Fillable PENSION/PROVIDENT PRESERVATION FUND APPLICATION (Law for All South Africa)

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PENSION/PROVIDENT PRESERVATION FUND APPLICATION (Law for All South Africa)

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(Contact us if you need help:
Call 0860 000 654 between 07:30 - 17:30 (Mon - Fri) or Email: info@allangray.co.za
Make an informed decision:
▪ Read our Product Range brochure to make sure you have chosen the right product to suit your needs.
▪ Refer to the fund factsheets (minimum disclosure documents) and the Allan Gray Local Investment Platform Fund
List for information on the unit trusts we offer. Certain unit trusts are subject to availability.
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 independent financial adviser’ section of
our website.
▪ Once you are a member of the preservation fund, you may only make one withdrawal, of 100% or less per
investment account, before retirement. You will not be able to make a withdrawal if you have previously taken
a withdrawal or where there are withdrawal restrictions imposed by the transferring fund. If you transferred to a
preservation fund from a pension or provident fund on leaving employment (after retirement age of your scheme),
you will not be entitiled to a withdrawal in respect of the transferred amount (including growth).
▪ Your unit trust selection must comply with Regulation 28 of the Pension Funds Act that limits the maximum
exposure you may have to various asset classes, for example: 75% in equities, 25% in property and 30% in foreign
assets (with an additional 10% in African assets).
▪ To check whether your selection complies, you can use the Regulation 28 calculator on our website, or contact
your financial adviser or our Client Service Centre.
▪ 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 the Conditions of Membership to understand the rules of your investment.
▪ You will need an investment overview to complete this form. This is available from your financial adviser or our
Client Service Centre.
You may need to complete additional forms, depending on the specifics of your investment:
▪ Are you representing the investor? Complete the 'Acting on behalf of the investor' form.
▪ Would you like to phase in your investment? Complete the 'Phase-instruction' form.
Send us the documents listed below:
Email: instructions@allangray.co.za or Fax: 0860 000 655 or +27 (0)21 415 2492
Completed 'Pension/Provident Preservation Fund application' form
Copy of your South African bar-coded ID, valid passport (if a foreign national) or birth certificate (if minor)
Where a unit transfer is required, please provide a recent statement of your investment
Any related instructions (e.g. 'Acting on behalf of the investor' form) and relevant supporting documents.
In certain instances we may contact you requesting additional documents
The relevant Allan Gray bank account details are as follows:
Account name: Allan Gray Pension Preservation Fund
Bank: First National Bank
Branch code: 20-41-09
Account type: Current
Account number: 620 463 424 08
Reference number: 13 digit SA ID number (South African residents)/passport number (if a foreign national)
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 completed documents and the money reflects in
the Allan Gray Pension/Provident Preservation Fund bank account.
▪ 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 1
COMPLETE THE FORM &
AGREE TO CONDITIONS
OF MEMBERSHIP
STEP 2
SEND DOCUMENTS
BANK ACCOUNT
DETAILS
CUT-OFF TIMES
WHAT HAPPENS
NEXT?
Allan Gray Provident Preservation Fund
First National Bank
20-41-09
Current
620 463 428 96
PENSION/PROVIDENT PRESERVATION FUND APPLICATION
D D M M Y Y Y Y
1 of 8Pension/Provident Preservation Fund application
1. Please provide us with your details
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 residential address, please tick this box
Postal code
Are you a foreign prominent public official or a domestic prominent influential person? Yes No
If yes, please specify
2. How much are you transferring?
You must invest a lump sum of at least R50 000.
Estimated transfer amount R
How would you like to invest your money?
You must allocate your lump sum into one or more unit trusts. Indicate the rand amount/percentage per unit trust in the table
below:
Unit trust Unit trust class Amount Percentage
R or %
R or %
R or %
R or %
R or %
R or %
R or %
R or %
R or %
R or %
Please ensure that the amounts or percentages allocated across unit trusts add up to your total lump sum amount, or to 100%.
Allan Gray Proprietary Limited is an authorised financial services provider.
No. 1.0 September 2020
PENSION/PROVIDENT PRESERVATION FUND APPLICATION
The Allan Gray Pension Preservation Fund’s registration number is 12/8/0037184/R and the tax approval number is 18/20/4/41344. The Allan Gray
Provident Preservation Fund’s registration number is 12/8/0037185/R and the tax approval number is 18/20/4/41565. Allan Gray Investment Services
Proprietary Limited, an approved fund administrator and authorised administrative financial services provider, is the Administrator.
D D M M Y Y Y Y
2 of 8Pension/Provident Preservation Fund application
3. Provide us with the transfer details
If this is a unit transfer, please tick the box (Unit transfers are subject to the rules of the transferring fund/insurer.)
Where does the transfer come from?
Transfer from another pension or provident preservation fund
Transfer due to a divorce order
Transfer from an employer pension/provident fund
Please complete last date of employment (if transfer is due to termination of employment, merger or takeover)
Please complete the transferring fund’s details below:
Transferring fund details 1
Estimated transfer amount: R
Registered name
FSCA registration number
Policy number
Contact telephone number
Have you reached retirement age as stipulated by your transferring fund? Yes No
This transfer is to be a member of the Allan Gray Pension Preservation Fund or Allan Gray Provident Preservation Fund
Transferring fund details 2
Estimated transfer amount: R
Registered name
FSCA registration number
Policy number
Contact telephone number
Have you reached retirement age as stipulated by your transferring fund? Yes No
This transfer is to be a member of the Allan Gray Pension Preservation Fund or Allan Gray Provident Preservation Fund
4. Please provide us with your tax information
▪ This section applies to all investors whether you are registered for tax or not.
▪ The South African Revenue Service (SARS) requires all financial services providers to collect tax information from their clients.
▪ If you are an existing investor and have additional tax information that you are required to disclose in order to meet FATCA or CRS
legislative requirements, please complete the ‘Change in tax details for individual investors’ form.
▪ Please refer to our ‘Tax guide’ at the end of this form if you need help understanding the terms used in this section.
4.1 If you are a South African resident for tax purposes, please tick the box below
I declare that I am a resident for tax purposes in South Africa.
Tax identification number (TIN) provided to you by SARS
Would you like to pay your annual fees from the Allan Gray Money Market Fund?
You may choose to have your annual administration fees and annual financial adviser fees (if applicable) paid from the Allan Gray
Money Market Fund. If you choose to do so, please ensure that you have allocated a portion of your investment to the Allan Gray
Money Market Fund. If no option is selected, fees will be deducted from your selection of unit trusts.
If you would like to pay your annual fees from the Allan Gray Money Market Fund, please tick this box.
No. 1.0 September 2020
3 of 8Pension/Provident Preservation Fund application
4.2 If you are a non-South African resident for tax purposes, please tick the box below
I declare that I am not a resident for tax purposes in South Africa.
Country of residence for tax purposes
TIN or its functional equivalent (FE) provided to you by your tax authority
Although not a tax resident in South Africa, are you registered for tax in South Africa? Yes No
If yes, please provide your TIN provided to you by SARS
5. Your family circle and nominees
If you die before you retire from the Allan Gray Pension/Provident Preservation Fund (the Fund), the trustees of the Fund are
responsible for allocating your benefits in terms of Section 37C of the Pension Funds Act (the Act). According to the Act, the
trustees must perform the following three duties:
1. Identify and find all of your dependants. Section 1 of the Act defines dependants as spouses, children, anyone proven to have
been financially dependent on you at the time of your death, anyone entitled to maintenance, as well as anyone who may in
future have become financially dependent on you.
2. Decide how to divide the benefit based on the outcome of their investigations. The individuals that you have asked the
trustees to consider when they allocate the benefit (your nominees) will also be taken into account.
3. Decide on how the benefit will be paid to your dependants and/or nominees.
For more information on how death benefits must be dealt with by the trustees, please refer to ‘Understanding the death claims
process of retirement funds’, which is available on our website.
▪ Please complete the details of all spouses, life partners, children and individuals that are financially dependent on you.
▪ For each individual, please indicate whether you want to nominate them and, if so, the benefit percentage.
▪ Please specify any other individuals, legal entities or trusts you want to nominate.
▪ The total of percentages across all your nominations must add up to 100%.
▪ If you are already a member of the Fund, this nomination will apply to all your investment accounts in the Fund. If you do not
make a nomination, your existing nomination will apply.
▪ Only you can make nominations. If this application form is signed by anyone else other than you, these nominations will not be valid.
D D M M Y Y Y Y
D D M M Y Y Y Y
This nomination will apply to the:
Allan Gray Pension Preservation Fund and/or Allan Gray Provident Preservation Fund
Spouses (current and previous) and life partners (current)
Please provide the details of your spouse or partner. If you have more than two spouses or life partners, please attach a signed copy
of this section to the application form.
Title Surname
First name(s)
ID number (passport number if foreign national)
Date of birth Telephone number
Relationship
I nominate this individual Yes No Benefit %
Title Surname
First name(s)
ID number (passport number if foreign national)
Date of birth Telephone number
Relationship
I nominate this individual Yes No Benefit %
No. 1.0 September 2020
4 of 8Pension/Provident Preservation Fund application
Children
Please provide the details of all your children irrespective of their age (include adopted children and children born out of wedlock,
but exclude stepchildren). If you have more children, please attach a signed copy of this section to the application form.
Title Surname
First name(s)
ID number/birth certificate number (passport number if foreign national)
Date of birth Telephone number
I nominate this individual Yes No Benefit %
Title Surname
First name(s)
ID number/birth certificate number (passport number if foreign national)
Date of birth Telephone number
I nominate this individual Yes No Benefit %
Title Surname
First name(s)
ID number/birth certificate number (passport number if foreign national)
Date of birth Telephone number
I nominate this individual Yes No Benefit %
Title Surname
First name(s)
ID number/birth certificate number (passport number if foreign national)
Date of birth Telephone number
I nominate this individual Yes No Benefit %
Other individuals whom you support financially
Please provide the details of anyone else whom you support financially. This may include for example your stepchildren, parents,
grandparents, brothers or sisters. If there are more individuals who you support financially, please attach a signed copy of this
section to the application form.
Title Surname
First name(s)
ID number (passport number if foreign national)
Date of birth Telephone number
Relationship
I nominate this individual Yes No Benefit %
Title Surname
First name(s)
ID number (passport number if foreign national)
Date of birth Telephone number
Relationship
I nominate this individual Yes No Benefit %
D D M M Y Y Y Y
D D M M Y Y Y Y
D D M M Y Y Y Y
No. 1.0 September 2020
5 of 8Pension/Provident Preservation Fund application
D D M M Y Y Y Y
Other individuals, legal entities or trusts you would like to nominate
If you want to nominate other individuals, legal entities or trusts not mentioned previously, please complete the details below. If
you want to nominate more nominees, please attach a signed copy of this section to the application form.
Individual
Title Surname
First name(s)
ID number (passport number if foreign national)
Date of birth Telephone number
Relationship
Benefit %
Legal entity or trust
Name of legal entity or trust
Registration or Master’s reference number
Contact person
Telephone number
Benefit %
6. 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.
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.
No. 1.0 September 2020
6 of 8Pension/Provident Preservation Fund application
D D M M Y Y Y Y
7. 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 have not received advice from the Administrator regarding this application.
▪ I confirm that the Administrator may accept instructions from any 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 investment overview. The version number is compulsory for the application to be processed. This
is available from your financial adviser or our Client Service Centre. Investment overview version number:
▪ I have read, understood and agree to the Conditions of Membership.
▪ 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 and consent to the Administrator sharing my tax information provided in section 4 with any other entity in the
Allan Gray group with whom I may have an investment account or product so that the entity can report my tax information to
SARS, where required. My most recent tax declaration will replace all previous declarations made.
▪ I acknowledge that SARS may share my tax information 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 undertake to inform the Administrator in writing if the circumstances referred to in the declaration above change.
▪ Under penalties of perjury, I declare that I have examined the tax information completed in section 4 on this form and to the best
of my knowledge and belief it is true, correct, and complete.
Signature of investor 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 September 2020
D D M M Y Y Y Y
7 of 8Pension/Provident Preservation Fund application
8. 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’s assistant dealing with this transaction
What negotiable fees must be paid to your financial adviser for this investment?
I agree to 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%.
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?
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.
Who should we send your account 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 services 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 Sector Conduct Authority (‘FSCA’), 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 FSCA, 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) on your behalf via Allan Gray Online?
Yes No
9. 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 Conditions
of Membership 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 7.
Signature of investor Date
No. 1.0 September 2020
D D M M Y Y Y Y
8 of 8Pension/Provident Preservation Fund application
10. 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 that 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 September 2020
Tax guide
The following definitions and explanations may help you complete the tax information sections of the form.
DWT/IWT
Term Definition Explanation
DWT Dividend withholding tax DWT is a tax imposed on shareholders on receipt of dividends. DWT 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.
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 FE Tax identification number (TIN) or
its functional equivalent (FE) i.e. the
number that functions as a TIN
The number that each jurisdiction issues to identify an individual for tax purposes.
The TIN could be called something different (FE) in different countries.
Examples:
▪ SA: Income tax number issued by SARS.
▪ US: For an individual this would be their US Social Security number.
▪ UK: National Insurance number or Unique Taxpayer Reference.
FATCA and CRS
Term Definition Explanation
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 Accounts 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.
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
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.
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.
If you need more information, please visit the following websites
▪ DWT/IWT: http://www.sars.gov.za/
▪ FATCA: https://www.irs.gov/
▪ CRS: https://www.oecd.org/
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PENSIONPROVIDENT PRESERVATION FUND APPLICATION (Law for All South Africa)

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