Application to open a Foreign Currency Account (FCA) for non-resident companies

Application to open a Foreign Currency Account (FCA) for non-resident companies Blue shaded areas for bank use only Foreign Currency Account (FCA) number Branch Date (YYYY-MM-DD) Contact number Name of consultant A Customer segment (if applicable) B Entity type Sole proprietor Body corporate Partnership Close corporation Company (including incorporated companies) Informal body, for example, club or society Other (specify) C Application information Registered name Name of account or trade name Physical business address (if applicable) Postal address Head office or registered address Business telephone number Identity or trust or registration number Income tax number Source of funds (for example, export proceeds, commissions) D Contact details Business fax number Registration date (YYYY-MM-DD) VAT number Contact person Capacity Contact telephone numbers Email E Details of existing accounts Current accounts held at Standard Bank, if applicable Branch IBT FCA accounts, if applicable Currency Currency Main Bank Country Bank Branch F Requirements Type of account Transaction account Term account Currency EUR GBP USD Other (please specify) Tiered Rate Code (Office use) Debit balances Credit balances Overdraft limit 00185996 2012-06 The Standard Bank of South Africa Limited (Reg.. 1962/000738/06) An authorised financial services and registered credit provider (NCRCP15). Initial Page 1 of 8

Interest (Please indicate how you would like interest paid/charged) In Foreign Currency - pay/charge interest to this CFC account (Capitalised) In Foreign Currency - pay/charge interest to another CFC account in the same currency Interest earned In Rand - pay/charge interest to my rand accounts (Paid) Exchange control details (if business requires more than one code, choose the one that is most relevant) Exchange control approval number (if applicable) Segregation codes Date of exchange control approval (YYYY-MM-DD) Branch code Expiry date of exchange control approval (YYYY-MM-DD) Account group description and code Explanation FCA non-resident account Bank statement FCA001 n resident companies. Monthly Quarterly Half-yearly Contact details Email address for statements Business online international banking Fax number for statements (if applicable) Yearly Are you a subscriber of Business online international banking? If yes, please provide profile identity number Date (YYYY-MM-DD) Signed at G Approval KYC or FICA requirements Business address and/or trade name(s) provided Verification documents required in respect of the account holder Does this account form part of a group? If yes, group number Verification of mandates Mandates have been checked by Personnel number Date (YYYY-MM-DD) H Resolution At a meeting of the directors, members, trustees, committee or partners (account holders) held at (place) on (date YYYY-MM-DD) it was resolved that the company, close corporation, trust, body corporate, partnership, informal body opens a FCA account with the Standard Bank of South Africa Limited ( the Bank ), the specific Bank branch or branches directors, members, trustees, committee or partners of account holders. or that may be indicated by the The persons specified in Section I of this application by means of a Y or under Signatory on the account are hereby authorised in terms of this resolution to act as signatories in respect of the above account in accordance with the signing arrangements on the signature form. 00185996 2012-06 Page 2 of 8 Initial

I Resolution (continued) For purposes of the release indemnity the following person(s) can sign: The said FCA account(s) applied for in this application as well as future FCA accounts to be opened with us are to be loaded to the international electronic facility. If yes, the persons specified in this resolution by means of a Y or under Signatory on the account are hereby, in addition to the above, authorised in terms of this resolution to act as signatories in respect of the above account for purpose of international electronic banking. They are hereby appointed to act as the authorised signatory(ies) *jointly or severally on behalf of the principal and the participant(s) who have authorised the principal to act on their behalf: 1 to conclude and sign the International Banking Agreement ( the Agreement ); 2 to appoint and terminate the appointment of the designated person(s); and 3 to generally perform any act or do anything required or prescribed in the agreement. *For (insert name of business, company, body, etc.) Name Capacity Date *Company seal (where available) J Natural persons These individuals are the authorised signatories, agents, secondary cardholders, guardians of minors, members of close corporations, elected office bearers of informal bodies, partners of a partnership, including silent partners, persons who exercise executive control in a partnership, directors of companies, including all directors authorised to act on behalf of the company, shareholders with 25% or more of the voting rights, trustees, beneficiaries or founders of a trust, manager of affairs of a foreign company and principal executive officer of domestic companies. Credit consent I/We as set out in section I of this application, consent to you making enquiries about my/our credit record with any credit reference agency and any other party to confirm any or all of the information provided by me/us. I/We further consent to you carrying out identity and fraud prevention checks and sharing information relating to this application with the Fraud Prevention Service (FPS) and/or through the country s relevant law enforcement agencies. Record details of related parties Type of identity and number (for example, passport, identity document) Country of issue Residential address and nationality Residential address Telephone number (residential or work or cellphone) Capacity or designation Signatory on account Initial: 00185996 2012-06 Page 3 of 8

K Specimen signature form - mandate file Name of applicant Signing instructions Specimen signature Authority or signature type Specimen signature Authority or signature type Specimen signature Authority or signature type Specimen signature Authority or signature type Specimen signature Authority or signature type Specimen signature Authority or signature type Date (YYYY-MM-DD) Chairman s or director s signature Director s or company secretary s signature Authentication Authenticated by K Juristic entities Date (YYYY-MM-DD) These are legal entities or businesses that are close corporations, partnerships, trusts, companies and other legal entities such as informal bodies, that are shareholders with 25% or more of the voting rights (with the exception of Nigeria which requires a minimum of 5%), partners, including joint ventures, trustees, beneficiaries, founders in respect of the applicant. Record details of related parties Registered name or name of trust or other legal entity Registration number or trust number Type of organisation (for example, Ltd company or informal body) Trade name Registered address or master s address (trusts) Head office address (if multiple offices) Physical business address Initial: 00185996 2012-06 Page 4 of 8

L Release and indemnity, fax and email transmission (If this facility is not required, please indicate by drawing a diagonal line across this page and initial) (Delete sections that are not applicable. Any deletion or alteration must be initialled by signatories and witnesses) Please consider the clauses that follow carefully as they limit the bank s liability and constitute an assumption of risk by you. We the undersigned, (insert full names) and (insert full names), herein representing (insert name of Company, Close Corporation, Partnership, etc.) in our capacities as (insert capacity) and (insert capacity) respectively (being duly authorised by a resolution passed on (insert date YYYY-MM-DD), a certified copy of which is attached hereto), I have requested the Standard Bank of South Africa Limited, email message. branch (insert name of branch) (you) to act on instructions we transmit to it by facsimile (fax) or by telephone or We acknowledge that it is not possible for you to check the authenticity of all fax transmissions, email messages or telephonic requests that claim to come from us; You have informed us that you are prepared to act on such faxed and/or emailed instructions that purport to emanate from us, provided you receive a release and indemnity as in this form. We are prepared to give such release and indemnity. By signing this release and indemnity we: 1 agree that all fax transmissions, email instructions, mandates, consents, commitments, resolutions, minutes of meetings and any other documents, which claim to come from us (claimed instructions) will be treated as having been given by us in the form actually received by you. Claimed instructions may, as a result of the malfunction of equipment, the distortion of communication links and the like, be different to that intended or sent - and we will be bound by them; 2 waive any rights we may have now or in the future against you for direct or indirect losses or damages we may suffer because you acted on any claimed fax transmissions, email instructions or telephonic requests. We indemnify you in the case of any claims, demands or actions made against you or losses or damages suffered by you because you acted on any claimed fax transmissions, email instructions or telephonic requests; 3 agree that you are not liable for errors or delays in transmissions, or the misinterpretation on receipt, or for any loss or damage no matter how caused as a result of allowing this arrangement, excluding losses arising from the proven unlawful or fraudulent acts of your employees; 4 agree to carry out and keep to any procedures or restrictions or both, imposed on us by you about the sending of fax, email instructions or telephonic requests to you; 5 agree that the release and indemnity will not be affected by any failure by you to impose any or sufficient procedures or restrictions or to ensure that any, or all of them, are complied with; 6 agree that you will not be obliged to act on any claimed instructions and that you may at any time on written notice sent to us withdraw from the arrangements made in this document; 7 agree to give the original document(s) related to the underlying agreement for which payment is made and that are needed for the payment(s) made on our behalf, to you for endorsement as needed in terms of Exchange Control Regulations and Rulings. We understand that you are required by the South African Reserve Bank (SARB) to endorse the original documents as you do not have authority from the SARB not to present original documents for foreign exchange payments; 8 consent that you may record telephone calls which you get from or make to us, for monitoring and record purposes. s Signed at on this day of For and on behalf of (Company, Close Corporation, Partnership, etc.) Name Designation Name Designation Witnesses Name of first witness Personnel number (where applicable) Name of second witness Personnel number (where applicable) 00185996 2012-06 Page 5 of 8 Initial

Foreign Currency Account for non-resident companies terms and conditions (Terms) 1 Introduction 1.1 These Terms become effective when you register for a Customer Foreign Currency account for non-resident companies. 1.2 You must know, understand and comply with these as they are a binding agreement between you and us. 1.3 Important clauses, which may limit our responsibility or involve some risk for you, will be in bold and italics or highlighted. You must pay special attention to these clauses. 2 Definitions We have defined some words for consistency. These words will begin with a capital letter, where indicated. Singular words include the plural and the other way round. Word Account Bank Drafts Bank, we, us BOP Forward Exchange Cover Rate te Buying Exchange Rate Ruling Airmail Exchange Rate Ruling Telegraphic Selling Rate of Exchange Spot Exchange Rate you Meaning The Customer Foreign Currency account opened by us in your name at your request. Foreign currency cheques issued by a bank abroad. The Standard Bank of South Africa Limited (Registration Number 1962/000738/06) and its successors or assigns. Balance of Payment Reporting. The rate at a set date in the future. The bank s buying rate for foreign bank notes. The bank s buying rate for cheques Travellers Cheques, including Personal Cheques, Business cheques, Bank Drafts. The bank s selling rate for outward electronic transfers. The rate at the date of the transaction. The person who applies for an Account, or in whose name an Account is opened. 7.3 You will be responsible for paying any taxes withheld from or tariffs imposed on us by the Government of the Republic of South Africa or any associated authority. You accordingly give up your right to recover such payments from us and protect us against any liability for any such taxes and tariffs. 7.4 The interest rate which money in the Account earns will: change depending on the amount of money in the Account; be calculated daily. 7.5 The interest which your Account has earned will be: paid on the basis of the actual number of days; based on the day count principle linked to the currency; and credited to your Account monthly. 7.6 Any interest due to you will be debited to the current account as indicated under section F of the application form. 8 Statements 8.1 If you believe there is a mistake on your Account statement, you must tell us in writing within 60 days of the date of the statement. 8.2 If you do not tell us about any mistakes within these 60 days, your Account statement will be treated as being correct (in law referred to as being deemed correct). 8.3 If you do not notify us in time of forged or unauthorised entries on your Account and these result in losses, we may refuse to refund further losses to you. 3 Governing laws 3.1 Transactions that cause currency to flow into or out of the Account will be subject to the criteria set out in these Terms. 3.2 South African law governs these Terms. 4 Deposits and withdrawals 4.1 Deposits into or withdrawals from the Account will be processed at the Spot or Forward Exchange Cover Rate with two business days value. 4.2 You should deposit foreign currency cheques, Bank Drafts or foreign currency notes (cash), (foreign currency proceeds) in the currency of the Account, at one of our bureau de change outlets (and not our International Business Centre). We will purchase the foreign currency proceeds at the ruling Airmail or te-buying Exchange Rate and then credit your Account at the ruling Telegraphic Selling Rate of Exchange. The exchange difference represents the out-of-pocket interest we incur until we receive value for the financial instrument. 4.3 As we are discounting the financial instrument, your account executive, relationship manager or portfolio manager must approve this facility. 4.4 If we receive foreign currency funds in the currency of your Account electronically, we will credit the Account with the full face value of the earnings, subject to applicable fees being deducted. 4.5 The value of the Account will always be given in the foreign currency relevant to the Account being made available. You will incur the risk associated with exchange rate fluctuations. 5 Cheque Deposits 5.1 The value of any cheque deposited into your Account will only be available to you when it has cleared. This may take up to 6 weeks 5.2 You may apply to your account executive, relationship manager or portfolio manager to discount any financial instrument and give you immediate value on it. We may approve or decline this application at our discretion. 5.3 If we give you immediate value on the financial instrument and it is returned unpaid, we will debit your Account with the amount of the financial instrument that did not clear. We will also debit your Account with the associated bank charges. Details of such charges are available from any of our retail foreign exchange outlets. 6 Payments 6.1 We will make payments from the Account on your instructions, if there are sufficient funds available. 6.2 If you have arranged so with us before-hand, you may instruct us electronically to make payments from the Account. We will debit your Account accordingly. 9 Closing of account 9.1 If there are no transactions over the Account within six months of the first transaction, we may close the Account as a security measure. We will tell you in writing if we do this. 9.2 If you would like to close your Account, you are required to notify us in writing. The letter must be signed in terms of the signing instructions which you provided on the application form. 9.3 If you would like to close your Account, you are required to notify us in writing. The letter instructing us to close your Account must be signed in terms of the mandate provided on the application form and delivered to your nearest foreign exchange change outlet. 10 Exchange control The relevant BOP forms and supporting documents must be completed and include instructions that direct us to process transactions on the Account. 11 General 11.1 We may perform identity and fraud prevention checks and share information relating to this application with the Fraud Prevention Service or relevant law enforcement agencies. Should your account conduct at any time in the future reasonably cause us to suspect that your account is being used for improper purposes details of this suspicion may be sent to the aforementioned agencies. 11.2 We may ask for updated confirmation documents relating to antimoney laundering, anti-terrorism financing documents and you must provide these to us within 7 days of our request. If you do not, we may close your Account, on notice to you. 11.2.1 We will be entitled to treat as a fact that you have received any of our notices sent to the: address; fax number; or e-mail address, which you give to us, within seven days of posting, or on the same day if hand delivered or sent by fax or email, even if this was not actually the case. 11.3 You must pay all our reasonable expenses in recovering any amounts you owe us, including: legal fees at the maximum rate permissible ( in law referred to as the attorney and own client scale); collection fees; tracing fees; and penalty fees. 11.4 We may at any time change these Terms by giving you notice in writing. 11.5 Each clause which together makes these Terms, is separate from the other. If any clause is found to be defective or unenforceable for any reason by any competent court, then the remaining clauses will continue with full force and effect. 11.6 By completing this application form and initialling each page you accept these Terms and declare that all information you have given is true. 7 Interest and charges 7.1 The standard charges applicable to foreign exchange transactions, as agreed with your authorised representatives and your account executive, relationship manager or portfolio manager, will apply to dealings over the Account and will be debited to your current account. 7.2 If any changes to applicable laws or rules or their interpretation cause our cost of maintaining the Account to increase, you must pay us an amount equal to such an increase. We will inform you if this happens. Initial 00185996 2012-06 Page 6 of 8

Foreign Currency Account for non-resident companies terms and conditions (Terms) 1 Introduction 1.1 These Terms become effective when you register for a Customer Foreign Currency account for non-resident companies. 1.2 You must know, understand and comply with these as they are a binding agreement between you and us. 1.3 Important clauses, which may limit our responsibility or involve some risk for you, will be in bold and italics or highlighted. You must pay special attention to these clauses. 2 Definitions We have defined some words for consistency. These words will begin with a capital letter, where indicated. Singular words include the plural and the other way round. Word Account Bank Drafts Bank, we, us BOP Forward Exchange Cover Rate te Buying Exchange Rate Ruling Airmail Exchange Rate Ruling Telegraphic Selling Rate of Exchange Spot Exchange Rate you Meaning The Customer Foreign Currency account opened by us in your name at your request. Foreign currency cheques issued by a bank abroad. The Standard Bank of South Africa Limited (Registration Number 1962/000738/06) and its successors or assigns. Balance of Payment Reporting. The rate at a set date in the future. The bank s buying rate for foreign bank notes. The bank s buying rate for cheques Travellers Cheques, including Personal Cheques, Business cheques, Bank Drafts. The bank s selling rate for outward electronic transfers. The rate at the date of the transaction. The person who applies for an Account, or in whose name an Account is opened. 7.3 You will be responsible for paying any taxes withheld from or tariffs imposed on us by the Government of the Republic of South Africa or any associated authority. You accordingly give up your right to recover such payments from us and protect us against any liability for any such taxes and tariffs. 7.4 The interest rate which money in the Account earns will: change depending on the amount of money in the Account; be calculated daily. 7.5 The interest which your Account has earned will be: paid on the basis of the actual number of days; based on the day count principle linked to the currency; and credited to your Account monthly. 7.6 Any interest due to you will be debited to the current account as indicated under section F of the application form. 8 Statements 8.1 If you believe there is a mistake on your Account statement, you must tell us in writing within 60 days of the date of the statement. 8.2 If you do not tell us about any mistakes within these 60 days, your Account statement will be treated as being correct (in law referred to as being deemed correct). 8.3 If you do not notify us in time of forged or unauthorised entries on your Account and these result in losses, we may refuse to refund further losses to you. 3 Governing laws 3.1 Transactions that cause currency to flow into or out of the Account will be subject to the criteria set out in these Terms. 3.2 South African law governs these Terms. 4 Deposits and withdrawals 4.1 Deposits into or withdrawals from the Account will be processed at the Spot or Forward Exchange Cover Rate with two business days value. 4.2 You should deposit foreign currency cheques, Bank Drafts or foreign currency notes (cash), (foreign currency proceeds) in the currency of the Account, at one of our bureau de change outlets (and not our International Business Centre). We will purchase the foreign currency proceeds at the ruling Airmail or te-buying Exchange Rate and then credit your Account at the ruling Telegraphic Selling Rate of Exchange. The exchange difference represents the out-of-pocket interest we incur until we receive value for the financial instrument. 4.3 As we are discounting the financial instrument, your account executive, relationship manager or portfolio manager must approve this facility. 4.4 If we receive foreign currency funds in the currency of your Account electronically, we will credit the Account with the full face value of the earnings, subject to applicable fees being deducted. 4.5 The value of the Account will always be given in the foreign currency relevant to the Account being made available. You will incur the risk associated with exchange rate fluctuations. 5 Cheque Deposits 5.1 The value of any cheque deposited into your Account will only be available to you when it has cleared. This may take up to 6 weeks 5.2 You may apply to your account executive, relationship manager or portfolio manager to discount any financial instrument and give you immediate value on it. We may approve or decline this application at our discretion. 5.3 If we give you immediate value on the financial instrument and it is returned unpaid, we will debit your Account with the amount of the financial instrument that did not clear. We will also debit your Account with the associated bank charges. Details of such charges are available from any of our retail foreign exchange outlets. 6 Payments 6.1 We will make payments from the Account on your instructions, if there are sufficient funds available. 6.2 If you have arranged so with us before-hand, you may instruct us electronically to make payments from the Account. We will debit your Account accordingly. 9 Closing of account 9.1 If there are no transactions over the Account within six months of the first transaction, we may close the Account as a security measure. We will tell you in writing if we do this. 9.2 If you would like to close your Account, you are required to notify us in writing. The letter must be signed in terms of the signing instructions which you provided on the application form. 9.3 If you would like to close your Account, you are required to notify us in writing. The letter instructing us to close your Account must be signed in terms of the mandate provided on the application form and delivered to your nearest foreign exchange change outlet. 10 Exchange control The relevant BOP forms and supporting documents must be completed and include instructions that direct us to process transactions on the Account. 11 General 11.1 We may perform identity and fraud prevention checks and share information relating to this application with the Fraud Prevention Service or relevant law enforcement agencies. Should your account conduct at any time in the future reasonably cause us to suspect that your account is being used for improper purposes details of this suspicion may be sent to the aforementioned agencies. 11.2 We may ask for updated confirmation documents relating to antimoney laundering, anti-terrorism financing documents and you must provide these to us within 7 days of our request. If you do not, we may close your Account, on notice to you. 11.2.1 We will be entitled to treat as a fact that you have received any of our notices sent to the: address; fax number; or e-mail address, which you give to us, within seven days of posting, or on the same day if hand delivered or sent by fax or email, even if this was not actually the case. 11.3 You must pay all our reasonable expenses in recovering any amounts you owe us, including: legal fees at the maximum rate permissible ( in law referred to as the attorney and own client scale); collection fees; tracing fees; and penalty fees. 11.4 We may at any time change these Terms by giving you notice in writing. 11.5 Each clause which together makes these Terms, is separate from the other. If any clause is found to be defective or unenforceable for any reason by any competent court, then the remaining clauses will continue with full force and effect. 7 Interest and charges 7.1 The standard charges applicable to foreign exchange transactions, as agreed with your authorised representatives and your account executive, relationship manager or portfolio manager, will apply to 11.6 By completing this application form and initialling each page you dealings over the Account and will be debited to your current account. accept these Terms and declare that all information you have given 7.2 If any changes to applicable laws or rules or their interpretation is true. cause our cost of maintaining the Account to increase, you must pay us an amount equal to such an increase. We will inform you if this happens. Initial 00185996 2012-06 Page 7 of 8 Customer s copy

Account record (Foreign Currency Account Signatories for non-resident companies) Are the Authorised Signatories the same as an existing current/vostro account? Please provide account number If there is not an existing current/vostro account kindly complete the form below. Please add the following signatory(ies) to the account Account type Customer Foreign Currency Account Name of account Currency Company registration number Telephone number Add Delete Name of signatory Fax number Initials Identity number Passport number Date to (YYYY-MM-DD) Date to (YYYY-MM-DD) Payment limit Signing arrangements Signatory to sign in block (Do not sign over the lines) Single rights Plus any other Group Add Delete Name of signatory Initials Identity number Passport number Date to (YYYY-MM-DD) Date to (YYYY-MM-DD) Payment limit Signing arrangements Signatory to sign in block (Do not sign over the lines) Single rights Plus any other Group Add Delete Name of signatory Initials Identity number Passport number Date from (YYYY-MM-DD) Date to (YYYY-MM-DD) Payment limit Signing arrangements Signatory to sign in block (Do not sign over the lines) Single rights Plus any other 00185996 2012-06 Page 8 of 8 Group

Foreign Account Tax Compliance Act (FATCA) and Common Reporting Standard (CRS) Juristic Person Self-Certification Reference information (for office use only) BP ID Section A1: Juristic person/entity The juristic account holder must complete this questionnaire. Registered name of the entity Trading name of the entity Registration or incorporation number of the entity Country of incorporation or registration In which country is your entity incorporated or registered, if not South Africa? South Africa Other Country of principal office Which is your country of principal office, if not South Africa? Country of effective management Which is your country of effective management, if not South Africa? South Africa South Africa Other Other Date of incorporation or registration Registered address Country Is your entity s registered address the same as its postal address? If they are not the same, please fill in the postal address Postal address Country Please tick the boxes next to any financial institution activities described below that your entity is involved in, as defined in: The Intergovernmental Agreement between the government of the United States of America and the government of the Republic of South Africa to improve international tax compliance and to implement FATCA Article 1 Standard for Automatic Exchange of Financial Account Information in Tax Matters Section VIII A 1 The entity accepts deposits in the ordinary course of banking or similar business. 2 The entity holds financial assets for the account of others as a substantial portion of its business. 3 The entity conducts activities on behalf of clients involving portfolio management or the administration or management of financial assets. 4 The entity is an insurance company which writes annuity contracts or obligations or issues insurance contracts which have a cash value, should they be cancelled. If you HAVE ticked any of the boxes, please complete Section A2. If you HAVE NOT ticked any of the boxes, please complete Section A3 and leave Section A2 blank. Section A2: Type of financial institution Global Intermediary Identification Number GIIN FATCA status: Reporting FFI Certified deemed-compliant FFI Registered deemed-compliant FFI n-reporting FFI If other please specify 00171764 2017-02 The Standard Bank of South Africa Limited (Reg.. 1962/000738/06) An authorised financial services and registered credit provider (NCRCP15). Page 1 of 5

Section A2: Type of financial institution (continued) AEOI status Custodial institution Specified insurance company If the entity is NOT an investment entity, please complete Section B. Section A3: n-financial Entity Investment entity Depository institution Please tick the boxes next to each statement that applies to your entity The entity is part of a government agency or an arm of a sovereign nation, including but not limited to national, provincial or local government. The entity is majority-owned or controlled by a government agency or an arm of a sovereign nation. The entity is a supranational organisation, being comprised of nation states or having a headquarters agreement. The entity s stock is regularly traded on a securities market or the entity is a member of the same corporate group as an entity whose stock is regularly traded on a securities market. If you HAVE ticked any of the boxes, please complete Section B. You do not have to complete any other section. If you HAVE NOT ticked any of the boxes, please give us the following information Is the entity a tax resident in any countries other than South Africa? If the entity is a tax resident outside of South Africa, what are the countries of tax resident? What is the entity s tax identification number or functional equivalent per tax residency? Does the entity earn more than fifty per cent of its gross income from passive sources such as interest, dividends, royalties, etc.? Does the entity hold more than fifty per cent of its assets to generate passive income such as interest, dividends, royalties, etc.? If you have answered yes to any of the above two questions, please complete Section B and Section C. If you have answered no to both questions, please complete Section B. Section B: Account holder declaration I declare that everything I have said above is true and complete. If there is any change in circumstances which may change the entity s tax residency status or if any of the information I gave above changes, I will complete a new self-certification and declaration and provide it within 90 days. Print name Capacity Date (YYYY-MM-DD) 00171764 2017-02 Page 2 of 5

Section C: Controlling person questionnaire Each controlling person of the account holder must complete a copy of this page. We also need all the necessary documentation for each controlling person of the entity. Title Full name Date of birth (YYYY-MM-DD) Country of birth South Africa Other Physical address Town or city of birth Country Is your physical address the same as your postal address? If they are not the same, please fill in your postal address Postal address Country Is the Controlling Person a citizen or a tax resident of any countries other than South Africa? If yes, what are your countries of citizenship/tax residency? If yes, and you are a citizen or a tax resident of any other countries, please fill in your tax identification number or functional equivalent. Documentation checklist for each controlling person Copy of ID/passport Proof of residential address Controlling person declaration I declare that everything I have said above is true and complete. If there is any change in circumstances which may change the entity s tax residency status or if any of the information I gave above changes, I will complete a new self-certification and declaration within 90 days. Print name Capacity Date (YYYY-MM-DD) 00171764 2017-02 Page 3 of 5

FATCA and Common Reporting Standard Glossary This glossary is of general guidance only for concepts you may be unfamiliar with. If uncertain as to your FATCA or CRS classification please consult your tax advisor. Cash Value The term Cash Value means the greater of (i) the amount that the policyholder is entitled to receive upon surrender or termination of the contract (determined without reduction for any surrender charge or policy loan), and (ii) the amount the policyholder can borrow under or with regard to the contract. twithstanding the foregoing, the term Cash Value does not include an amount payable under an Insurance Contract. Cash Value Insurance 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. Controlling Person The term Controlling Persons means the natural persons who exercise control over an Entity. In the case of a trust, such term means the settlor, the trustees, the protector (if any), the beneficiaries or class of beneficiaries, and any other natural person exercising ultimate effective control over the trust, and in the case of a legal arrangement other than a trust, such term means persons in equivalent or similar positions. The term Controlling Persons shall be interpreted in a manner consistent with the Financial Action Task Force Recommendations. b ii iii certificates of deposit, derivatives, etc.); foreign exchange; exchange, interest rate and index instruments; transferable securities; or commodity futures trading; Individual and collective portfolio management; or Otherwise investing, administering, or managing Financial Assets or money on behalf of other persons; or The gross income of which is primarily attributable to investing, reinvesting, or trading in Financial Assets, if the Entity is managed by another Entity that is a Depository Institution, a Custodial Institution, a Specified Insurance Company, or an Investment Entity described in subparagraph A(6)(a). An Entity is treated as primarily conducting as a business one or more of the activities described in subparagraph A(6)(a), or an Entity s gross income is primarily attributable to investing, reinvesting, or trading in Financial Assets for purposes of subparagraph a(6)(b), if the Entity s gross income attributable to the relevant activities equals or exceeds 50% of the Entity s gross income during the shorter of: i The three-year period ending on 31 December of the year preceding the year in which the determination is made; or ii The period during which the Entity has been in existence. Custodial Institution The term Custodial Institution means any Entity that holds, as a substantial portion of its business, financial assets for the account of others. An entity holds financial assets for the account of others as a substantial portion of its business if the entity s gross income attributable to the holding of financial assets and related financial services equals or exceeds 20 percent of the entity s gross income during the shorter of: (i) the three-year period that ends on December 31 (or the final day of a non-calendar year accounting period) prior to the year in which the determination is being made; or (ii) the period during which the entity has been in existence. Depository Institution The term Depository Institution means any Entity that accepts deposits in the ordinary course of a banking or similar business. Financial Asset The term Financial Asset includes a security (for example, a share of stock in a corporation; partnership or beneficial ownership interest in a widely held or publicly traded partnership or trust; note, bond, debenture, or other evidence of indebtedness, partnership interest, commodity, swap (for example, interest rate swaps, currency swaps, basis swaps, interest rate caps, interest rate floors, commodity swaps, equity swaps, equity index swaps, and similar agreements), Insurance Contract or Annuity Contract, or any interest (including a futures or forward contract or option) in a security, partnership interest, commodity, swap, Insurance Contract, or Annuity Contract. The term Financial Asset does not include a non-debt, direct interest in real property. Financial Institution Please note that FATCA and the Common Reporting Standard are law in South Africa in terms of the Tax Administration Act. There is no legal entity to which the Regulations do not apply. If uncertain as to your organisation s classification, please seek tax advice. Misrepresentation of your classification to any South African financial institution may expose you to severe penalties by SARS. The term Financial Institution means a Custodial Institution, a Depository Institution, an Investment Entity, or a Specified Insurance Company. Insurance Contract The term Insurance Contract means a contract (other than an Annuity Contract) under which the issuer agrees to pay an amount upon the occurrence of a specified contingency involving mortality, morbidity, accident, liability, or property risk. Investment Entity The term Investment Entity means any Entity: a That primarily conducts as a business one or more of the following activities or operations for or on behalf of a customer: i Trading in money market instruments (cheques, bills, n-reporting Financial Institution Please note that FATCA and the Common Reporting Standard are law in South Africa in terms of the Tax Administration Act. There is no legal entity to which the Regulations do not apply. If uncertain as to your organisation s classification, please seek tax advice. Misrepresentation of your classification to any South African financial institution may expose you to severe penalties by SARS. The following definition is an excerpt from the Regulations. The term n-reporting Financial Institution means any Financial Institution that is: a a Governmental Entity, International Organisation or Central Bank, other than with respect to a payment that is derived from an obligation held in connection with a commercial financial activity of a type engaged in by a Specified Insurance Company, Custodial Institution, or Depository Institution; b a Broad Participation Retirement Fund; a Narrow Participation Retirement Fund; a Pension Fund of a Governmental Entity, International Organisation or Central Bank; or a Qualified Credit Card Issuer; c any other Entity that presents a low risk of being used to evade tax, has substantially similar characteristics to any of the Entities described in subparagraphs B(1)(a) a n d (b), and is included in the list of n-reporting Financial Institutions referred to in Annex I (see below) to these Regulations as a n-reporting Financial Institution, provided that the status of such Entity as a n Reporting Financial Institution does not frustrate the purposes of the Common Reporting Standard; d an Exempt Collective Investment Vehicle; or e a trust established under the laws of a Reportable Jurisdiction to the extent that the trustee of the trust is a Reporting Financial Institution and reports all information required to be reported pursuant to Section I with respect to all Reportable Accounts of the trust. ANNEX I n-reporting Financial Institutions 1 The following Retirement Funds: a A Pension Fund (including an umbrella Pension Fund) as defined in section 1 of the Income Tax Act, 1962; b A Provident Fund (including an umbrella Provident Fund) as defined in section 1 of the Income Tax Act, 1962; c A Pension Preservation Fund as defined in section 1 of the Income Tax Act, 1962; d A Provident Preservation Fund as defined in section 1 of the Income Tax Act, 1962; e A Retirement Annuity Fund as defined in section 1 of the Income Tax Act, 1962; provided that such fund is not a n- Reporting Financial Institution under Section VII(B) and 00171764 2017-02 Page 4 of 5

i ii iii iv v is approved by the Commissioner for SARS and registered by Financial Services Board as a fund under section 1 of the Income Tax Act, 1962; is subject to regulation by the Financial Services Board under the Pension Funds Act, 1956; does not have a single beneficiary with a right to more than five per cent of the fund s assets except where the fund is being wound down or in a manner regulated by the Pension Funds Act, 1956, or amalgamated in a manner regulated by the Financial Services Board with another retirement fund that is a n-reporting Retirement Fund under this paragraph; provides information reporting to SARS as and when required, including obtaining a tax directive from SARS prior to the payment by the fund of a lump sum benefit as defined in section 1 of the Income Tax Act, 1962, to a member or beneficiary of the fund; and is generally exempt from tax on investment income. Passive Income Passive income includes the portion of gross income that consists of: a dividends; b interest; c income equivalent to interest; d e f g h i j rents and royalties, other than rents and royalties derived in the active conduct of a business conducted, at least in part, by employees of the entity; annuities; the excess of gains over losses from the sale or exchange of Financial Assets that gives rise to the passive income described previously; the excess of gains over losses from transactions (including futures, forwards, options, and similar transactions) in any Financial Assets; the excess of foreign currency gains over foreign currency losses; net income from swaps; or amounts received under Cash Value Insurance Contracts. Specified Insurance Company The term Specified Insurance Company means any Entity that is an insurance company (or the holding company of an insurance company) that issues, or is obligated to make payments with respect to, a Cash Value Insurance Contract or an Annuity Contract. TIN The term TIN means Taxpayer Identification Number (or functional equivalent in the absence of a Taxpayer Identification Number). 00171764 2017-02 Page 5 of 5