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Wealth Namibia Direct Investment for Individual investors

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Published: 07/2020
Namibia Direct Investment for individual investors
Wealth Namibia
Direct Investment for
Individual investors
Your investment application
1. This form, the investment terms, the guides and the fund fact sheets, are the basis of our investment agreement. If you want copies of any of
these documents, you can ask your nancial adviser or contact us.
2. We populated certain elds on this form to guide you. You can change these elds according to your requirements.
3. You may not change any part of this form and the terms of this investment. When you correct any information you have completed, sign next to it.
4. According to the Financial Intelligence Act, Act 13 of 2012 (“FIA”), we must identify you, and verify information if it is new or different to what we
have on our records. Based on the information you provide, we may ask for additional information and documents. Refer to the FIA checklist for
the required supporting documents.
5. If we cannot process any part of this request, we will inform you or your nancial adviser.
1: Investor details
Only natural persons who are ordinary tax residents in Namibia can invest in this investment.
1.1 Personal details
We need proof of your identity
Surname
Previous surname
Title
Full name
Identication number
Nationality N A M (NAM if Namibia) Country of birth N A M (NAM if Namibia)
Citizenship N A M (NAM if Namibia) If you hold dual citizenship, give the other country code
Date of birth D D M M Y Y Y Y Gender Male Female
Physical address Unit number Complex
Street number Street name/Farm
Suburb/District
City/ Town
Postal code Country code N A M (NAM if Namibia)
What is your source of income or wealth?
Business prot Interest and dividends Savings Salary Inheritance Other
Give more details like name and nature of the business, name of the nancial institution and the account reference, name of the employer, the estate
that paid the inheritance, or describe “other”:
A politically exposed person (PEP) is someone who is involved, or has been involved, in a prominent public function. This includes local functions
or functions in foreign countries. You are also considered a politically exposed person if any of your family members, nominated beneciaries or close
associates are politically exposed. A politically exposed person status is not only relevant to government employees or a person involved in politics.
It includes for example, heads of state, cabinet ministers, members of parliament, members of local and provincial government, senior administrators
in government departments (nancial departments/tender processes), senior judges, managers of local municipalities who award tenders, senior and
inuential ofcials, ambassadors, commissioners, consulate employees and senior representatives of religious organisations.
Are you a politically exposed person? Yes No
If “yes”, give details and
complete the PEP questionnaire
Investment number P P
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Namibia Direct Investment for individual investors
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Investment number P P
1.2 Communication details
Cell phone number + 2 6 4 (8) Other + 2 6 4
Email address (primary)
Email address (secondary)
If an email indemnity is signed in the investor declaration, the above email address will apply for the receipt of emailed transactions/instructions.
We will communicate by email. Do you prefer to receive communication by post instead? Yes No
If “yes” and the postal address is different to the physical address above, we need the postal address.
Postal address
City/ Town
Postal code Country code N A M (NAM if Namibia)
If the investor is a minor,
name of the contact person
Identication number of the
contact person
1.3 Income tax details
If this investment is for a minor who is not registered for tax, provide the guardian’s tax information.
Are you a registered tax payer with the Namibia Revenue Agency (NRA)? Yes No
If “yes”, give your tax reference number
If you are currently, or have been previously, registered for tax in other countries, complete those details below.
Tax residence (country code) Tax identication number (TIN)
Use the list of country codes for the correct country code.
1.4 Tax exemption details
We must withhold tax on interest distributions made from our investment portfolios. Should you be exempt from interest withholding tax or be entitled
to a reduced withholding tax rate according to the Namibian Income Tax Act, give a reason for an exemption or reduced rate by choosing an option
below.
1. Section 34E: Qualifying person or institution:
(a) Person contemplated under Section 16 of the Income Tax Act
(b) Person exempt from tax in terms of legislation
2. Other (please provide reasons along with supporting documentation)
2: Investment details
Type of investment 2.1 Lump sum investment 2.2 Regular investment 2.3 Unit transfer 2.4 Regular withdrawal
2.1 Lump sum investment
Are you paying the lump sum amount? Yes No
If “yes”, complete sections 2.1.1 and 2.5.
If “no”, we need an Investment payer form (WN201) from the payer to conrm the payment details. Complete section 2.5 only.
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Namibia Direct Investment for individual investors
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Investment number P P
2.1.1 Payment of the investment amount
The minimum lump sum investment amount is N$2 000 per portfolio.
Lump sum amount N$ ,
What is the source of the lump sum amount?
Business prot Interest and dividends Savings Salary Inheritance Other
Give more details like name and nature of the business, name of the nancial institution and the account reference, name of the employer, the estate
that paid the inheritance, or describe “other”:
Read the information below before you choose a payment option.
Electronic transfer Bank deposit Collect from bank account
Electronic transfer
or
bank deposit
After we have reviewed the investment application, we will conrm the bank account details you must use for the
electronictransfer or the bank deposit.
We need a copy of the electronic transfer conrmation or bank deposit slip before we can nalise your
investmentapplication.
Collect from bank
account
If we collect the investment amount or if you make a cheque deposit, you can only ask for a withdrawal or refund after
30 days. We will wait 30 days before we exchange any investment amount to a foreign currency.
Collect from bank
account
Legislation limits collections to N$500 000 per transaction and N$1 000 000 per day. If we have to collect the investment
amount over a number of days, we will invest each collection in the investment components you choose. The rst collection
will be the initial investment amount and we will report the subsequent collections as additional investment amounts.
We need ofcial proof of your Namibian bank account for the collection, not older than three months.
Name of bank
Branch name
Account number Branch code
Type of account Current/Cheque Savings Transmission
Collection date D D M M Y Y Y Y
If we cannot collect on the date you chose, we will collect on the next possible date.
2.2 Regular investment
We can only collect the regular investment by debit order. You can only ask for a refund or withdrawal 30 days after we have collected the regular
investment amount.
Are you paying the regular amount? Yes No
If “yes”, complete sections 2.2.1 and 2.5.
If “no”, we need an Investment payer form from the payer to conrm the payment details. Complete section 2.5 only.
2.2.1 Payment of the regular amount
The minimum regular monthly investment amount is N$200 per portfolio.
Regular amount N$ ,
every
month
every
quarter
every
half year
every
year
Yearly increase in regular amount 0 0 , 0 0 % Month of increase
What is the source of the regular amount?
Business prot Interest and dividends Savings Salary Inheritance Other
Give more details like name and nature of the business, name of the nancial institution and the account reference, name of the employer, the estate
that paid the inheritance, or describe “other”:
If you asked for a collection of the lump sum from your bank account, must we use the same bank account for the
regular amount?
Yes No
If “no”, complete your Namibian bank account details for the regular amount. We need ofcial proof of this bank account, not older than three months.
Name of bank
Branch name
Account number Branch code
Type of account Current/Cheque Savings Transmission
Collection day of the month
D D
First collection date
D D M M Y Y Y Y
If we cannot collect on the date you chose, we will collect on the next possible date.
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Namibia Direct Investment for individual investors
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Investment number P P
2.3 Unit transfer
We need a Wealth transfer of unit trusts to Momentum Wealth Namibia: Voluntary products only form (WN832) for each transfer from the nancial
services provider.
How many nancial services providers are transferring units to us?
2.4 Regular withdrawal
The minimum withdrawal amount is N$250 per portfolio and the minimum balance required in a portfolio is N$2 000.
If you withdraw money and the value of your portfolio drops below N$2 000 and you do not have an active debit order in place, we may end your
investment and pay you the full balance.
Withdrawal amount N$ ,
every
month
every
quarter
every
half year
every
year
We can only pay you until the 25th of the month. If you do not tell us which day you prefer, we will use the 25th. We will sell out of your investment
components before the withdrawal day to make sure we pay you in time.
Withdrawal day of the month
D D
2.4.1 Payment of the regular withdrawals
If you asked for a collection of the lump sum from your bank account, do you want to use the same bank account for the
regular withdrawals?
Yes No
If “no”, we need your Namibian bank account details for the withdrawal payments. We need ofcial proof of this bank account, not older than three months.
Name of bank
Branch name
Account number Branch code
Type of account Current/Cheque Savings Transmission
2.5 Investment instruction
Investment components
Fee
class Lump sum investment Regular investment
Regular
withdrawal
Fee account
Momentum Namibia Money Market Fund
N$ N$ N$
Momentum Namibia Diversied Income Fund
N$ N$ N$
Momentum Namibia Defensive Growth Fund
N$ N$ N$
Momentum Namibia Diversied Growth Fund of Funds
N$ N$ N$
Momentum Namibia Growth Plus Fund of Funds
N$ N$ N$
Momentum Namibia Real Growth Core Equity Fund
N$ N$ N$
N$ N$ N$
2.6 Portfolio distributions
Portfolios declare distributions of interest and dividends earned. The minimum disclosure documents (MDDs) or fund fact sheets of each portfolio
have details about the portfolio distribution. Refer to momentum.com.na for the list of available portfolios.
We will automatically re-invest any distributions from your investment back into the applicable investment portfolio.
2.7 Fees
Investment management company
All investment manager charges that apply to your investment are available on the relevant fund fact sheet of the investment portfolio. You can also
ask your nancial adviser for more details.
Financial adviser
The initial and ongoing adviser fees are negotiated between you and your appointed nancial adviser. We calculate the ongoing adviser fee using
the total portfolio value every month. Refer to the table below for maximum permissible combinations of initial and ongoing adviser fees.
We will add VAT to the following fee percentages if the adviser fee is subject to VAT. If the fee differs from the fee and benet proposal, the fee on
this form will apply.
The maximum initial fee is 3% and the maximum ongoing fee is 1%.
Initial adviser fee Ongoing adviser fee
0
,
0 0 % excluding VAT 0
,
0 0 % excluding VAT
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Namibia Direct Investment for individual investors
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Investment number P P
3: Beneciary details
You cannot nominate a beneciary for this investment. It will form part of your estate when you die.
4: Financial adviser details and declaration
The servicing nancial adviser must complete and sign this section.
4.1 Financial adviser details
Name and surname
Financial
adviser code FSP name FSP code Fee reference
Fee
split %
Marketing
adviser code
Servicing nancial adviser (preferred adviser)
%
%
%
100
%
Servicing nancial adviser details
Cell phone number
+ 2 6 4 (8) Other + 2 6 4
Email address
4.2 Servicing nancial adviser declaration
1. I conrm that I have identied the investor, any guardian and the investment payer. I obtained and stored the verication
documents and have veried these details as required by the Financial Intelligence Act (FIA).
Yes No
2. I explained and provided all documents that apply to this investment to the investor before this form was signed.
3. I explained to the investor all the fees and charges that apply to this investment.
4. I acknowledge that the investor is not a resident, national, or citizen of the United States of America and is not a US person within the meaning of
the denition of that term contained in Regulation S of the US Securities Act 1933 (as amended).
5. Any request to you will be within the limits of the mandate I have from the investor.
I have read this application form, the terms and the minimum disclosure documents or fund fact sheets that apply to this investment.
The information on this form is, to my knowledge, true and correct. I will not hold you liable for any loss or damage if this application is altered
after I sign it.
Signature
Date
D D M M Y Y Y Y
5: Investor declaration
1. This investment amount is not the proceeds of any crime.
2. I acknowledge that investment performance is not guaranteed and, if my investment is exposed to market risk, its value may uctuate.
3. It is my responsibility to get advice before making any investment decisions. I accept the risks related to this investment if I choose not to use the
services of a nancial adviser or do not follow my nancial adviser’s advice.
4. I know that my nancial adviser must be appropriately registered with the Namibia Financial Institutions Supervisory Authority (Namsa).
5. Any future request for this investment:
Must be signed by me or the authorised signatory or
Can be signed by my appointed nancial adviser as per
the mandate for this investment
6. If I am also an investment payer, I agree that for this investment:
• you can check my details with my bank and collect money from my bank account; and
• I can sign for this bank account.
7. I understand and accept:
• your timelines, business practices and administrative processes;
• all fees related to this application and that you will pay it from the investment components when it is due;
• that you can invest an amount when you have collected it or once a deposit reects in your bank account;
• the use of a default investment component for certain transactions and investment events; and
• that you can share my personal information within Momentum Metropolitan Namibia Limited, its subsidiaries and contracted service providers
in order to administer my investment and provide me with nancial wellness information.
8. I am aware that the Financial Intelligence Act (FIA) applies and I will follow its requirements.
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Namibia Direct Investment for individual investors
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Investment number P P
Contact details
Client contact centre
Telephone: (+264) 61 297 3737, Fax: (+264) 61 297 3679, Email: wealthservice@momentum.com.na
Address: Cnr Dr Frans Indongo & Werner List Streets, Postal: PO Box 3785 Windhoek Namibia, Website: momentum.com.na
Momentum Wealth Namibia (Pty) Ltd, an authorised nancial services provider Reg no 2016/0297
Momentum Metropolitan Namibia Limited, an authorised nancial services provider Reg no 89/327
Directors: GD Marais, JA Ipinge, JJ Comalie, LCC Rankin
9. I am not, nor am I acting on behalf of a person who is either a resident, national or citizen of the United States of America or a US person within
the meaning of the denition of that term contained in Regulation S of the US Securities Act 1933 (as amended).
10. Future instructions for this investment can be emailed to the appointed nancial adviser or the Momentum ofce.
11. I, the undersigned, herewith consent that Momentum Wealth Namibia (Pty) Ltd:
• may communicate with me via email and may send all relevant contracts, statements and other information pertaining to my investment to me
to the email address provided in this application;
• I further conrm that the email address provided herein is complete and correct in all respects and undertake that I will inform Momentum
Wealth Namibia (Pty) Ltd immediately of any changes to the details herein contained and specically of any changes to my email address;
• I acknowledge that I am aware that communications sent by email:
– can easily be tampered with;
– intercepted or fraudulently abused by outsiders; and
• I herewith expressly and fully indemnify Momentum Wealth Namibia (Pty) Ltd, its representatives and employees against and waive any
rights in connection with any demand, claim or action, whether directly or indirectly relating to or in connection with any email communication,
unless the matter is as a result of gross negligence or willful misconduct of Momentum Wealth Namibia (Pty) Ltd or any of its employees, in
which case the matter shall be dealt with on its legal merits.
12. I undertake to inform you in writing of any changes in my circumstances or details I provided within 30 days of any change.
I have carefully read, and I understand and accept this application form, the terms, fees and minimum disclosure documents or fund fact
sheets that apply to this investment. The information I completed on this form is true and correct. I will not hold you liable for any loss or
damage if someone changes this form after I sign it.
Name and surname
If not the investor, capacity of signatory
I am also signing as the: Lump sum investment payer Regular investment payer
Signed at Date D D M M Y Y Y Y
Authorised signatory
Other signature if required
For ofce use:
EMPLOYEE/FINANCIAL ADVISER WHO CONFIRMED RECEIPT OF ALL ORIGINAL DOCUMENTS
Full name
Surname
Employee number
Signature
Date
D D M M Y Y Y Y
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Completed 7 January 2021

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