Fillable SYGNIA DIRECT INVESTMENT APPLICATION FORM

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SYGNIA DIRECT INVESTMENT APPLICATION FORM

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SYGNIA FINANCIA
L SERVICES (PTY) LTD REGISTRATION NO. //
CAPE TOWN: 7th Floor I The Foundry I Cardiff Street I Green Point I 8001 I T +27 21 446 4940 I F +27 86 680 8045
JOHANNESBURG: Unit 40 I 6th Floor I Katherine & West Building I West Street I Sandton I 2196 | T +27 10 595 0550 I F +27 86 206 5173
DURBAN: Office 2 | 2nd Floor | Ridgeview | 1 Nokwe Avenue | Ridgeside | Umhlanga Ridge | 4319 | T +27 31 001 0650 | F +27 86 206 4421
info@sygnia.co.za | www.sygnia.co.za
Sygnia Financial Services (Pty) Ltd is a licensed Financial Services Provider [FSP 44426]
NOTE: If you are completing this form online, please save the form to your computer prior to completing any details to ensure a copy is kept
for your records.
DOCUMENT CHECKLIST
South African bar-coded ID, valid passport (if foreign national) or birth certificate (if minor)
Proof of residential address less than 3 months old (Refer to Annexure A for examples)
Proof of banking details (e.g. bank statement or cancelled cheque)
Proof of deposit/transfer in to the relevant Sygnia bank account
If a unit transfer is required, please provide a recent statement of your current investment
FOR THE AUTHORISED REPRESENTATIVE
South African bar-coded ID or valid passport (if foreign national)
Proof of residential address less than 3 months old (Refer to Annexure A for examples)
Proof of authority to act (e.g. power of attorney)
INVESTOR DETAILS
Title: First name(s): Surname:
ID or Passport number (if foreign national): Passport country:
Date of birth: Country of birth:
South African resident:
Yes
No Occupation:
Is your postal address the same as your residential address:
Yes
No
Residential address:
Code:
Postal address:
Code:
Home telephone number: ( ) Work telephone number: ( )
Cellphone number: Fax number: ( )
Email:
SYGNIA DIRECT INVESTMENT
APPLICATION FORM
NATURAL PERSONS
• No instruction will be processed unless all requirements have
been met, all relevant documentation received and the funds
reflected in Sygnia’s bank account.
• The daily cut-off for receipt of instructions is 14:00.
• For full information on turnaround times please refer to the
Sygnia Terms and Information document.
• Completed forms and required documentation must be faxed to
0866 808 045 or emailed to instructions@sfs.sygnia.co.za.
• Please read the Terms and Information document applicable to this
investment. This is available from your financial advisor, the Sygnia
Client Service Centre or www.sygnia.co.za.
• Should you have any queries regarding this application, please
contact your financial advisor, or alternatively the Sygnia Client
Service Centre on 0860 794 642 (0860 SYGNIA)
COMMUNICATION PREFERENCE
Please select only one of the following communication methods. If no selection is made, or if both are selected, communication will be
made via email.
Communication method:
Post
Email
If you have a financial advisor, you may choose to have your communication sent to you, your financial advisor or to both.
Send communications to:
Me
My financial advisor
both
If no selection is made we will send communication to you only.
Please keep me informed of the latest news, exclusive Sygnia Investor events and any additional products or services on offer via my chosen
communication method above:
Yes
No
MANAGE AND VIEW YOUR INVESTMENT ON THE SYGNIA ONLINE PLATFORM:
Once your funds have been invested and unitised, you will be able to register on the Sygnia Alchemy Online Platform:
https://online.sygnia.com/Account/Login to view your personal and investment details.
Within 5 business days of your investment being finalised, you will receive your log on details and Sygnia Welcome Pack.
In order to grant you access to the platform and before registration can take place, an authentic email address will be required.
INVESTOR TAXATION DETAILS - REQUIRED SECTION
IMPORTANT NOTE: This section is required for all investors, whether you are registered for tax or not.
Are you a registered South African tax payer:
Yes
No
TAX RESIDENCY SELF-DECLARATION
In terms of the Tax Administration Act we are required to collect information about each investor’s tax residency, including the related tax
reference numbers.
If you are a resident for tax in any country other than South Africa, certain information is required to be reported to SARS, who may in turn
share this information with any or all participating tax jurisdictions. This is to ensure correct reporting as required by the US tax authorities
in terms of the Foreign Tax Compliance Act (FATCA) and the Organisation for Economic Cooperation and Development (OECD) Common
Reporting Standard for Automatic Exchange of Financial Account Information (CRS).
Please indicate all countries (including South Africa) in which are a resident for tax purposes, and the associated tax reference number in
the table below. Tax residence refers to the country in which you pay tax on your income.
Country of Tax residence:
Tax reference number/TIN*
Country of Tax residence: Tax reference number/TIN*
Country of Tax residence: Tax reference number/TIN*
Country of Tax residence: Tax reference number/TIN*
*TIN refers to the US Tax Identification Number
If you do not have a tax reference number/TIN, please select on of the following reasons:
The country/jurisdiction does not issue tax reference numbers/TINs to its residents (does not apply to South Africa or United States)
The investor is not required to be registered for tax (even though income tax is levied by the jurisdiction)
A tax reference number is not required to be reported by such jurisdiction under local law (does not apply to South Africa or United States)
DIVIDEND WITHOLDING TAX
Please select one of the following:
I am a South African taxpayer. I understand that I will be subject to a Dividend Witholding Tax of 20% on all local dividends and Interest
Witholding Tax will not apply. I also understand that distributions from Real Estate Investment Trusts constitute income that needs to be
declared in my annual tax return as Sygnia will not withold tax on my behalf.
I am a non-South African taxpayer. I understand that I will be subject to the standard 20% Dividends Witholding Tax on local dividends and
the default 15% Interest Witholding Tax on local interest. I also understand that distributions from Real Estate Investment Trusts are
exempt from South African income tax but will be subject to Dividend Witholding Tax.
If you qualify for dividend tax exemption in terms of section 64F of the Income Tax Act, please complete the “Dividend Tax Declaration
and Undertaking for Exemption” form available on www.sygnia.co.za, or from your Financial Advisor. Failure to do so will result
in dividends tax being witheld.
DETAILS OF PERSON ACTING ON BEHALF OF INVESTOR
* Capacity:
(* e.g. Guardians/Persons with Power of Attorney or mandate acting on behalf of investor.)
Title:
First name(s): Surname:
Occupation:
ID or Passport number (if foreign national): Passport country:
Residential address:
Code:
Postal address:
Code:
Home telephone number: ( ) Work telephone number: ( )
Cellphone number: Fax number: ( )
Email:
ANNUAL ADMINISTRATION FEE
The following administration fee applies depending on the investment funds that you have chosen:
SYGNIA INVESTMENTS ANNUAL ADMINISTRATION FEE (EXCL VAT)
VALUE OF ALL ACCOUNTS
SYGNIA
UNIT TRUSTS
SYGNIA
ETFS
EXTERNAL UNIT TRUSTS
AND ETFS
First R2 000 000 0.00% 0.20% 0.40%*
Over R2 000 000 0.00% 0.10% 0.20%**
* 0.40% (excl VAT) is levied on the proportionate value of the external-manager funds below R2 million.
** 0.20% (excl VAT) is levied on the proportionate value of the external-manager funds above R2 million.
Please note: While Sygnia does not charge any administration fees in respect of its own funds, we consider all your investments when assessing the
R2 million threshold, including your investments in Sygnia funds. For fees relating to the underlying investment managers, please refer to the Sygnia Alchemy
Funds document available on request, or online at www.sygnia.co.za.
INVESTMENT DETAILS
SOURCE OF FUNDS (COMPULSORY)
This information is required by legislation and Sygnia in order to invest your funds.
Existing Sygnia account
Bonus
Savings
Inheritance
Salary
Transfer from another financial services provider
Other
If other, please specify:
NOTE: Sygnia Financial Services (Pty) Ltd reserves the right to request proof of source of funds.
LUMP SUM CONTRIBUTION - MINIMUM R  (MINIMUM OF R IF INVESTED INTO THE SYGNIA MONEY MARKET CLASS S OR
S)
Will this be a unit transfer:
Yes
No
Rands:
Cents: Date of deposit/transfer: / /
Electronic/Internet transfer (EFT): Electronic/Internet transfers may take up to 2 days to reflect in the Sygnia Bank
account. Sygnia Financial Services (Pty) Ltd requires proof of transfer or deposit
before this application can be processed.
Electronic collection by Sygnia: This is a once-off direct debit from your bank account and is restricted to R1 000 000 per day.
Units bought with a direct debit can only be withdrawn after 32 business days.
Electronic collection to be collected from:
Investor’s bank account
Third party bank account
FUND SELECTION:
NOTE: Only unit trust funds, ETFs and ETNs may be selected in respect of this product.
FUNDS CLASS RAND AMOUNT PERCENTAGE
R
OR
%
R
OR %
R
OR %
R OR %
R
OR %
R
OR %
R
OR %
R
OR %
R
OR %
R
OR %
R
OR %
TOTAL R
TOTAL
1 0 0
%
PHASING-IN
You may phase in your lump sum contribution. The amount to be phased in must be R100 000 or more.
Do you require a phase-in:
Yes
No
If yes:
over 3 months
over 6 months
over 12 months
Default Phase-in Money Market Fund: The investment will be phased-in from the Sygnia Money Market Fund Class A.
DEBIT ORDER INVESTMENT: Minimum R500 per month. Of this amount, the minimum investment amount in any ETF must be R250.
Rands:
Cents: per month
Escalation rate per annum:
0%
5%
10%
15%
Commencement month:
Collection date:
1
st
15
th
Debit order to be collected from:
Investor’s bank account
Third party bank account
FUND SELECTION:
NOTE: Only unit trust funds, ETFs and ETNs may be selected in respect of this product.
FUNDS CLASS RAND AMOUNT PERCENTAGE
R
OR
%
R
OR %
R
OR %
R OR %
R
OR %
R
OR %
R
OR %
R
OR %
R
OR %
R
OR %
R
OR %
TOTAL R
TOTAL
1 0 0
%
REGULAR WITHDRAWAL DETAILS
Regular withdrawal amount: Rands: Cents: Commencement month:
Regular withdrawal frequency:
Monthly in arrears
Quarterly in advance
Bi-annually in advance
Annually in advance
You may only schedule a regular withdrawal payment if you have more than R20 000 in your account.
Regular withdrawal payments are scheduled for the 25
th
of each month. Sygnia must receive the instruction 5 business days before the
scheduled payment date to be effective. If not, the first withdrawal will take place the following month.
FUND SELECTION FROM WHICH TO DEDUCT REGULAR WITHDRAWAL
Select one of the following options:
Regular withdrawal is withdrawn proportionately across all investments.
OR
Regular withdrawal is withdrawn from the specific fund/s selected below.
NOTE: If at any stage there is an insufficient balance available in the selected fund/s, the withdrawal will be made proportionately from the
other available funds.
Only unit trust funds, ETFs and ETNs may be selected in respect of this product.
FUNDS CLASS RAND AMOUNT PERCENTAGE
R
OR
%
R
OR %
R
OR %
R OR %
R
OR %
R
OR %
R
OR %
R
OR %
R
OR %
R
OR %
R
OR %
TOTAL R
TOTAL
1 0 0
%
INVESTOR BANKING DETAILS
The details specified below must be in the investor’s name and will be used for all future banking transactions. Should any changes occur,
the investor must notify Sygnia in writing.
Bank:
Account number:
Branch: Branch code:
Type of account:
Current
Transmission
Savings
Name of account holder:
A recent bank statement must accompany this application form as confirmation of proof of bank details. No payments will be made to third
parties (i.e. payments will only be made to the bank account in the name of the registered investor). Payments to credit cards or market-linked
accounts are not permitted. The Administrator executes all payment instructions electronically to a South African bank account in the name
of the investor. No payment will be made by cheque.
THIRD PARTY BANKING DETAILS
This section must be completed where a third party makes payment on behalf of the investor. In the event that the payment is a debit order/
electronic collection the third party must provide Sygnia with authorisation by signing below.
Bank:
Account number:
Branch: Branch code:
Type of account:
Current
Transmission
Savings
Name of account holder:
A recent bank statement must accompany this application form as confirmation of proof of bank details. No payments will be made to third
parties (i.e. payments will only be made to the bank account in the name of the registered investor). Payments to credit cards or market-linked
accounts are not permitted. The Administrator executes all payment instructions electronically to a South African bank account in the name
of the investor. No payment will be made by cheque.
Signed at:
on this day of year
Signature of third party:
SYGNIA BANK ACCOUNT DETAILS
Account holder: Sygnia Financial Services Inflow Account
Bank: Nedbank
Branch name: Corporate Client Services Cape Town
Branch code: 198765
Account number: 1032 604 158
Reference number: Initial and surname together with Sygnia Client Code / South African ID number / Passport number (if foreign national)
The Administrator requires proof of deposit or transfer together with receipt of the applicable documentation as set out in this form, before
this application can be processed.
FINANCIAL SERVICES PROVIDER DETAILS
Financial advisor full name and surname:
Financial Service Provider (FSP) name:
FSP registration number:
FSP code:
INVESTOR DECLARATION (ONLY APPLICABLE WHERE AN FSP HOLDS A CATEGORY II DISCRETIONARY LICENCE)
I/We confirm that:
• I/We have entered into a mandate with the FSP
Yes
No
• The mandate gives the FSP discretion to act on my/your behalf
Full
Limited
NOTE: A copy of the signed mandate must accompany this application form.
Signature of investor:
FSP DECLARATION
I/We
• declare that I/we am/are a licensed Financial Service Provider(s) and have made the disclosures required in terms of the Financial Advisory and
Intermediary Services Act, No. 37 of 2002, and subordinate legislation thereto, to the investor.
• warrant what I/we have established and verified the identity of the investor(s) (and persons acting on behalf of the investor) in accordance
with the Financial Intelligence Centre Act, No. 38 of 2001 (“FICA”) and subordinate legislation thereto, and I/we will keep records of such
identification and verification according to the provisions of FICA.
• are not aware of any activities in which the investor is involved which may lead us to suspect or reasonably suspect that the investor is or
may be involved in any unlawful activities or money laundering. Should we subsequently become aware of suspicions of this nature, we shall
immediately inform Sygnia Financial Services (Pty) Ltd.
Signed at:
on this day of year
Signature of financial advisor:
FINANCIAL ADVICE FEES
I hereby confirm that the Financial Advisor whose details are completed in the “Financial Services Advisor Details” section above, is my
appointed Financial Advisor and agree to payment of fees as follows:
Initial advice fee:
% excluding VAT (Negotiable to maximum 3% exclusive of VAT. Applied to each lump sum contribution and
(Lump sum) deducted before investment is made).
Initial advice fee: % excluding VAT (Negotiable to maximum 3% exclusive of VAT. Applied to each debit order contribution and
(Debit order) deducted before investment is made).
Annual advice fee: % excluding VAT (Negotiable to a maximum of 1%) per annum of the market value of the investment portfolio,
charged by way of unit reduction and paid to the Financial Advisor monthly in arrears (If an initial fee in excess
of 1.50% has been deducted the annual fee is limited to 0.50% per annum.) This authority may be withdrawn
by written notice to the Fund.
PROMINENT INFLUENTIAL PERSON DECLARATION - REQUIRED SECTION
In terms of Financial Intelligence Centre Act (FICA), Sygnia Financial Services (Pty) Ltd is an accountable institution and is required to establish
the risk profile of its investors. This includes determining whether an investor is a prominent influential person.
Please refer to Annexure B for the definition of a Prominent Influential Person.
By taking the definition of a Prominent Influential Person in Annexure B into consideration, please answer the following question:
Are you regarded as a Prominent Influential Person?
Yes
No
DECLARATION BY INVESTOR
• I/We acknowledge, understand and accept the Sygnia Terms and Information document.
• I/We consent to Sygnia processing my/our personal information as described in the Sygnia Terms and Information document. I/We further
confirm that the information provided by me/us is true and correct and undertake to notify Sygnia should any of the information change.
• I/We acknowledge, understand and accept that Sygnia may use the information I/we have provided in this form for either of the following
purposes:
› to effectively process my/our transactions;
› to detect and prevent fraud;
› to comply with auditing and record-keeping requirements;
› to comply with legal and regulatory requirements;
› to verify my/our identity;
› to share information with service providers with whom Sygnia has a business agreement to process such information on Sygnia’s behalf
or to those who render services to Sygnia.
• I/we acknowledge and understand that I/we may access the personal information Sygnia have on record and that I/we may request that
Sygnia correct any errors or delete my/our information.
• I/we acknowledge and understand that I/we can view Sygnia’s full privacy policy on Sygnia’s website on www.sygnia.co.za.
• I/we confirm that I/we was/were provided with the Minimum Disclosure Document prior to transacting.
• I/We hereby instruct and authorise Sygnia or its assignees to draw against my account the lump sum electronic collection or debit order
instruction, if applicable, from the bank account noted in this form (or any other bank or branch to which I may transfer my account).
• I/We hereby confirm that the Financial Advisor whose details are completed in the “Financial Advisor Details” section above, is my
appointed Financial Advisor and agree to payment of fees per the “Financial Advisor Fees” section above.
Signed at:
on this day of year
Signature of investor:
ANNEXURE A: EXAMPLES OF
DOCUMENTATION WE ACCEPT AS
PROOF OF ADDRESS
Before Sygnia can enter into a transaction or a business relationship, the Financial Intelligence Centre Act 38 of 2001, and the regulations
thereto, require that the identity of a client be established and verified. Sygnia may only place an investor’s investments, or conclude a contract
with a financial advisor, once all the required FICA documentation has been received.
THE FOLLOWING FICA DOCUMENTATION IS REQUIRED:
• A copy of your South African bar-coded ID, valid passport (if foreign national) or birth certificate (if minor)
• Proof of your residential address which must be less than 3 months old:
THE LIST BELOW PROVIDES GUIDANCE OF WHAT DOCUMENTATION WILL BE ACCEPTED AS PROOF OF RESIDENTIAL ADDRESS IN YOUR
NAME:
• Utility bill reflecting the name and residential address of the person (not older than 3 months);
• Municipal rates and taxes invoice reflecting the name and residential address of the person (not older than 3 months);
• Telephone or cellular account reflecting the name and residential address of the person (not older than 3 months);
• A recent income tax return reflecting the name and residential address of the person;
• Bank statement reflecting the name and residential address of the person if the person previously transacted with a bank registered in
terms of the Banks Act (not older than 3 months);
• Recent lease or rental agreement reflecting the name and residential address of the person;
• Mortgage statement reflecting the name and residential address of the person (not older than 3 months);
• Valid television licence reflecting the name and residential address of the person;
• Recent long-term or short-term insurance policy document issued by an insurance company and reflecting the name and residential
address of the person;
• Recent motor vehicle license documentation reflecting the name and residential address of the person;
• A statement of account issued by a retail store that reflects the residential address of the person (not older than 3 months); or
• A recent tax invoice issued by a regulatory body (e.g. SAICA) that reflects the residential address of the person.
IF YOU DO NOT HAVE PROOF OF RESIDENTIAL ADDRESS IN YOUR OWN NAME THE FOLLOWING WILL BE ACCEPTED:
• Utility bill or any other acceptable proof of residence in your spouse’s, partner’s or parent’s name;
• A copy of your spouse’s, partner’s or parent’s South African bar-coded ID, valid passport (if foreign national);
• Confirmation of residential address by co-habitant or home owner form, which is available on our website www.sygnia.co.za.

ANNEXURE B: PROMINENT
INFLUENTIAL PERSON DEFINITION
A person is considered to be a domestic prominent influential person if he or she holds the position in the country, including in an acting
position for a period exceeding six months, or has held the position for a period of at least 12 months after the date on which that person
ceased to hold that position as set out below:
A) A PROMINENT PUBLIC FUNCTION INCLUDING THAT OF:
i. The President or Deputy President;
ii. a government minister or deputy minister;
iii. the Premier of a province;
iv. a member of the Executive Council of a province;
v. An executive mayor of a Municipality;
vi. A leader of a registered political party;
vii. A member of a royal family or senior traditional leader;
viii. The head, accounting officer or chief financial officer of a national or provincial department or government component;
ix. The municipal manager or a chief financial officer of a municipality;
x. The chairperson of the controlling body, the chief executive officer, or a natural person who is the accounting authority, the chief financial
officer or the chief investment officer of a public entity listed in Schedule 2 or 3 to the Public Finance Management Act; or
xi. The chairperson of the controlling body, chief executive officer, chief financial officer or chief investment officer of a municipal entity;
xii. A constitutional court judge or any other judge;
xiii. An ambassador or high commissioner or other senior representative of a foreign government based in South Africa;
xiv. An officer of the South African National Defence Force above the rank of major-general.
B) THE POSITION OF:
i. Chairperson of the board of directors;
ii. Chairperson of the audit committee;
iii. Executive officer; or
iv. Chief financial officer
Of a company, if the company provides goods or services to an organ of state and the annual transactional value of the goods or services or
both exceeds the amount prescribed by the Minister [insert amount when published]
C) THE POSITION OF HEAD OR OTHER EXECUTIVE DIRECTLY ACCOUNTABLE TO THAT HEAD OF AN INTERNATIONAL
ORGANISATION BASED IN SOUTH AFRICA.
A person is considered to be a foreign prominent public official if he or she holds, or has held at any time in the preceding 12 months, in any
foreign country a prominent public function including that of a –
• Head of State or head of a country or government;
• Member of a foreign royal family;
• Government minister or equivalent senior politician or leader of a political party;
• Senior judicial official;
• Senior executive of a state owned corporate; or
• High ranking member of the military.
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SYGNIA DIRECT INVESTMENT APPLICATION FORM

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Completed 8 March 2021

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