ADDITIONAL CONTRIBUTION FORM - …

1 ADDITIONAL CONTRIBUTION FORMPROFESSIONAL PROVIDENT SOCIETY INVESTMENTS PROPRIETARY LIMITED ( PPS INVESTMENTS )CLIENT SERVICE CENTRE CONTACT DETAILS TEL: 0860 468 777 (0860 INV PPS) FAX: 021 680 3680 EMAIL: WEBSITE: Please complete the form in BLOCK LETTERS Please indicate all choices selected with an [X] Please initial any amendments made to this transaction form Please note, Investment Option(s) refer to the relevant underlying unit trusts within your portfolio Financial Intelligence Centre Act ( FICA ) requirements are available on the PPS Investments website The daily cut-off for receipt of instruction is 14.

2 00 General Terms, Conditions and Declarations are available on the PPS Investments websiteCONTACT PERSON FOR OUTSTANDING REQUIREMENTSAPERSONAL DETAILSBT itle Surname or name of entityFirst name(s) or initial, surname and designation of contact person of entityIdentity or passport number Investment number PAGE 1 OF 6 ADDITIONAL CONTRIBUTION FORMN ovember 2016 Please note, this is a fillable form . Please print, sign where required and send to the details above for fields in red are and surnameTelephone number EmailCapacityBANK DETAILSCBank details of investorThe following bank details will be used for all payments.

3 A cancelled cheque or recent bank statement (not older than three (3) months and clearly displaying your name and the bank s logo) must accompany this application form as confirmation of these details. Any changes to your banking details in future must be forwarded in writing to PPS Investments together with proof Account numberBranch Branch codeType of accountCurrent Savings TransmissionBank details of third party (if payer differs from the investor)

4 Use the bank details below for the recovery of my debit order, as the payer differs from the investor (please provide proof of bank details such as a cancelled cheque or a bank statement not older than three (3) months, a copy of the ID of the payer and a specimen signature of the payer). Collection requests from a third party legal entity s account must be accompanied by a resolution, copies of the ID documents and signatures of the signatories of the third party as well as all supporting Initials Surname / Name of entityBank Account numberBranch Branch codeType of accountCurrent Savings TransmissionCONTRIBUTION DETAILSDPAGE 2 OF 6 ADDITIONAL

5 CONTRIBUTION FORMP lease note: Only one product may be selected Lump sum investmentPPS / OPN Endowment Plan (minimum R 5,000) PPS / OPN Personal Pension (minimum R 5,000) PPS / OPN Investment Account (minimum R1,000) PPS Retirement Annuity (minimum R 5,000)PPS / OPN Tax Free Investment Account (minimum R1,000 and may not exceed R33,000 per tax year) Debit order investment (minimum R500 per month) PPS / OPN Endowment Plan PPS / OPN Personal Pension PPS / OPN Investment Account PPS Retirement AnnuityPPS / OPN Tax Free Investment Account (maximum R2,750 per month)Source of funds for this investment (compulsory)

6 Professional / Liquidation of Property Gift / Donation SavingsBusiness investment disposal inheritance Other (specify)INVESTMENT DETAILEYou may invest via one or all of the options below Lump sum ad hoc CONTRIBUTION amount RDate of deposit / transferDebit order investment (on an existing investment)New debit order CONTRIBUTION R per monthCommencement month Collection date 1st 7th 15th 28thEscalation rate 5% 10% 15% % (No decimal places)It is strongly advised that you escalate your debit order amount annually in order to ensure your contributions are in-line with.

7 PPS / OPN Tax Free Investment Account - Please note that your selected escalation rate might be capped to ensure that the escalation rate does not lead to a breach of the annual and lifetime CONTRIBUTION limits. Should the cut-off for my selected debit order date be missed, please commence the same day of the following month; or as soon as possible, on the next collection date. Please increase my debit order as followsFrom R to REffective dateI, the undersigned, request and authorise PPS Investments to arrange to collect the monies payable from the bank account specified of account holder / Signatory DatePAGE 3 OF 6 ADDITIONAL CONTRIBUTION FORMTRANSFER OF EXISTING INVESTMENT OPTION(S)

8 GTransferor s details - The transferor is the person in whose name the existing Investment Option(s) are : Transfers on PPS / OPN Tax Free Investment Account is currently not Initials SurnameIdentity or passport number / Registration number of entityDetails of transactions requiredI hereby instruct the management company(ies) specified below to transfer the Investment Option(s) held in my name to an account held by PPS Investments. Management company Name of Investment Option Investment number at relevant % of investment to be Cancel exisiting debit order management company transferred Yes No

9 Investment Option(s) must be switched after transfer(If no selection is made, the funds will remain in the transferred Investment Option(s)) Yes, switch according to the Investment Option(s) selected in Section H NoI hereby instruct PPS Investments to make the necessary arrangements to effect this transfer. I further declare that my estate is not insolvent and has not been of transferor Signature of guardian (if applicable) DateHMETHOD OF PAYMENTF Cheque deposit* All cheques must be endorsed as Non Transferable and deposited directly into the product s bank account.

10 Electronic / Internet transfers* Electronic transfers may not reflect immediately and may take a few days to appear in the product s bank account. Regular debit order If your banking details have been updated or the payment is being made by a third party, please ensure that the bank account details are completed in Section C. The reference on your ba