D D M M Y Y Y Y
1 of 1Allan Gray Online (AGO) Application
▪ Complete this form to register for a Allan Gray Online (AGO) account.
▪ This form only applies if you are requesting online access for an existing investment account.
▪ Please read the Terms and Conditions as they may have changed since your original investment.
Send the following documents to: Email instructions@allangray.co.za or Fax 0860 000 655 or +27 (0)21 415 2492
Completed Online account application
Completed the ‘Acting on behalf of investor’ form, if you are representing the investor (if not previously
provided).
In certain instances we may contact you requesting additional documents.
1. Please provide us with your details
Full name and surname/Entity name
ID number (passport number if foreign national)/Registration number
Email (compulsory)
Mobile (compulsory) Telephone (h)
Fax Telephone (w)
Residential address
Postal code
Postal address
Postal code
2. Would you like to access a third party’s online account?
▪ If you require access to someone else’s investment or adviser information please provide the investor number(s) or IFA code(s) you
would like to access.
▪ Send the relevant completed ‘Online authorisation’ form signed by the investor or adviser together with this form.
Investor number/IFA code Investor number/IFA code
Investor number/IFA code Investor number/IFA code
3. Declaration
▪ I have read, understood and agree to the Terms and Conditions that govern the use of the secure section of the Allan Gray
website.
▪ I authorise Allan Gray to accept instructions submitted via the secure section of the Allan Gray website and waive any claim that
I may have against Allan Gray. I indemnify Allan Gray against any loss incurred as a result of Allan Gray receiving and/or acting
upon such instruction.
Signature of User Date
Allan Gray Proprietary Limited is an authorised financial services provider.
Important
information
Send
documents
ALLAN GRAY ONLINE APPLICATION
No. 1.0 March 2019
