offshore application for legal entities - allan gray · south african companies and south african...

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(Contact us if you need help:Call 0860 000 654 between 07:30 - 17:30 (Mon - Fri) or Email: [email protected]

Make an informed decision:

▪ Refer to the fund factsheets (minimum disclosure documents) and the Allan Gray Offshore Platform Fund List

for information on the unit trusts we offer. Certain unit trusts are subject to availability.

▪ Please also refer to the schedules of similarities and differences between South African regulations and the

regulations governing Foreign Collective Investment Schemes.

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 adviser’ section of our website.

▪ South African companies and South African trusts need to obtain SARB approval.

▪ If you wish to make use of Allan Gray's preferred foreign exchange administrator, please complete section 6 of this

form. For more information on foreign exchange administrators, please contact the Client Service Centre.

▪ If you have elected to invest in the Allan Gray Africa ex-SA Bond Fund and are investing less than US$100 000,

please complete the 'Allan Gray Africa ex-SA Bond Fund Declaration' form which is available on our website.

▪ 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.

▪ Read and agree to the Offshore Terms and Conditions to understand the rules of your investment.

Send the following documents to:

Email: [email protected] or Fax: 0860 000 655 or +27 (0)21 415 2492

Please note that Allan Gray may request additional documents (over and above the documents listed here) in certain

instances. This may require certification. You will be notified of this by the administrator.

Please make payment into the Administrator's relevant bank account and send us proof of payment

▪ Please refer to Annexure C for the relevant bank account details in order for you to make payment.

▪ The Allan Gray bank account details are also included in Annexure C, if you have chosen to pay your

annual administration and annual financial adviser fees from the Allan Gray Money Market Fund (ZAR).

Refer to the Allan Gray Offshore Investment Platform fund list for each unit trust's trading frequency, cut-off day and

trading day.

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.

▪ We will process your instruction once we receive all the required documents and your lump sum payment.

▪ 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.

BEFORE YOU INVEST

ADDITIONAL

INFORMATION

STEP 1COMPLETE THE FORM &

AGREE TO THE Ts & Cs

STEP 2SEND DOCUMENTS

STEP 3MAKE PAYMENT

CUT-OFF TIMES

WHAT HAPPENS

NEXT?

We need the following documents for all representatives

acting on behalf of and the contact person for the legal entity:

Completed Annexure B

Proof of authority (e.g. power of attorney)

Copy of South African bar-coded ID or valid

passport (if foreign national)

Completed 'Offshore application for legal entities' form

FICA documents as set out in Annexure A

Resolution signed by all authorised signatories

Proof of bank details (e.g. cancelled cheque or

bank statement)

SARB approval form (SA entities and SA trusts only)

OFFSHORE APPLICATION FOR LEGAL ENTITIES

https://www.allangray.co.za/what-we-offer/unit-trusts/

https://www.allangray.co.za/globalassets/documents-repository/product/brochures/Offshore/Files/Offshore%20Investment%20Platform%20Fund%20List.pdf

https://www.allangray.co.za/find-an-adviser/

https://www.allangray.co.za/globalassets/documents-repository/product/brochures/Offshore/Files/Offshore%20terms%20and%20conditions.pdf

www.allangray.co.za

1 of 8Offshore Application for Legal Entities

1. Please provide us with your details

Type of entity

Foreign company Foreign trust Other (specify)

Details of the legal entity

Registered name

Trading name

Registration number

Country of inception

VAT number

Registered address (head office)

Postal code

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

Details of the contact person

Title Surname

First name(s)

Nationality Telephone (w)

Mobile Fax

Email

2. 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

Confirm your offshore investor eligibility

If the legal entity is a “US Person”, please contact Allan Gray to determine the legal entity’s eligibility to invest offshore.

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

Reportable Account”, you may be required to submit further documents. For more information, please see www.allangray.co.za.

Allan Gray Proprietary Limited is an authorised financial services provider.

No. 1.0 April 2018

OFFSHORE APPLICATION FOR LEGAL ENTITIES

Allan Gray Investment Services Proprietary Limited (‘The Administrator’), an authorised administrative financial services provider, is the Administrator.

www.allangray.co.za


Would you like to pay your annual fi nancial adviser and/or administration fees from a money market unit trust?

If you are investing with the help of an independent � nancial adviser, you may choose to have your annual � nancial adviser fees

deducted from either the Allan Gray Money Market Fund (in rands), or from a foreign currency Money Market Unit Trust (in the

relevant currency). The same applies for your annual administration fees.

▪ If you choose to have these fees deducted from a foreign currency Money Market Unit Trust, please tick this box and complete

the unit trust details below:

Unit trust code Unit trust Currency

Ensure that you have allocated a portion of your investment to this unit trust in the table above.

▪ If you choose to have these fees deducted from the Allan Gray Money Market Fund, please tick this box and complete the details

of your money market investment below:

Investment amount (a minimum of R1 500 applies) R

My investment into the Allan Gray Money Market Fund for the purpose of paying fees will be via:

Electronic transfer (refer to Annexure C for our bank details)

A transfer from my Allan Gray Money Market Fund held in my existing local Allan Gray investment account

AGUT account AGLP account

The Allan Gray Money Market Fund is only available on the offshore platform for the purposes of paying these fees, not for general

investment. You do not need to add the Allan Gray Money Market Fund to your unit trust selection in the table above.

How would you like to invest your money?

You must allocate your lump sum into one or more unit trusts. Indicate the percentage per unit trust in the table below:

Unit trust code Unit trust Currency Percentage

%

%

%

%

%

%

%

%

%

%

Please ensure that the percentages allocated across funds add up to 100%.

3. How much would you like to invest?

▪ You must invest a lump sum of at least US$1 500 (or foreign currency equivalent).

▪ You must invest a minimum of US$400 (or foreign currency equivalent) per unit trust.

▪ You must invest a minimum of US$1 000 (or foreign currency equivalent) per unit trust denominated in Japanese yen.

Complete your total investment amount in transfer currency

US$ EUR AUD

GBP JPY ZAR

No. 1.0 April 2018

D D M M Y Y Y Y


4. 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)

5. How to pay us your lump sum

▪ It is your responsibility to transfer your money to the relevant bank account held at Citibank.

▪ Please use the legal entity’s name as a reference to enable the Administrator to identify your money and start processing your

investment. This is also required by international money laundering legislation.

▪ All bank accounts can be found in Annexure C of this application form. The Administrator (Allan Gray Investment Services) only

accepts GBP, US$, EUR, JPY and AUD deposits via bank transfer. Cheques are not accepted.

▪ Please note that routing costs will apply (after conversion) if a correspondent bank is used to make payment to Allan Gray.

Do you hold the currency of the unit trust you want to invest in?

▪ Electronic transfers should be made in favour of Beneficiary customer: Allan Gray Investment Services Client Subscription Account.

Do you hold foreign currency that is different to the unit trust you want to invest in?

▪ Instruct your bank to convert your money into the currency of the unit trust(s) you want to invest in and transfer it into the

relevant currency bank account(s) with the Administrator.

▪ Transfer your money in the currency you hold to the matching currency bank account with the Administrator. The Administrator

will convert your money to the correct currency, or split the money and convert it to the correct currencies if the unit trusts you

selected are not all offered in the same currency.

Do you hold South African rands?

▪ Use the services of an independent foreign exchange administrator (refer to section 6).

▪ Instruct your bank to convert your money into the currency of the unit trust(s) you want to invest in and then transfer it into the

relevant currency bank account(s) with the Administrator. The Administrator will convert your money to the correct currency, or

split the money and convert it to the correct currencies if the unit trusts you selected are not all offered in the same currency.

6. Incompass - Foreign exchange administration services

Allan Gray has negotiated with Incompass, an authorised financial services provider, to provide foreign exchange administration

services to you at preferential rates. By completing and signing this section of the form, you request Incompass to provide you with

foreign exchange administration services.

Do you want to make use of Incompass’s services? Yes No

Incompass will be in contact to provide all the necessary information pertaining to the foreign exchange transaction.

Who would you like Incompass to contact? Me My financial adviser

If you select ‘My financial adviser,’ please complete the independent financial adviser section at the end of this form in full.

Signature of investor Date

No. 1.0 April 2018

7. 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.

▪ Please refer to our ‘Tax guide’ at the end of this form if you need help understanding the terms used in sections 7 and 8.

▪ The South African Revenue Service (SARS) 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 Interest Withholding

Tax (IWT) on its behalf.

Please complete either section 7.1 or 7.2. The completed section determines your IWT rate.

7.1 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.

Tax Identification Number provided to you by SARS

If the legal entity is unable to provide a Tax Identification Number, please complete section 7.3 below.

7.2 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 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.

Country of residence for tax purposes

Effective date of tax residency

Tax Identification Number provided to you by your tax authority

If the legal entity is unable to provide a Tax Identification Number, please complete section 7.3 below.

7.3 If you are unable to provide a Tax Identification Number please provide us with a reason below

Where you are unable to provide a Tax Identification Number (TIN) or its Functional Equivalent (FE) , please tick one of the following

reasons:

Reason A: The legal entity has never registered for a TIN/FE with the tax authority

Reason 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

Reason 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)

Reason D: The country does not issue TINs/FEs to its tax residents (does not apply to South African or United States tax residents)

Reason E: I am unable to obtain the legal entity’s TIN/FE (please specify)

7.4 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 Tax Identification Number, or its Functional Equivalent, below.

▪ Please note that the countries listed below will not have an impact on the IWT rate applied to the legal entity’s investment.

▪ If the legal entity does not have a Tax Identification Number, please tick the reason (refer to section 7.3 above).

D D M M Y Y Y Y

Country Tax Identification Number (TIN) Reason for no TIN

A B C D E

A B C D E

A B C D E


No. 1.0 April 2018


9. Provide us with your bank account details

▪ Payments will be made in the currency of your unit trust. Please make sure that your bank account is able to accept multiple

currencies.

▪ We make all payments electronically to a bank account in the investor’s name. We will not make any payments to credit cards,

market-linked accounts or third party bank accounts.

Name of account holder

Name of bank

SWIFT code

IBAN/Account number

Type of account Current/Cheque Savings

Currency of account US$ GBP EUR ZAR JPY AUD

10. 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.

Your quarterly statements and other communications relating to your account may reflect the currency of your choice.

Please select currency US$ GBP EUR ZAR JPY AUD

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.

8. 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 8.1 or 8.2

to confirm the legal entity’s classification.

8.1. Is the legal entity a Financial Institution?

If the legal entity has registered as a Financial Institution with the US Internal Revenue Service (IRS) 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”

8.2. 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”

No. 1.0 April 2018

D D M M Y Y Y Y


11. Investor declaration

▪ 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 the Administrator regarding this application.

▪ I confirm that the Administrator may accept instructions from any authorised third party who has been authorised by me in writing.

▪ I confirm that the Administrator may accept instructions in the prescribed format by fax or via other electronic means.

▪ I have read and understood the Allan Gray Offshore Investment Platform fund list or the investment overview as well as the

relevant fund factsheet (minimum disclosure document) of the unit trusts I wish to invest in.

▪ I have read, understood and agree to the Terms and Conditions.

▪ I confirm that I will take responsibility for any tax requirements governed by my country of residence at the time of this investment.

▪ I confirm that I will take responsibility for, and have received, the necessary exchange control approvals and/or authorisations as may

be necessary to undertake this investment.

▪ I agree that my contractual relationship with the Administrator 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 through the Administrator is based on my own initiative and not

due to any offer or solicitation by the Administrator.

▪ I acknowledge that the Administrator may be required to submit the information provided in sections 2, 7 and 8 to SARS 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 Reporting Standard (‘CRS’).

▪ 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 Republic 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, 7 and 8 on this form and to

the best of my knowledge and belief it is true, correct, and complete.

▪ I undertake to inform the Administrator in writing if the circumstances referred to in the declaration above change.

Signature of representative (1) Signature of representative (2)

Date

If you have an independent financial adviser for this investment, please tick this box and complete the next section of this form.

No. 1.0 April 2018

D D M M Y Y Y Y


12. Complete this section if you have an independent financial adviser

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 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 . %

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%. No initialfees are applicable to unit transfers.

Annual . %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?

We will send you/your financial adviser confirmation that your transactions have been processed.

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.

We will send you/your financial adviser account statements and other communications.

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 Board (FSB), 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 FSB, 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 on your behalf via Allan Gray Online?

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.

13. 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 the Administrator 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 the Administrator will not be held liable for acting on any instructions submitted by my financial

adviser and I indemnify the Administrator 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 11.

Signature of representative (1) Signature of representative (2)

Date

No. 1.0 April 2018

D D M M Y Y Y Y


14. This section must be completed by your financial adviser

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 the

Administrator to cancel future fees.

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 the Administrator will not be held liable for acting on any instructions submitted by me, and I

indemnify the Administrator from all direct or indirect claims (including claims for consequential damages) in this regard.

▪ I understand the Administrator 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

No. 1.0 April 2018

Tax guideThe following definitions and explanations may help you complete the tax information sections of the form.

IWT

Term Definition Explanation

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 SARS by the company paying the dividend or by a regulated intermediary.

TIN or its

Functional

Equivalent

Tax Identification Number or the

number that functions as a TIN

The number that each jurisdiction issues to identify an organisation for tax

purposes. The Tax Identification Number could be called something different in

different countries.

Examples: ▪ SA: Income tax number issued by SARS.

▪ US: Employer Identification Number

▪ UK: National Insurance Number or Unique Taxpayer References.

FATCA and CRS


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.

CRS Common Reporting Standard The Common Reporting 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 Revenue

Service (IRS) 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 Reportable

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 Revenue 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 Rico

▪ An individual born in Guam

▪ An individual born in the US Virgin Islands

FATCA and CRS


US Person Defines which individuals and

organisations fall into the definition

“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 Revenue Code.

US

Reportable

Account

Financial account that falls in scope

by the FATCA legislation for reporting

to the IRS

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


Active Non-

Financial

Institution

A Non-Financial Institution that

operates in an active trade or business

other than that of a financial business

An Active Non-Financial Institution is an entity that primarily earns active income

(e.g. by trade or sales).

Deemed

Compliant

Financial

Institution

An Investment Entity that is exempt

from the FATCA requirements based

on the nature of the entity

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-

Reporting South African Financial Institutions that shall be treated as deemed-

compliant FInancial Institutions for purposes of section 1471 of the U.S. Internal

Revenue 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

Exempt

Beneficial

Owner

Entities that are exceptions to the

definition of Financial Institution

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 Reserve Bank

▪ Treaty-Qualified Retirement Fund

▪ Broad Participation Retirement Fund

▪ Narrow Participation Retirement Fund

▪ Pension Fund of an exempt beneficial owner

▪ Certain Investment Entities wholly-owned by one or more of the above

Entity classification


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

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 sotcks/foregin

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 IRS agreement

▪ Exempt Beneficial Owner - Entities that are excluded from the definition of

Financial Institution

GIIN Global Intermediary Identification

Number

The Inland Revenue Services (IRS) identification number issued to Participating Financial Institutions.

Non-

Financial

Institution

An entity that does not fit the

definition of a Financial Institution

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.

Non-

Participating

Financial

Institution

A Financial Institution that does not

enter into an agreement with the

IRS and is not deemed compliant or

excepted

This relates to Financial Institutions that are not in a Participating Jurisdiction.

Participating

Financial

Institution

Financial Institution that enters into an

agreement with the IRS to undertake

certain due diligence, withholding

and reporting requirements for US

account holders

A Participating Financial Institution will have been issued a Global Intermediary

Identification Number (GIIN).

Passive Non-

Financial

Institution

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

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

▪ IWT: http://www.sars.gov.za/

▪ FATCA: https://www.irs.gov/

▪ CRS: https://www.oecd.org/

Annexure ABefore 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 Registrar 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 Resolution 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 ▪ Registration Certificate CM1/CoR14.3 ▪ Where the company has changed its name we require the Certificate of Name Change CM9/CoR14.3 ▪ Notice of registered office and postal address stamped by the Registrar of Companies and signed by the company secretary CM22 / CoR21.1 ▪ 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 /

CoR21.1 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 ▪ Resolution of authorised signatories ▪ Identity documents for the authorised signatories ▪ Annexure B (attached to this application form) for authorised signatories

Retirement funds ▪ Registration certificate from the Registrar of Pension Funds (FSB) ▪ Approval certificate from the Commissioner of Inland Revenue (SARS) ▪ List of authorised signatories and specimen signatures ▪ Identity documents for the authorised signatories ▪ Board resolution

D D M M Y Y Y Y

D D M M Y Y Y Y

Annexure B: Related party details if you are a natural personThe Financial Intelligence Centre Act 38 of 2001 requires accountable institutions to verify the identity of its clients and the South

African Revenue Service (SARS) 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 Member

Partner Authorised representative

Persons exercising executive control Person holding 25% or more of the voting rights

Trustee, beneficiary and/or founder of trust

Details of the related party

Title Surname

First name(s)

Date of birth

Country of birth

ID number (passport number if foreign national)

Email

Mobile Telephone (h)

Fax Telephone (w)

Residential address

Postal code

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

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).

▪ Reason A: I have never registered for a TIN/FE with my tax authority

▪ Reason B: I do not know my TIN/FE, but I will take steps to get this and submit it to Allan Gray

▪ Reason C: My tax authority does not require me to provide a TIN/FE (does not apply to South African or United States tax residents)

▪ Reason D: My country does not issue TINs/FEs to its tax residents (does not apply to South African or United States tax residents)

▪ Reason E: I am unable to obtain a TIN/FE

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

A B C D E

A B C D E

A B C D E


D D M M Y Y Y Y

Annexure B: Related party details if you are a legal entityThe Financial Intelligence Centre Act 38 of 2001 requires accountable institutions to verify the identity of its clients and the South

African Revenue Service (SARS) requires all financial service providers to collect various tax information from their clients.

Details of the related party

Capacity

Registered name

Date of inception Country of inception

Registration number

Email

Telephone (w) Fax

Registered address (Head office)

Postal code

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

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).

▪ Reason A: The legal entity has never registered for a TIN/FE with the tax authority

▪ Reason 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

▪ Reason 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)

▪ Reason D: The country does not issue TINs/FEs to its tax residents (does not apply to South African or United States tax residents)

▪ Reason E: I am unable to obtain the legal entity’s TIN/FE

A B C D E

A B C D E

A B C D E

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

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