Provident Preservation Fund Application Form · 1 of 14 14834 Provident Preservation Fund Application Form/20191118 Guide for investing STEP 1 Make an informed decision Read the terms

1 of 14 14834 - Provident Preservation Fund Application Form/2020-10-19

Guide for investing

STEP 1Make an informed decision

■ Read the terms and conditions to understand the rules of your Alexander Forbes Investments Provident Preservation Fund.

■ Read the applicable fund fact sheet/s to assist you in making an informed investment decision.

■ Consider getting financial advice:Alexander Forbes Investments does not provide financial advice. If you are not comfortable making your own investment decisions or if you feel that you need financial advice, consider appointing a financial adviser.

STEP 2Complete the application form

■ Complete all fields marked with an asterisk (*) ■ By signing this application form, you agree to the terms and conditions.

STEP 3Send your application form

■ Email: [email protected] ■ Fax: 011 263 6142 ■ For assistance phone: 0860 333 316 ■ To ensure efficient handling of your application, it is important that all the initial stated

requirements are supplied together with the completed application form. You agree to provide all documentation and information required in terms of the Financial Intelligence Centre Act, 2017 as amended (“FIC Act”), and understands that Alexander Forbes Investments, as an Accountable Institution(“AI”), is prohibited from processing any business transactions on your behalf until all such documentation and information has been received as part of its customer due diligence procedures. We may also at any time require additional information to meet our statutory obligation in this regard as part of our due diligence procedure. Your prompt response to our requests, where the information form is incomplete or we have outstanding documentation or both, will assist us to meet your expectations.

STEP 4Send supporting documents

■ Supporting documentation must be attached to your application, please refer to the FICA REQUIREMENTS FOR INDIVIDUALS document for our requirements.

■ Proof of your Bank Details (e.g. certified copy of a posted bank statement or a bank confirmation letter stamped by the bank, it may be a digital one or ink stamp (not older than three (3) months).

■ Proof of authority to represent the investor if you are acting on behalf of the investor.

We reserve the right to request additional information

What happens next? ■ We will process your application once we have received all the required documents and the money reflects in Alexander Forbes Investments Provident Preservation Fund bank account.

■ You will receive an sms or email confirmation once your application has been processed ■ You will receive a welcome letter and statement within five (5) business days of your

application having been processed and your investment received.

Provident Preservation Fund Application Form

ALEXANDER FORBES INVESTMENTS LIMITEDRegistration number: 1997/000595/06. FAIS number: 711 Pension fund administrator number: 24/217. Long-term insurance licence number: 00018/001

Pension fund administrator, registered long-term insurer and licensed financial services provider

INVESTMENTS 115 West Street, Sandown, 2196 | PO Box 786055, Sandton, 2146 Telephone number: 0860 333 316 | Fax number: +27 (0) 11 263 6142General queries email: [email protected] email: [email protected]: www.alexanderforbesinvestments.co.za

http://transact.alexanderforbesinvestments.co.za/Files/PDFFiles/FICARequirements-IndividualsPresProv.pdf



Male Female

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Member detailsPlease complete all fields marked with an asterisk (*).

Client type*

Surname*

Title First name(s)*

First name(s)*

Maiden name/Previous surname (if applicable)

Preferred name Gender*

Date of birth*

Country of birth* Nationality*

Citizenship* Country of residence*

Identity number*

Passport number(s), if foreign national

Attach a certified copy of each passport.

Occupational status*

Industry*

For a detailed list, CLICK HERE.

Employer name

Residential address*

Unit number Complex name

Street number Street/farm name

Suburb/district

City/town

Province

Passport number Country of issue Expiry date

Natural person: Local Natural person: Foreign Sole proprietor Minors Refugees

Estate lates Asylum seekers Student Retired

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Employed Unemployed Self employed Commission earner


Country Postal code

Postal address (if different to residential address)

City/town Province

Country Postal code

Contact details*home work cellphone

fax

email

Selected retirement age OR Retirement age as prescribed by the transferring fund

How should we communicate with you?Please indicate how you would like us to communicate with you.

If you have no preference, we will send correspondence to your email address. If you have not provided an email address, we will send correspondence to your postal address.

Email Post

Authorised representative

If you are acting on behalf of the member, or opening an investment for a minor, complete Annexure A (page 10), and attach your FICA documents and proof of authority, allowing you to represent the investor (no proof of authority is required for the parent of a minor). Refer to the FICA REQUIREMENTS FOR INDIVIDUALS document for details on what FICA documents to submit.

Resolution/Signing Authority/Mandate

Surname

Title First name(s)

Identity number (or passport number, if foreign national)

Contact detailshome work cellphone

fax email

Yes No



Banking details for payment to you

Attach a certified copy of a bank statement or letter from the bank (not older than three (3) months), to confirm the banking details below. This information is needed for payment of income distributions, withdrawals and/or disinvestments. We cannot make pay-ments into a third party’s bank account. We can only make payment into your bank account, which must be a South African bank account.

Name of bank

Branch code

Account holder

Account number Account type

Current Savings

Branch name

Please ensure that the bank details provided are for your own bank account. We will not pay any person, other than you.

Your dependants and nominees ■ Section 37C of the Pension Funds Act 24 of 1956 regulates the payment of death benefits and stipulates that the trustees must determine

who receives your death benefit, and the proportion to be paid to each dependant and/or nominee. ■ When deciding this, the trustees are required to consider your dependants and nominees, but they are not bound by your nominations. The

trustees must identify your dependants to establish their financial dependency and use their discretion to ensure all dependants are considered fairly in the distribution of your death benefit.

■ Please indicate the percentage of your benefit you would like each dependant/nominee to receive, and their personal details, in the table below. The percentages across all your nominations must add up to 100% (no decimal points).

■ A dependant is someone who relies on you for financial support. For example, spouse, fianc(e)é, life partner, child(ren), parents, siblings. ■ A nominee is a person or entity that does not rely on your financial support. For example, a charity, a trust or a friend.

Full name ID number (passport number, if foreign national) Relationship Dependant Nominee Percentage

Example: Joseph Soap 3902285042081 Spouse Yes No 0%

%

%

%

%

%

%

%

%Total 1 0 0 %

Reason for transfer

Resignation Retrenchment Dismissal Winding-up of fund Merger or takeover of employer

Non-member spouse divorce order Voluntary transfer (only applicable from another preservation fund)


Investment detailsWhich portfolio(s) do you want to invest in and how much do you want to invest?

Minimum transfer value R200 000

Portfolio selection

Portfolio Percentage

%

%

%

%

%

%

%

%

Total 1 0 0 %

Source of funds* Where do the funds you are investing come from?

Bonus (Annual and ad-hoc) Business earnings Company sale/sale of interest in a company

Court-order Divorce settlement Donation Gift

Pension Property sale Retirement lump sum (1/3) Sale of other asset excluding property

Other _____________________________________

Inheritance Loan Maintenance Maturing investment

Sale of shares Savings Sole proprietor Winnings

Source of income*

Where does your income come from?

Annuity payments Business earnings based on Industry activity (AFS) Commission

Consultancy fee (Fixed Contract) Consulting - Contract for provision of services Grants

Investment income Maintenance Rental income

Royalty income Sole proprietor - Contract for provision of products/services Salary

Other __________________________________________________

Alexander Forbes Investments’ banking details

In accordance with the requirements under the FIC Act, we do not reflect our banking details on our forms. In order to meet our obligations in this regard, we will first establish and verify your identity before your financial adviser will send our banking details to you.

*This information is required by the FIC Act, to identify potential money laundering. We reserve the right to request documentary proof of your source of funds and/or source of income, as indicated above.


Portfolio optionsTo fully understand the costs involved for this application, please speak to your financial adviser or call our Contact Centre on 0860 333 316, to obtain an effective annual cost (EAC) disclosure.

Portfolio name

Balanced Range Average annual service charge (incl. VAT)

Independent Partners Balanced Aggressive Fund 1.10%

Independent Partners Balanced Moderate Fund 1.08%

Independent Partners Balanced Conservative Fund 1.15%

Specialist Range

Independent Partners Specialist Aggressive Fund 1.35%

Independent Partners Specialist Moderate Fund 1.20%

Independent Partners Specialist Conservative Fund 1.15%

Passive Range

Independent Partners Passive Aggressive Fund 0.40%

Independent Partners Passive Moderate Fund 0.40%

Independent Partners Passive Conservative Fund 0.40%

Other

Independent Partners Banker Fund 0.54%

Independent Partners Maximiser Fund 0.85%

Independent Partners Inflation-linked Bond Fund 0.80%

Independent Partners Enhanced Income Fund 1.00%

For detailed information on the funds and the total investment charges, which consist of transaction costs (TC) and the total expense ratio (TER), refer to the latest FACT SHEETS that are available from your financial adviser or our Contact Centre on 0860 333 316 or our website.

Phase-inOur phase-in option allows you to invest your transfer value in the Independent Partners Banker Fund and switch (phase) this transfer value into other portfolios over your selected period.

■ The minimum phase-in period is three (3) months, and will be allocated in equal amounts over the selected period. ■ A phase-in takes place on the 10th of each month. Where your investment takes place after the 10th of the month, you can only phase in on

the 10th of the following month. If the 10th is not a business day, the phase-in will happen on the next business day. ■ Your documents must reach us by the 5th business day before the 10th of the month in which you choose to invest. ■ When you invest into the Independent Partners Banker Fund your financial adviser may only charge a maximum initial fee of 0.54%.

Do you wish to use our phase-in option? Yes No

What is your phase-in period? 3-month 6-months 9-months 12-months 24-months

Phase in the amount of R .

Which portfolio(s) will you phase into?

Portfolio name Rand/Percentage amountR or %

R or %

R or %

R or %

Total R or 1 0 0 %

https://www.alexanderforbesinvestments.co.za/for-you/fact-sheets


Transferring information*

This section must be completed to avoid delays to your transfer.

Registered name of the transferring fund

FSCA fund registration number

Member number

Contact name

Contact number

Registered name of the transferring fund

FSCA fund registration number

Member number

Contact name

Contact number

Important note

Replacement of any insurance may be to the disadvantage of the client.

Is this application to replace the whole or any part of your existing insurance with any insurer (whether replacement is to occur immediately or toreplace an insurance discontinued within the past four (4) months or within the next four (4) months)?

Yes No

If yes, the financial adviser must discuss and complete the Replacement Policy Advice Record available on page 13 of this application form.

Signature of member ___________________________________________________ Date d d / m m / y y y y

Replacement declaration by the financial adviser.

I hereby declare that I have requested and recorded the client’s responses to the above question with regard to replacement and that the client is fully aware of the possible detrimental consequences of the replacement of an insurance policy.

I further declare that, irrespective of the client’s response to the replacement question above, I explained the following to the client:

1. The meaning of replacement.2. That a replacement is potentially prejudicial.3. The levying/deduction of a termination charge, and4. That where a replacement is considered, the client is legally entitled to comprehensive information regarding the consequences of

replacement.

Signature of financial adviser _____________________________________________ Date d d / m m / y y y y


Financial adviser detailsPractice name

Name of adviser

FSP license number

Adviser code

FAIS declaration

1. I/We declare that I/we am/are a licensed Financial Services Provider and have made the disclosures required in terms of the Financial Advisory and Intermediary Services Act 37 of 2002 and subordinate legislation thereto, to the client.

2. I/We declare that I/we have disclosed all the charges related to this investment to the client and understand that the client may cancel my/our charges and appointment at any time in writing.

3. I/We confirm that all information provided herein is true and correct and I/we have read and understood the content of this form.

FICA declaration

I confirm that Alexander Forbes Investments Limited is the primary accountable institution, in terms of the FIC Act, and is responsible for the identification and verification of the investor. This application will only be processed on completion of such identification and verification.

Signature of financial adviser _____________________________________________ Date d d / m m / y y y y

Financial adviser charges

Initial charge % (excluding VAT) Annual charge % (excluding VAT)

■ If no initial charge is indicated 0% will apply.

Please indicate from which portfolio(s) your annual charge must be paid.

Proportionally from all your portfolios, OR from ___________________________________________ portfolio.

■ If no annual charge is indicated 0% will apply. ■ An equivalent value to the annual charges (plus VAT) will be recovered from your benefit. ■ The charge accrued is paid to your appointed financial adviser on a monthly basis in accordance with the Terms and Conditions. ■ Ongoing charges/fees may be paid to your appointed financial adviser and should be revised and confirmed annually.

Signature of member _____________________________________________

. .

Date d d / m m / y y y y


Member declaration1. I warrant that all the information provided by me in this application form and all supporting document in connection with this application are

true and accurate at the date of submission. 2. I have not received advice from the Board of Trustees, Alexander Forbes Investments or the Administrator in respect of this application.3. I agree that the Administrator may accept instructions from my financial adviser or another person authorised by me in writing to act on my

behalf.4. I understand that my financial adviser must be authorised in terms of the Financial Advisory and Intermediary Services Act 37 of 2002, and

that if my financial adviser is not appropriately authorised, Alexander Forbes Investments must by law decline any instructions from my financial adviser.

5. I confirm that my financial adviser will have access to my investments in electronic format as made available by the Administrator from time to time.

6. I agree and confirm that my membership is subject to the Rules of the Fund, governing Legislation and the Terms and Conditions of Membership. I agree that in the event of conflict between the Terms and Conditions of Membership and Legislation, the Rules of the Fund and Legislation will prevail.

7. I/we have read and understand the TERMS AND CONDITIONS and GENERAL DISCLOSURE, that forms part of this application form and are available on your website, or on request from you, or my financial adviser. I/We agree to the Terms and Conditions and am aware that they may be amended from time to time.

8. I acknowledge that the value of my Fund Credit is not guaranteed and can go up and down based on market performance of the portfolio I have chosen to invest in.

9. I confirm that I have been provided with an effective annual cost (EAC) disclosure for this transaction, and have read and understood the effect on my investment. The EAC is a measure that has been introduced, to allow me to compare the charges that I incur and their impact on my investment’s returns, when I invest in different financial products. The EAC is made up of four components: investment management charges, advice charges, administration charges, and other charges, which is expressed as an annualised percentage. The figures only show the estimated impact of immediate and future charges, and do not include the impact of any charges that I have already incurred. I know that the effect of some of the charges may vary, depending on my investment period. The EAC calculation assumes that I terminate my investment in the financial product at the end of the relevant period.

10. Alexander Forbes Investments Limited may not request or induce an investor in any manner to waive any right or benefit conferred on the investor by legislation or accept or act on any such waiver.


Protection of personal information (POPI)I know that Alexander Forbes Investments Limited (you) will use my personal information to consider my application for membership of the Fund. If you accept my application, I agree that you may:

1. process my personal information to administer my contract with you and for related purposes.2. give it (electronically or otherwise) to:

a. a third party (you contract with to provide services to you) so that you can provide services or products to me;b. a third party (you contract with to provide services to you) so that you can confirm my personal information;c. any person related to you (as described in the Companies Act) and your associates who provide services (like administration services)

to you.


https://www.alexanderforbesinvestments.co.za/Files/RetailDocuments/PresProvident_Terms and Conditions.pdf

http://transact.alexanderforbesinvestments.co.za/Files/PDFFiles/GeneralDisclosure.pdf


Annexure A - Self-certification for representative If you are acting on behalf of the investor, or opening an investment for a minor, complete ALL fields to avoid any delays in processing the instruction.

We are committed to complying with the Foreign Account Tax Compliance Act (FATCA) and the Organisation for Economic Co-op-eration and Development (OECD) Common Reporting Standard for automatic exchange of financial account information (CRS). This means that we must collect information about the tax residency of each client and their representative(s). If you are a U.S. Person of if you are a tax resident in any country other than, or in addition to, South Africa (or if we do not receive a valid self-certification), we are obliged to share your information with SARS, who may in turn share your information with the tax authorities in the relevant jurisdiction(s).

If you have any questions about the investor’s tax residency and/or classification status, please contact your tax adviser.

For an explanation of terms used in this Annexure, refer to the UNIT TRUST TAX INFORMATION SHEET FOR INDIVIDUAL INVESTORS that is available on our website, or on request from us or your financial adviser. (Click on the name to download the document.)

Personal detailsClient type

Surname

Title First name(s)

Maiden name/Previous surname (if applicable)

Preferred name Gender

Date of birth

Country of birth Nationality

Citizenship Country of residence

Identity number

Passport number(s), if foreign national

Attach a copy of a bank statement or letter from the bank (not older than three (3) months) to confirm the banking

Attach a certified copy of each passport.

Occupational status

Industry

For a detailed list, CLICK HERE.

Employer name

Residential address

Unit number Complex name

Street number Street/farm name

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Male Female

Passport number Country of issue Expiry dated d / m m / y y y y

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Parent Guardian Curator Mandate Executor Power of Attorney

Employed Unemployed Self employed Commission earner


Suburb/district

City/town

Province

Country Postal code

Contact details home work cellphone

fax email

Postal address (if different to residential address)

Province

City/town Postal code

Tax information

Are you a South African tax resident1? Yes No

If yes, please provide your South African income tax number.

Are you resident for tax purposes1 in any country other than, or in addition to, South Africa? Yes No

If yes, please list all countries in which you are resident for tax purposes2, and indicate the tax identification number (TIN) for each of those countries. If a country does not issue a TIN, please provide an equivalent number, for example, a registration number or similar official identification number.

If you cannot provide a TIN or other equivalent number, please provide one of the following reasons:

■ Reason A – The country does not issue TINs to its residents.

■ Reason B – You are not required to be registered for tax.

■ Reason C – The domestic law of the country does not require the TIN to be disclosed.

1. You are a South African tax resident if you are physically present in South Africa for certain time periods or if you are ordinarily resident in South Africa. 2. The taxation laws of a country will determine whether you are a tax resident of that country. If you are unsure about this person’s tax residency, please

contact your tax or financial adviser. Declaration and undertaking

1. I declare that the above information is true, accurate and complete. 2. I undertake to immediately inform Alexander Forbes Investments, in writing, if there is a change in circumstances that causes the above

information to be incorrect. 3. I understand that the information contained in this form may be reported to SARS and exchanged with tax authorities in other jurisdictions.

Signature ___________________________________________________

Country TIN or equivalent number* If no TIN is available enter reason A, B or C



Important noteOur pension preservation fund (“the fund”) is an “underwritten fund” that only invests in policies of insurance. The policies made available to the fund are linked policies under which no guarantees are issued, and the policy benefits are determined solely on the value of the assets or categories of assets to which the policies are linked. The fund is a defined-contribution fund, in which your fund benefit is directly linked to the value of underlying investments. It may therefore be in your best interest to obtain financial advice from an accredited financial adviser about your investment decisions.

Policy Registration number Tax approval code

AF Investments Provident Preservation Fund 12/8/38079 7660781743

Alexander Forbes Investments as Registered Long-term Insurer and authorised financial service provider

Alexander Forbes Investments LimitedPO Box 786055, Sandton, 2146Telephone number: +27 (0) 11 505 6000Fax number: +27 (0) 11 263 1311Email: [email protected] number: 0018/001FAIS licence number: 711

The Ombud for Long-term InsuranceThe Ombudsman for Long-term InsurancePrivate Bag X45, Claremont, Cape Town, 77353rd Floor, Sunclare Building, 21 Dreyer Street, Claremont, Cape Town, 7700Telephone number: +27 (0) 21 657 5000Fax number: +27 (0) 21 674 0951Email: [email protected] share-call help line: 0860 103 236

Compliance Officer of Alexander Forbes Investments Limited

The Compliance OfficerPO Box 786055, Sandton, 2146Telephone number: +27 (0) 11 505 6000Fax number: +27 (0) 11 263 1001Email: [email protected] licence number: 711

The Ombud for Financial Services Providers

FAIS OmbudPO Box 74571, Lynnwood Ridge, 0040Eastwood Office Park, Baobab House, Ground Floor, Lynnwood Road and Jacobson Drive, Lynnwood Ridge, 0081Telephone number: +27 (0) 12 470 9080Fax number: +27 (0) 12 348 3447Email: [email protected]: www.faisombud.co.za

Market Conduct Regulator for Financial Institutions

Financial Sector Conduct AuthorityPO Box 35655, Menlo Park, 0102Telephone number: +27 (0) 12 428 8000

Registrar of Pension Funds

The Compliance OfficerPO Box 35655, Menlo Park, 0102Telephone number: +27 (0)12 428 8000Fax number: +27 (0) 12 347 0221

Important information

Insurer details


To be completed in consultation with your financial adviser - (please note that this does not serve as a cancellation of the replaced policy; you must advise the insurer in writing about cancellation of a policy).

PolicyholderSurname

First name(s)

Identity number (or registration number in case of juristic persons)

RepresentativeSurname

First name(s)

Full name of FSP (Brokerage or Insurer)

FSP number

Replacement Policy Advice Record

New policy

Policy/Application number Insurer

Policy being replaced

Policy/Application number Insurer

Reasons why replacement may not be advisable

If you do replace any policy, we want to ensure that you make an informed choice. Please mark with an “X” in each block to indicate that the following information has been carefully discussed with you by your financial adviser.

You will pay some charges and fees twice (e.g. commission, underwriting expenses and other initial charges levied by the insurer) - initially on the existing policy and once again on the new policy.

You may pay higher premiums for risk (or a bigger part of the premium) on the new policy because you are older now or your health situation might have changed.

Your new policy may not have the same life cover or premium guarantees as the existing policy. Check the period for which the life cover or other cover amounts are guaranteed before the insurer is entitled to change your premiums or reduce or remove cover.

Your new policy may have more exclusions, restrictions or waiting periods particularly if your health has deteriorated.

Your new policy may not have the same investment performance guarantees as the existing policy (if applicable).

The amount of money that you can withdraw under the new policy may be less (if applicable). A new policy will usually have legal restrictions on access within the first 5 years.


To be completed if the new business was effected via electronic business.

Was the replacement policy effected as a result of the?

Please indicate the date, time of the phone call/negotiation and (if applicable), reference number:

_____________________________ ______________________________Date Time Reference

Internet Telephone Direct marketing

Declaration(Signatures compulsory unless the replacement policy was effected as a result of the internet, telephone or direct marketing).

RepresentativeI confirm that I have taken all reasonable steps to confirm that the information in this Replacement Policy Advice Records (RPAR) is true and correct. I confirm that in pursuance of my advice to the policyholder to replace the policy/ies mentioned in this RPAR, I have fully discharged my duties as set out in Section 8(d) of the General Code of Conduct for Authorised Financial Services Providers and their Representatives (the Code) and have retained a record of such advice as required by Section 3 of the said Code.

Signature of representative ___________________________________

PolicyholderI confirm that the representative has fully explained the consequences of the replacement of the policy(ies) mentioned in this Replacement Policy Advice Record and I understand the consequences of such replacement(s).

Signature of policyholder ______________________________________

Name

Contact telephone number and/or e-mail address

You may lose the tax advantage of your existing policy (if applicable).

The surrender value or paid up value of your existing policy may be as low as 60% of the policy value before the change, and could be even less than premiums paid in since unrecovered initial expenses must first be deducted. Check what charges you will be paying on termination of the old policy and see whether the advantages of the new policy will make up for any such charges.

The investment risk under the new policy may be higher. Remember that the past performance of a fund or asset manager of a fund is not necessarily an indication of future performance.

The representative informed you whether the existing/terminated policy could be amended to provide similar benefits to the replacement policy.

If such amendment is/was possible, your representative discussed with you why it is appropriate that the terminated policy be replaced by the replacement policy.


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Alexander Forbes Investments Limited is a licensed financial services provider in terms of Section 8 of the Financial Advisory and Intermediary Services Act, 37 of 2002, as amended, FAIS licence number 711. This information is not advice, as defined in the Act. Please be advised that there may be representatives acting under supervision.

Company Registration Number: 1997/000595/06. Pension Fund Administrator Number: 24/217. Long-term Insurer Number: 00018/001. Postal Address: PO Box 786055, Sandton 2146. Physical Address: 115 West Street, Sandown 2196. Telephone Number: + 27 (0) 11 505 6000. The COMPLAINTS POLICY and CONFLICT OF INTEREST MANAGEMENT POLICY can be found on the website.

http://www.alexanderforbesinvestments.co.za/about-us/risk-and-compliance-matters

http://www.alexanderforbesinvestments.co.za/about-us/risk-and-compliance-matters