AMENDMENT FORM - ppsisecure.co.za

1 AMENDMENT 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 changes made to this transaction form Financial Intelligence Centre Act ( FICA ) requirements are available on the PPS Investments website The daily cut-off for receipt of instructions is 14:00 General Terms, Conditions and Declarations are available on the PPS Investments websitePERSONAL DETAILS OF INVESTORAPAGE 1 OF 2 AMENDMENT FORMP lease note, this is a fillable form .

2 Please print, sign where required and send to the details above for fields in red are apply the amendments indicated below to the following investmentInvestment numberID or passport number / Registration number of entityTitle Surname or Name of entityFirst name(s) or surname and designation of contact person of entityPhysical address Postal codePostal address Postal codeTelephone number (home) Telephone number (work) Cellphone number FaxEmail (Compulsory)INVESTOR BANK ACCOUNT DETAILS BWe require proof of bank details (eg.)

3 A bank statement not older than three (3) months clearly showing your name, bank account number and the bank s logoI authorise the administrator to debit/ deposit monies from the account specified belowAccount holder name Bank Account numberBranch Branch code Type of account Current Savings TransmissionJANUARY 2019 Income tax reference number Income tax office

4 Country of tax residenceCINVESTOR TAX DETAILSPAGE 2 OF 2 AMENDMENT form PPS Investments (Pty) Ltd, PPS Multi-Managers (Pty) Ltd, PPS Investment Administrators (Pty) Ltd and PPS Insurance Company Ltd are licensed financial services providers. Coronation Life Assurance Company Limited is registered in terms of the Long Term Insurance Act 53 of 1998 to carry on long term insurance business. PPS Management Company (Pty) Ltd (RF) is a licensed collective investment scheme House, Boundary Terraces, 1 Mariendahl Lane, Newlands, 7700 Website: Email: I hereby confirm that I, , haveread and understood.

5 All information provided in this form and all other documents signed by me, whether in my handwriting or not, is correct I am responsible for the accuracy and completeness of all answers, statements or other information provided by me or on my behalf I will inform PPS Investments if any of the information supplied changes I have not received advice from PPS Investments or the Administratorand I have read, understood and agreed to: The Product Terms, Conditions and Declarations which may change from time to time The Minimum Disclosure Document (MDD) of the chosen fund(s), are included but not limited to the Total Expense Ratio (TER) and Transaction Cost (TC) applicable to my investment available on the PPS Investments website In the case of Customised Solutions, the Minimum Disclosure Document of the underlying funds can be obtained from the respective Managers.

6 I also certify that the information provided in terms of FATCA is correct and that unless stated otherwise, I am not a tax resident of the United States of America. The Effective Annual Cost disclosure available from my financial adviser, the PPS Investments website or from the Client Services Centre. I will have fourteen (14) days after receipt of the AMENDMENT confirmation to report any errors to PPS Investments. I hereby acknowledge that the terms, conditions and declarations agreed upon when entering my investment continue to apply. This also includes the AMENDMENT requested. If there are any discrepancies between these and General Terms, Conditions and Declarations available on , the document published on our website will apply.

7 I understand and agree to the General Terms, Conditions and Declarations on (This document can also be requested from the PPS Investments Client Service Centre on 0860 468 777).ETERMS AND CONDITIONSFCLIENT DECLARATIONS ignature of investorDateBENEFICIARY NOMINATIONS DPlease indicate the beneficiary changes in the table below. You may nominate beneficiaries who may receive the proceeds of your investment following your death. If you elect to review and make changes to the nomination of any beneficiaries, a signed instruction must be received before your death. For product-specific rules regarding beneficiary nominations payments, please refer to your investment confirmation beneficiary change only relates to the PPS Investments investment number completed on this form .

8 For beneficiary changes on PPS Insurance products, please complete the Beneficiary Nomination form available from beneficiaries for proceeds:Beneficiary 1 Beneficiary 2 Surname First name(s) Relationship Gender ID / Passport number PercentageBeneficiary 3 The beneficiaries for ownership (Applicable to Endowment Plan only):Beneficiary 1 Surname First name(s) Relationship Gender ID / Passport number Percentag