT rate of 20% on local dividends and the default IWT rate of 15% on local interest unless there is a Double Taxation Agreement (DTA) in place between South Africa and its country of tax residence (as provided below). If there is a DTA in place, Allan Gray will apply the rate as contained in the article number referenced in the Withholding Tax Annexure. Distributions from a eal Estate Investment Trust are exempt from South African income tax, but are subject to DWT at the rate applicable to the investor. Country of residence for tax purposes Effective date of tax residency D D M M Y Y Y Y TIN provided to you by your tax authority If the legal entity is unable to provide a TIN, please complete section 2.3 on the next page. 2 of 9
No. 1.0 December 2018 2.3 If you are unable to provide a Tax Identification Number (TIN) please provide us with a reason below Where you are unable to provide a TIN or its Functional Equivalent (FE), please tick one of the following reasons: eason A: The legal entity has never registered for a TIN/FE with the tax authority eason B: I do not know the legal entity s TIN/FE, but I will take steps to get this and submit it to Allan Gray eason C: The tax authority does not require the legal entity to provide a TIN/FE (does not apply to South African or United States tax residents) eason D: The country does not issue TINs/FEs to its tax residents (does not apply to South African or United States tax residents) eason E: I am unable to obtain the legal entity s TIN/FE (please specify) 2.4 Is the legal entity resident anywhere else for tax? If the legal entity has any tax information for countries in addition to the country indicated on the previous page, please list the additional countries and the legal entity s associated TIN, or its FE, below. Please note that the countries listed below will not have an impact on the DWT/IWT rates applied to the legal entity s investment. If the legal entity does not have a TIN, please tick the reason (refer to section 2.3 above). Country Tax Identification Number (TIN) eason for no TIN 3. Is the legal entity a US Person? Does the legal entity or any controlling persons associated with this investment (e.g. authorised signatory) have a United States tax number, residency or citizenship? Yes No Additional documents may be required If Allan Gray identifies, through the information provided on this application form, that the legal entity is considered a US eportable Account, you may be required to submit further documents. For more information, please see www.allangray.co.za. 3 of 9
No. 1.0 December 2018 4. What is the legal entity s classification? A legal entity must be classified as a Financial Institution or as a Non-Financial Institution. Please complete either section 4.1 or 4.2 to confirm the legal entity s classification. 4.1. Is the legal entity a Financial Institution? If the legal entity has registered as a Financial Institution with the US Internal evenue Service (IS) and received a Global Intermediary Identification Number (GIIN). Please provide the GIIN below. If the legal entity is a Financial Institution but does not have a GIIN, please tick the appropriate box below: The Financial Institution is an Exempt Beneficial Owner The Financial Institution is a Non-Participating Financial Institution The Financial Institution is a Deemed Compliant Financial Institution 4.2. Is the legal entity a Non-Financial Institution? If the legal entity is a Non-Financial Institution, please tick the appropriate box below: An Active Non-Financial Institution A Passive Non-Financial Institution 5. How much would you like to invest? You must invest a lump sum of at least 20 000 and/or commit to a debit order of at least 500 per month. Debit orders are restricted to a maximum of 1 000 000 per debit. Lump sum amount and/or Monthly debit order amount How would you like to invest your money? You must allocate your lump sum and/or monthly debit order into one or more unit trusts. Please note that our Allan Gray-Orbis rand-based offshore unit trusts are subject to availability. Please check our Unit trusts, prices and factsheets page on our website before making your selection. Indicate the rand amount/percentage per unit trust in the table below: Unit trust Lump sum allocation Monthly debit order allocation Allan Gray Equity Fund or % or % Allan Gray Balanced Fund or % or % Allan Gray Stable Fund or % or % Allan Gray Optimal Fund or % or % Allan Gray Bond Fund or % or % Allan Gray Money Market Fund or % or % Allan Gray-Orbis Global Equity Feeder Fund* or % or % Allan Gray-Orbis Global Fund of Funds* or % or % Allan Gray-Orbis Global Optimal Fund of Fund* or % or % Please ensure that the amounts/percentages allocated across unit trusts add up to your total lump sum or monthly debit order amounts, or to 100%. * Subject to availabilty Please visit www.allangray.co.za/what-we-offer/offshore-rand-based/ to check if the Allan Gray-Orbis unit trusts are available. If they are unavailable and you would like to be notified when they are open, kindly subscribe to our sms alerts by clicking on the Subscribe to our sms alerts option. Would you like to pay your annual financial adviser fees from the Allan Gray Money Market Fund? (if applicable) If you are investing with the help of an independent financial adviser, you may choose to have your annual financial adviser fees paid from the Allan Gray Money Market Fund. If you choose to do so, please ensure that you have allocated a portion of your investment to the Money Market Fund. If no option is selected, fees will be deducted from your selection of unit trusts. If you would like to pay your annual financial adviser fees from the Allan Gray Money Market Fund, please tick this box. 4 of 9
No. 1.0 December 2018 6. Where does the money come from? This information is required by legislation and we need it in order to process your investment. Please make a selection below: Existing Allan Gray account Capital/savings Company profit Donation Transfer from other financial services provider Other (specify) 7. How would you like to receive your income distributions? Your investment may earn income distributions (interest and/or dividends). We will automatically reinvest income distributions earned on your investment, which means you will receive additional units. If you would prefer your income distributions to be paid into your bank account, please tick this box. 8. How are you making payment? Are you making a lump sum payment? Lump sum amount of Select a payment option below: Cheque deposit Electronic/Internet transfer (EFT) Collection by Allan Gray All cheques must be endorsed as non-transferable and deposited directly into the relevant Allan Gray bank account. Units bought with a cheque deposit can only be withdrawn after 14 days. Electronic/Internet transfers may take up to two days to appear in the Allan Gray bank account. Allan Gray will collect the full amount via a debit order by collecting in parts a maximum of 1 000 000 per day, for each consecutive day until the full amount has been collected. Units bought with a direct debit can only be withdrawn after 32 business days. Are you setting up a debit order? Monthly debit order of to start on the 1st or 15th of Indicate by how much you would like your monthly debit order to increase each year: 0% 2.5% 5% 10% 15% 20% M M Y Y Y Y Provide us with permission to debit your bank account Complete this section if you are setting up a debit order or if you would like Allan Gray to collect your lump sum payment from your bank account. I authorise Allan Gray to draw direct debits from the following South African bank account: Name of account holder Name of bank Branch code Account number Type of account Current/Cheque Savings Additional documents may be required if: The bank account holder is a third-party individual? Provide a copy of their ID and proof of their bank account details. The bank account holder is a third-party legal entity? Provide copies of all the signatories IDs and a letter from the bank listing the authorised signatories on the account. Signature of bank account holder Date D D M M Y Y Y Y 5 of 9
9. Would you like to start a regular withdrawal? If you would like to receive a regular withdrawal from this investment account, please complete this section. You may only schedule regular withdrawal payments if you have more than 20 000 in your account. No. 1.0 December 2018 You can either withdraw proportionately across your unit trusts (complete table 1), or you can specify the unit trusts you would like to withdraw from and the amount to be withdrawn (complete table 2). Total amount to be withdrawn per frequency Select your payment frequency: Monthly Quarterly Biannually Annually Withdraw proportionately across your unit trusts Table 1 The proportionate split for withdrawals under this instruction will be determined at the processing date of the form. The proportions will only change if you send us an amended instruction. Unit trust Allan Gray Equity Fund Allan Gray Balanced Fund Allan Gray Stable Fund Allan Gray Optimal Fund Allan Gray Bond Fund Allan Gray Money Market Fund Allan Gray-Orbis Global Equity Feeder Fund Allan Gray-Orbis Global Fund of Funds Allan Gray-Orbis Global Optimal Fund of Funds Table 2 Amount per regular withdrawal 10. Provide us with your bank account details Provide your bank account details if you have chosen to have your distributions paid into your bank account and/or if you have selected a regular withdrawal. We will make all payments electronically to a South African bank account in the investor s name. We will not make any payments to credit cards, market-linked accounts or third-party bank accounts. If the same as the bank account details in the previous section, please tick this box. Name of account holder Name of bank Branch code Account number Type of account Current/Cheque Savings 11. How should we communicate with you? We will send all communications to you via email. If you prefer post or do not have an email address, please tick this box. Manage your investments online You will receive an Allan Gray Online account with this investment. Allan Gray Online enables you to view your personal and investment details (e.g. bank account details, account balance, transaction history) and manage your investments (e.g. perform transactions) online. We need an email address to set up your online account. If you do not want online access, please tick this box. 6 of 9
12. Investor declaration No. 1.0 December 2018 I confirm that all information provided in this form and all other documents signed by me in connection with this application, whether in my handwriting or not, are correct. I am responsible for the accuracy and completeness of all answers, statements or other information provided by me or on my behalf. I consent to Allan Gray processing my personal information according to the Terms and Conditions. I have not received advice from Allan Gray regarding this application. I confirm that Allan Gray may accept instructions from any authorised third-party who has been authorised by me in writing. I confirm that Allan Gray may accept instructions in the prescribed format by fax or via other electronic means. I have read and understood the relevant fund factsheets (minimum disclosure documents) and Unit Trust Characteristics and Objectives of the unit trusts I wish to invest in. I have read, understood and agree to the latest Terms and Conditions. I agree that my contractual relationship with Allan Gray will be subject to South African law and regulation (including but not limited to Exchange Control and tax requirements). I confirm that if I am not a South African resident, my investment with Allan Gray is based on my own initiative and not due to any offer or solicitation by Allan Gray. I acknowledge that the Administrator may be required to submit the information provided in sections 2, 3 and 4 to SAS who may share it with my local tax authority to adhere to the Foreign Accounts Tax Compliance Act ( FATCA ) and the Organisation for Economic Co-operation and Development s ( OECD ) Common eporting Standard ( CS ). I acknowledge that if the Administrator identifies through the information provided on this application form that the legal entity falls into the definition of a US person, I may be required to submit further documents. I declare that I comply with the relevant provisions in the Income Tax Act and, where applicable, the requirements in terms of the relevant double taxation agreement (DTA) in force between the epublic of South Africa and the country of residence I have specified above as contained in the article number as referenced in the Withholding Tax Annexure. Under penalties of perjury, I declare that I have examined the information completed in sections 2, 3 and 4 on this form and to the best of my knowledge and belief it is true, correct, and complete. I undertake to inform Allan Gray in writing if the circumstances referred to in the declaration above change. Signature of representative (1) Signature of representative (2) Date D D M M Y Y Y Y If you have an independent financial adviser for this investment, please tick this box and complete the next section of this form. 7 of 9
13. Complete this section if you have an independent financial adviser No. 1.0 December 2018 Provide us with your financial adviser s details Name and surname of financial adviser Name of Financial Services Provider (FSP) Financial adviser code Financial adviser s assistant dealing with this transaction What negotiable fees must be paid to your financial adviser for this investment? I agree to pay the following negotiated fees on this and all future transactions until otherwise specified: Initial. % Annual. % Maximum 3.0% (excluding VAT) deducted prior to the investment being made. Where the annual fees are more than 0.5%, initial fees are capped at 1.5%. If it is agreed that no initial fee is payable, please insert 0%. Maximum 1.0% (excluding VAT) of the investment account. Where the initial fee is more than 1.5%, the maximum annual fee is 0.5%. If no annual fee is payable, please insert 0%. Who should we communicate with? Who should we send your transaction confirmations to? Me Financial adviser Both If no option is selected, your transaction confirmations will be sent to both you and your financial adviser. Who should we send your statements and other communications to? Me Financial adviser Both If no option is selected, your communications will be sent to you only. Provide authorisation for your financial adviser to submit instructions on your behalf You may authorise the Financial Service Provider (FSP) to submit instructions for this investment on your behalf, either online or via forms. If the FSP holds a Category II licence with the Financial Services Conduct Authority ( FSCA ), it is licensed to exercise discretion and submit instructions on your behalf. To do this for all your investments the FSP will need a mandate (instruction) from you. Have you entered into a mandate with this FSP to exercise discretion and submit instructions on your behalf? Yes No Alternatively, if your financial adviser holds a Category I licence with the FSCA, they are not licensed to exercise discretion and submit instructions on your behalf. However, you may authorise them to submit online instructions for this investment only on your behalf. Do you authorise this financial adviser to submit instructions (excluding withdrawals and regular withdrawals) on your behalf via Allan Gray Online? Yes No Additionally, do you authorise this financial adviser to submit withdrawal instructions and to set up and change regular withdrawals on your behalf via Allan Gray Online (where applicable)? Yes No In all cases money will be paid into your bank account that Allan Gray has on record and the bank account can only be changed with your prior written consent. 14. Investor declaration for clients with a financial adviser I confirm that this financial adviser, as authorised representative of the FSP above, is my appointed financial adviser. I confirm that Allan Gray may accept instructions from my financial adviser who has been appointed by me in writing. I confirm that my appointed financial adviser and any other third parties with whom I have an agreement to manage this investment (e.g. a discretionary investment manager) will have access to my investment details via a secure electronic channel. I understand and agree that all instructions submitted by my financial adviser will be governed by the relevant and latest Terms and Conditions in force as at the date the instruction is submitted. I acknowledge and agree that Allan Gray will not be held liable for acting on any instructions submitted by my financial adviser and I indemnify Allan Gray from all direct or indirect claims (including claims for consequential damages) in this regard. I have read and agree to the investor declaration in section 12. Signature of representative (1) Signature of representative (2) Date D D M M Y Y Y Y 8 of 9
15.This section must be completed by your financial adviser No. 1.0 December 2018 Financial adviser FAIS declaration I have made the disclosures required in terms of the Financial Advisory and Intermediary Services (FAIS) Act, No. 37 of 2002 to the investor. I have explained all fees that relate to this investment to the investor. I understand and accept that the investor may write to Allan Gray to cancel future fees. Financial adviser FICA declaration I have identified all applicable parties to this transaction and verified their details under the requirements of Section 21 of the Financial Intelligence Centre Act, No. 38 of 2001 ( the Act ). I keep these parties records as is required in terms of Section 22 of The Act and maintain these records as required in regulation 19 of The Act. Yes No I understand that I am the primary accountable institution under the Act. I understand that if I have selected No, Allan Gray will be responsible for the primary Know Your Client requirements of the Act and that the application will be delayed until Allan Gray receives the necessary documents. Financial adviser online instruction declaration In the absence of a mandate, I acknowledge and agree that I will only act on my client s instruction when submitting instructions via Allan Gray Online. I have read, understood and agree to the Terms and Conditions applicable to submitting instructions via Allan Gray Online. I acknowledge and agree that Allan Gray will not be held liable for acting on any instructions submitted by me, and I indemnify Allan Gray from all direct or indirect claims (including claims for consequential damages) in this regard. I understand that Allan Gray reserves the right, at any time, to review my licence and/or to audit or request copies of my client s consent (whichever applicable) for instructions that I have submitted via Allan Gray Online. Signature of financial adviser Date D D M M Y Y Y Y Allan Gray Proprietary Limited is an authorised financial services provider. 9 of 9
Tax guide The following definitions and explanations may help you complete the tax information sections of the form. DWT/IWT Term Definition Explanation DWT Dividend Withholding Tax DWT is a tax imposed on shareholders on receipt of dividends. DWT is categorised as a withholding tax, as the tax is withheld and paid to SAS by the company paying the dividend or by a regulated intermediary. IWT Interest Withholding Tax IWT will be applied to local interest distributed to non-south African residents for tax purposes. IWT is categorised as a withholding tax, as the tax is withheld and paid to SAS by the company paying the dividend or by a regulated intermediary. TIN or its FE Tax Identification Number (TIN) or its Functional Equivalent (FE) i.e. the number that functions as a TIN The number that each jurisdiction issues to identify an organisation for tax purposes. The TIN could be called something different (FE) in different countries. Examples: SA: Income tax number issued by SAS. US: Employer Identification Number UK: National Insurance Number or Unique Taxpayer eferences. FATCA and CS Term Definition Explanation Additional tax Information Global Tax Information Additional tax Information relates to the disclosure of each tax jurisdiction where the investor could be liable to declare their assets and income - regardless of where the asset is housed, or income is earned. CS Common eporting Standard The Common eporting Standard calls on jurisdictions to obtain information from their financial institutions and automatically exchange that information with other jurisdictions on an annual basis. FATCA Foreign Accounts Tax Compliance Act FATCA stands for the Foreign Account Tax Compliance Act and is a United States (US) initiative aimed at reducing the potential for offshore tax evasion. FATCA requires that financial institutions outside the US provide the Inland evenue Service (IS) with financial account information they hold on US citizens. Specified US Person Excludes certain types of investors from the definition of US Person and therefore excludes these investors from being a US eportable Account Is a US Person, other than: A corporation with stock that is regularly traded on one or more established securities markets, and any entity related to such a corporation. The United States government or governmental agency. A dealer in securities, commodities or derivative financial instruments that is registered under the laws of the US. An entity that is a bank, a broker or common trust fund, an organisation exempt from taxation, a real estate investment trust, a regulated company or a trust that is exempt from tax, as defined in the relevant US Internal evenue Code. US Acronym United States (of America) US Citizen A citizen of the United States of America The term US citizen means: An individual born in the US An individual who has a parent who is a US citizen A former immigrant who has been naturalised as a US citizen An individual born in Puerto ico An individual born in Guam An individual born in the US Virgin Islands
FATCA and CS Term Definition Explanation US Person US eportable Account Defines which individuals and organisations fall into the definition Financial account that falls in scope by the FATCA legislation for reporting to the IS US Person means: An individual that is a US citizen or resident in the United States. A partnership or corporation organised in the US or under the laws of the US or any State of the US. A trust, subject to the following cumulative requirements i) a court within the United States would have authority under applicable law to render orders or judgments concerning substantially all issues regarding administration of the trust ( court test ); and ii) one or more US Persons have the authority to control all substantial decisions of the trust, or an estate of the decedent that is a citizen or a resident of the United States ( control test ). This term shall be interpreted in accordance with the US Internal evenue Code. Any account that is held by one or more Specified US Persons, or by a Non-US Entity with one or more Controlling Persons that are Specified US Persons. Entity classification Term Definition Explanation Active Non- Financial Institution Deemed Compliant Financial Institution Exempt Beneficial Owner A Non-Financial Institution that operates in an active trade or business other than that of a financial business An Investment Entity that is exempt from the FATCA requirements based on the nature of the entity Entities that are exceptions to the definition of Financial Institution An Active Non-Financial Institution is an entity that primarily earns active income (e.g. by trade or sales). Annex II of the Intergovermental agreement provides for several categories of Investment Entities (summarised below) that qualify as deemed-compliant Financial Institutions. Financial Institutions described in Annex II(IV) are Non- eporting South African Financial Institutions that shall be treated as deemedcompliant FInancial Institutions for purposes of section 1471 of the U.S. Internal evenue Code. Examples of Deemed Compliant Financial Institutions: Trustee-Documented Trust Sponsored Investment Entity and Controlled Foreign Corporation Sponsored Closely Held Investment Vehicle Investment Advisors and Investment Managers Collective Investment Vehicle Certain entities are excluded from FATCA reporting based on the nature of their business. Examples of Exempt Beneficial Owners are: The South African Government, as well as any of its political subdivisions, wholly-owned agencies and instrumentalities International organisations located in South Africa The South Africa eserve Bank Treaty-Qualified etirement Fund Broad Participation etirement Fund Narrow Participation etirement Fund Pension Fund of an exempt beneficial owner Certain Investment Entities wholly-owned by one or more of the above
Entity classification Term Definition Explanation Financial Institution GIIN Non- Financial Institution Non- Participating Financial Institution Participating Financial Institution Passive Non- Financial Institution Any entity that: Accepts deposits in the ordinary course of banking or a similar business such as banks and credit unions Holds financial assets for the account of others as a substantial portion of its business such as brokerages or custodians Is engaged, or holding itself out as being engaged, primarily in the business of investing, reinvesting, or trading in securities, partnership interests, commodities, or any interest. This includes a futures or forward contract or option in such securities, partnership interests, or commodities such as mutual funds, private equities and hedge funds Global Intermediary Identification Number An entity that does not fit the definition of a Financial Institution A Financial Institution that does not enter into an agreement with the IS and is not deemed compliant or excepted Financial Institution that enters into an agreement with the IS to undertake certain due diligence, withholding and reporting requirements for US account holders A Non-Financial Institution that is in receipt of passive income or holds passive assets and do not fall under any of the other FATCA classifications. These entities do not perform business of a financial institution The sub-categories of Financial Institutions are: Custodial Institution - is defined as any Entity that holds, as a substantial portion of its business, financial assets for the account of others. Depository Institution - is defined as any Entity that accepts deposits in the ordinary course of a banking or similar business. Investment Entity - is defined as an Entity that conducts as a business (or is managed by an Entity that conducts as a business) investment portfolio management, trading in money market instruments and other stocks/foreign exchange/commodities and the management of funds on behalf of other persons. Specified Insurance Company - An insurance company (or the holding company of an insurance company) is a Specified Insurance Company if it issues, or is obligated to make payments pertaining to a Cash Value Insurance Contract or an Annuity Contract. (The term Cash Value Insurance Contract means an Insurance Contract, other than an indemnity reinsurance contract between two insurance companies, that has a Cash Value greater than $50 000.) Exemptions: Deemed Compliant Financial Institution - Financial Institution that is exempt from withholding without entering into an IS agreement Exempt Beneficial Owner - Entities that are excluded from the definition of Financial Institution The Inland evenue Services (IS) identification number issued to Participating Financial Institutions. In general, but not always, entities that are not in the financial services industry will generally fall into one of two categories of non-financial foreign entities Active or Passive. This relates to Financial Institutions that are not in a Participating Jurisdiction. A Participating Financial Institution will have been issued a Global Intermediary Identification Number (GIIN). A Passive Non-Financial Institution is an entity that primarily earns passive income (e.g., interest, dividends, rents, royalties, etc.). An entity primarily earns passive income if more than 50% of its gross income over the last three-year period is passive income and where more than 50% of the entity s assets that produce, or are held for the production of, passive income. If you need more information, please visit the following websites DWT/IWT: http://www.sars.gov.za/ FATCA: https://www.irs.gov/ CS: https://www.oecd.org/
Annexure A Before we can enter into a transaction with you the Financial Intelligence Centre Act (FICA) requires that we verify the identity of all members, directors and other representatives. We require a copy of all members, directors and authorised representatives green bar-coded identity documents (South African citizens) or a copy of a valid passport (foreign nationals). We require proof of the legal entity s physical business address that is not older than three months We require the following documents for legal entities: Close corporations (CCs) incorporated before the Act The Founding Statement and Certificate of Incorporation (CK1) Where the CC has changed its members we require an amended Founding Statement CK2 stamped by the egistrar of Companies A document less than three months old containing the trade name and the business address (if the address is not the same as the CK2 document) A resolution on the CC s letterhead signed by all members appointing the authorised signatories The completed Annexure B (attached to this application form) for all members and authorised signatories Identity documents for all members and authorised signatories Trusts The Trust Deed (including Testamentary (Will) Trusts) A Will and letter of Executorship in the case of Testamentary Trust The Letter of Authority (if the trust is registered in South Africa) stamped by the Master of the High Court A esolution signed by all trustees appointing the authorised signatories of the Trust Annexure B (attached to this application form) for founders of the Trust, trustees, beneficiaries and authorised signatories Identity documents for founders of the Trust, trustees, beneficiaries and authorised signatories Where the Founder is deceased we require a copy of the death certificate SA companies egistration Certificate CM1/Co14.3 Where the company has changed its name we require the Certificate of Name Change CM9/Co14.3 Notice of registered office and postal address stamped by the egistrar of Companies and signed by the company secretary CM22 / Co21.1 A document less than three months old containing the trade name and the business address (if the address is not the same as the CM22 / Co21.1 document) A resolution on the company s letterhead signed by all members appointing the authorised signatories Identity documents for all managers, authorised signatories and individuals holding 25% or more of the voting rights at a general meeting Annexure B (attached to this application form) for all members and authorised signatories Foreign companies Official documents from the foreign regulator witnessing incorporation, bearing the name, number and address A document less than three months old containing the trade name and the business address (if the address is not the same as the one on the official registration document) Identity documents for all managers, authorised signatories and individuals holding 25% or more of the voting rights at a general meeting A resolution on the company s letterhead signed by all members appointing the authorised signatories Annexure B (attached to this application form) for all members and authorised signatories Partnerships A partnership agreement or signed letter from all the partners confirming the informal partnership A resolution signed by all partners appointing the authorised signatories Identity documents for all partners Annexure B (attached to this application form) for all partners Other legal entities (e.g. clubs, associations, churches) The copy of the constitution or other founding documents for the legal entity esolution of authorised signatories Identity documents for the authorised signatories Annexure B (attached to this application form) for authorised signatories etirement funds egistration certificate from the egistrar of Pension Funds (FSCA) Approval certificate from the Commissioner of Inland evenue (SAS) List of authorised signatories and specimen signatures Identity documents for the authorised signatories Board resolution
Annexure B: elated party details if you are a natural person The Financial Intelligence Centre Act 38 of 2001 requires accountable institutions to verify the identity of its clients and the South African evenue Service (SAS) requires all financial service providers to collect various tax information from their clients. Please tick the boxes below to indicate the roles individuals play in your organisation. Each of these people must complete this annexure (please attach copies of this section, if necessary): Manager Partner Persons exercising executive control Trustee, beneficiary and/or founder of trust Member Authorised representative Person holding 25% or more of the voting rights Details of the related party Title Surname First name(s) Date of birth D D M M Y Y Y Y ID number (passport number if foreign national) Email Mobile Fax esidential address Country of birth Telephone (h) Telephone (w) Postal address If the same as the residential address, please tick this box Postal code I want secure online access to this investment? Yes No Postal code Tax information for the related party Please list below each country in which you are a resident for tax purposes, as well as your associated Tax Identification Number or its Functional Equivalent. Please refer to the Tax guide if you need assistance with completing this section. Please indicate the appropriate reason if you are not able to provide the appropriate Tax Identification Number (TIN) or its Functional Equivalent (FE). eason A: I have never registered for a TIN/FE with my tax authority eason B: I do not know my TIN/FE, but I will take steps to get this and submit it to Allan Gray eason C: My tax authority does not require me to provide a TIN/FE (does not apply to South African or United States tax residents) eason D: My country does not issue TINs/FEs to its tax residents (does not apply to South African or United States tax residents) eason E: I am unable to obtain a TIN/FE Country Tax Identification Number (TIN) eason for no TIN Is the related party a US Person? Do you have a United States tax number, residency or citizenship? Yes No Declaration by the related party Under penalties of perjury, I declare that I have examined the information completed in this annexure and, to the best of my knowledge, believe it is true, correct, and complete. Signature Date D D M M Y Y Y Y
Annexure B: elated party details if you are a legal entity The Financial Intelligence Centre Act 38 of 2001 requires accountable institutions to verify the identity of its clients and the South African evenue Service (SAS) requires all financial service providers to collect various tax information from their clients. Details of the related party Capacity egistered name Date of inception D D M M Y Y Y Y egistration number Email Telephone (w) egistered address (Head office) Country of inception Fax Postal address If the same as the registered address, please tick this box Postal code I want secure online access to this investment? Yes No Postal code Tax information for the related party Please list below each country in which the legal entity is a resident for tax purposes, as well as the associated Tax Identification Number or its Functional Equivalent. Please refer to the Tax guide if you need assistance with completing this section. Please indicate the appropriate reason if the legal entity is not able to provide the appropriate Tax Identification Number (TIN) or its Functional Equivalent (FE). eason A: The legal entity has never registered for a TIN/FE with the tax authority eason B: I do not know the legal entity s TIN/FE, but I will take steps to get this and submit it to Allan Gray eason C: The tax authority does not require the legal entity to provide a TIN/FE (does not apply to South African or United States tax residents) eason D: The country does not issue TINs/FEs to its tax residents (does not apply to South African or United States tax residents) eason E: I am unable to obtain the legal entity s TIN/FE Country Tax Identification Number (TIN) eason for no TIN Legal entity classification for the related party A legal entity must be classified as a Financial Institution or as a Non-Financial Institution. Please tick the boxes below to indicate the legal entity classification: Financial institution. Please provide us with your GIIN... If the legal entity is a Financial Institution but does not have a GIIN, please tick the appropriate box below: The Financial Institution is an Exempt Beneficial Owner The Financial Institution is a Non-Participating Financial Institution The Financial Institution is a Deemed Compliant Financial Institution If the legal entity is a Non-Financial Institution, please tick the appropriate box below: An Active Non-Financial Institution A Passive Non-Financial Institution
Is the related party a US Person? Does the legal entity have a United States tax number, residency or citizenship? Yes No Declaration by the related party Under penalties of perjury, I declare that I have examined the information completed in this annexure and, to the best of my knowledge, believe it is true, correct, and complete. Signature of authorised representative Date D D M M Y Y Y Y