Withdrawal request form

Withdrawal request form (This form must be completed for withdrawals on Endowment Plans and Flexible Investment Plans) Contact us Tel: 0860 67 5777, PO Box 653574, Benmore, 2010, www.discovery.co.za Content of this form Page 1. Investor details 1 2. Cession details 2 3. Withdrawal details 2 4. Bank account details 3 5. Financial adviser details 3 6. Terms and conditions 4 Appendix A: FICA and other documents required 5 How to complete this form To enable Discovery Invest to process the request form quickly and correctly, please ensure that it is completed in full. 1. Please complete the form in black ink and print clearly in block letters using black ink 2. Complete one letter per block 3. Where you need to make a choice between different options, please mark your selection with an X. Process to confirm the withdrawal request 1. Please fax this form and all supporting documents to Discovery Invest at (011) 539 5777 or email it to invest_payments_support@discovery.co.za or DFCinvest_payments_support@discovery.co.za or you can contact your financial adviser. 2. Should you have any queries about this form, please contact us on 0860 67 5777. 1. Investor details Natural person Company/Closed Corporation Trust Investment number Natural person information Title Initials First name Surname Date of Birth Y Y Y Y M M D D ID/Passport number Legal entity policyholder information Legally registered name Registration number Address details Postal address VAT number Residential address Code Contact details Telephone (H) Fax Email address Page 1 of 5 Telephone (W) Cellphone Code 120446 (17004) INVE 2032 (V9) 05.15

2. Cession details Is this investment subject to a cession or other encumbrance? Yes No Cessionary name If the investment has been ceded the following will apply: If the investment has been ceded in terms of the ante-nuptial contract, the spouse must co-sign this form. If the investment has been ceded as collateral, the cessionary needs to sign this document and provide proof in the form of a Bank stamp or letter. If the cession was an absolute cession, the cessionary (new owner) must sign this document. 3. Withdrawal details Option 1: Full withdrawal/surrender Endowment surrender Flexible Investment withdrawal Please note: If your surrender value on your Endowment Plan is higher than your total contribution, your investment will be subject to the following in accordance with Section 54 of the Long Term Insurance Act: 1. Lump sum Endowment only the restricted amount and not the full surrender amount can be withdrawn, the investment status will also reflect as restricted and not surrendered. 2. For recurring contribution Endowment only the restricted amount and not the full surrender amount can be withdrawn, the investment status will also reflect as restricted and not surrendered, no further premiums will be deducted. 3. Please be advised that pricing on the following funds (RightChoice TM, Escalator and CROCI) takes 3 to 5 days. 4. Note that no payments will be made to third parties. For both instances above, the remaining amount of the investment contributions will stay invested. Upon your request, you will be entitled to the remaining amount after the five year option has been reached. Option2: Partial withdrawal/surrender Withdrawal amount Indicate from which investment choice/s the partial withdrawal must be made: Fund name % Value Total: 100% Please note that the values above exclude any early exit fees that may be payable according to your contract. Please see the fact file for details. Please note a signed surrender quote is required before your withdrawal will be processed. Option3: Regular withdrawal (Flexible Investment Plan only) Income amount Frequency of Income Monthly (in arrears) *Quarterly *Half annually *Annually Date of payment 10th 20th 28th *Quarterly, half annually and annually are all paid in advance. Indicate from which investment portfolio/s the recurring withdrawal must be made: Investment choice % Rand amount Total: 100% Option 4: Withdraw the Upfront Investment Integrator payout only Please note: Please consult your financial adviser in order to understand the full impact of withdrawing your Upfront Investment Integrator benefit. A withdrawal of the Upfront Investment Integrator payout, in part or in full, will not have an impact on your future Upfront Investment Integrator payouts. Any withdrawal in excess of the Upfront Investment Integrator payout will reduce your future integration payouts. R Page 2 of 5

4. Payment details Note: Please provide Discovery Invest with proof of banking details. Name of accountholder Name of bank Account number Branch Branch code _ Account type Current Savings Transmission Payment will be done by electronic transfer. No payment to a third party will be allowed. Proof of bank account details in the name of the policy holder is required, payments into third party bank accounts are not allowed. Acceptable proof of bank account details: the proof of account should not be older than three months and can be in the form of a cancelled cheque, stamped letter from the bank or bank statement. Internet statements and bank deposit slips will not be accepted. I warrant that the above information is true and correct. I understand that the same terms and conditions contained in the initial application form apply to this procedure and that I have read the information contained herein. Note that no payments will be made to third parties. Signed at (town or city) on Y Y Y Y M M D D Signature of investor Date Y Y Y Y M M D D Signature of cessionary Date Y Y Y Y M M D D 5. Financial adviser details Financial adviser name and surname Financial adviser code Intermediary house Intermediary house code Telephone (W) Cellphone Email address FICA declaration I warrant and confirm that I have identified and verified the identities of the signatories with regard to this transaction in terms of the Financial Intelligence Centre Act 2001, and related Regulations. Yes No I warrant that I have copies of the relevant documentation in my possession Yes No OR I have verified and attached the required FICA documents to this application Yes No Signed at (town or city) on Y Y Y Y M M D D Signature of financial adviser Date Y Y Y Y M M D D Page 3 of 5

6. Terms and conditions and declarations 6.1 Procedures Please read the following carefully. This explains the procedures and processes that will impact on the withdrawal of your investment: 1. The cut-off time for a withdrawal instruction to be processed on any trading day is 10am. 2. Discovery Invest will not attend to the request to withdraw from your investment unless we receive a fully completed form. 3. If we receive a valid and fully completed request to withdraw on a specific date, the unit prices we use to determine the value of the withdrawal will be those as at the evening before Discovery received a fully completed withdrawal form and when the outstanding have been met. If we receive your instruction on a weekend or public holiday, the prices of the next working day will apply. 4. Payment will normally be made within 10 working days if invested in local portfolios and up to 21 days if invested in offshore portfolios, after receipt of a valid withdrawal form. 6.2 Restriction on withdrawals The following restrictions apply to withdrawals from Endowment and Retirement Plans. These are mainly regulated by legislation: 1. You are only allowed one withdrawal in the first five years of the investment. 2. The amount you may withdraw from the Endowment Plan in the first five years is limited: a. The amount you may withdraw may not exceed the total of all contributions paid increased with interest compounded at 5% per year. Please note that this amount could be different from the actual withdrawal value on your investment which is determined by the value of the underlying units of the portfolio in your investment fund. b. If the difference between your actual withdrawal value and the amount determined in terms of the maximum you are allowed to withdraw is less than R2500, or an amount prescribed by legislation from time to time, you may withdraw the full amount. c. If the difference between the actual withdrawal value and the total of all paid contributions plus compounded interest of 5% per year is more than R2500, you will only be able to access the rest of the withdrawal value after five years. 3. If you stopped paying contributions previously and the investment was made paid-up, the withdrawal value will be based on the paid-up value at the time, which in turn would be limited to a percentage of your fund value. This has been explained in your contract. 4. On a partial surrender, early exit fees will be applied across your selected investment options proportionately. 6.3 Capital Gains Tax on Endowment Policies Capital Gains Tax on an Endowment Policy is charged once a year, usually after 30 June, as this is the Discovery tax year-end. Capital Gains Tax may also be charged when a surrender, withdrawal or claim takes place. General a. Discovery Invest will not be liable for any losses incurred during the time it takes to action the withdrawal instruction, including any loss in value in the underlying financial instruction. b. Discovery Invest will not be liable for any losses incurred due to incorrect information supplied by either the investor or financial adviser. c. If the investor was married in communty of property after November 1984, the investor s spouse must sign this form. Please note: It is your responsibility to ensure that this form, any instructions that are part of the form and subsequent instructions submitted electronically by fax or email to Discovery Invest, have been received by Discovery Invest. However, Discovery Invest does not consider a fax confirmation or a printed copy of a sent email, as proof of receiving the document or instruction. To process any instruction on a specific trading day, Discovery Invest must receive the instruction before 10:00 (am) on that trading day otherwise the instruction will only be processed on the following trading day and provided that all have been met. Investor signature Date Y Y Y Y M M D D Cessionary s signature Date Y Y Y Y M M D D Signature of Investor s spouse (if married in community of property) Date Y Y Y Y M M D D Page 4 of 5

APPENDIX A FICA and other documents required Due diligence : New Applicants must send the following applicable FICA documents together with a fully completed Discovery application form. Additional or updated documentation may be requested in certain circumstances. Please ensure that the information provided on the FICA documentation is clear and certified if a copy. All FICA documents must be less than 3 months old except for income tax forms / property insurance policy schedules. If a Financial Service Provider (FSP) / Representative is utilised, a certified copy of the FSP license is required. Page 5 of 5 Founding Statement and Certificate of Incorporation Resolution of the members to invest Members as per Natural person Trust Investing in Name of Minor Investor Clubs and Stokvels Company Partnership Close Corporations Clear copy of one of the following: Latest Annual Reports and Accounts Resolution of the partners to invest All Partners as per Certificate of Incorporation (COR15, COR22 and COR39) Board resolution authorising the investment (and/or approval to act as trustee if a corporate trustee) Directors as per All shareholders holding 25% or more of voting rights at a general meeting as per Copy of constitution/founding document Copy of register of participants Letter electing and authorising person to act on behalf of the club/stokvels Representative as per Administrator reserves the right to request FICA documents for all participants Minor Certified copy of birth certificate Legal guardian as per Trustees as per individual, or company for corporate trustees Extract of Trust Deed pages showing name of Trust, parties to the Trust and signature pages Letter of Authority from Master (SA Trust) or Foreign Regulator (Foreign Trusts) to Trustees National identity card or document Current valid passport Identification Close Corporation CK1 and CK2 Members as per All Partners as per Company COR15, COR22 and COR39 Directors as per Name(s) and address(es) of all directors All shareholders holding 25% or more of voting rights at a general meeting as per Representative as per Address of legal guardian as per individual Trust as per individual Trustees as per individual Clear copy of one of the following, confirming name and address: A utility bill Telkom account An income tax form / extract An insurance policy schedule A most recent lease / rental agreement Confirmation of address Proof of banking details as per Proof of VAT registration (if applicable) Proof of Income Tax Authorised signatory list including specimen Proof of Banking details as per individual Authorised signatory list including specimen Proof of Banking details as per individual Authorised signatory list including specimen Proof of Club or Stokvels banking details as per Authorised signatory list including specimen Proof of Trust banking details as per individual Proof of South African banking details either: Cancelled cheque or bank statement (no internet or credit card statement accepted) A letter from bank confirming banking details Related due diligence