Standard Bank Fundisa Application Form

1 E-mail 0867 277 501 or 011 448 6666 Standard bank Fundisa Application FormCollective Investments (Unit Trusts)Before completing this form , please refer to the Standard bank Fundisa Fund brochure which is available on submit the following to STANLIB: Completed and signed Application form , copy of the Client's South African ID/ Passport, copy of the Child/nominated student's ID/ unabridged birth DETAILSTITLEINITIAL/SFIRST NAME*SURNAME*ID NUMBER/PASSPORT NUMBER* (COPY REQUIRED)CELLPHONE NUMBER*-OTHER CONTACT NUMBER-POSTAL ADDRESSCODEPHYSICAL ADDRESSCODEEMAIL ADDRESS(IF YOU HAVE ONE)

2 *SOURCE OF FUNDSI CONFIRM THAT THE MONTHLY INCOME OF THE CHILD/NOMINATED STUDENT S HOUSEHOLD IS 0 - R15 000 OVER R15 000* Note that this is a compulsory STUDENT DETAILS The minimum investment amount for each child/ nominated student is R40. Fundisa grants are strictly for the tertiary education of students fromhouseholds earning less than R180 000 per annum and who are younger than 35 years. NAME/SSURNAMEIDENTITY NUMBERGENDER FEMALE MALEDATE OF BIRTH--DDMMYYYYRACE BLACK COLOURED INDIAN WHITEIS THE BENEFICIARY'S HOUSEHOLD INCOME MORE THAN R180 000 PER ANNUM?

3 The beneficiary's household income refers to thecombined income of the parents/ guardians of beneficiary. YES NO INVESTMENT AMOUNT (ONCE OFF)R. DEBIT ORDER AMOUNT (MONTHLY)R. STAUTINV0282016/12HX3144 Please note this form expires on 2017/06/30.

4 Up to date forms are always available on 1 of 5 < - - P a g e B r e a k - - >CHILD/NOMINATED STUDENT DETAILS The minimum investment amount for each child/ nominated student is R40. Fundisa grants are strictly for the tertiary education of students fromhouseholds earning less than R180 000 per annum and who are younger than 35 years. NAME/SSURNAMEIDENTITY NUMBERGENDER FEMALE MALEDATE OF BIRTH--DDMMYYYYRACE BLACK COLOURED INDIAN WHITEIS THE BENEFICIARY'S HOUSEHOLD INCOME MORE THAN R180 000 PER ANNUM? The beneficiary's household income refers to thecombined income of the parents/ guardians of beneficiary.

5 YES NO INVESTMENT AMOUNT (ONCE OFF)R. DEBIT ORDER AMOUNT (MONTHLY)R. CHILD/NOMINATED STUDENT DETAILS The minimum investment amount for each child/ nominated student is R40. Fundisa grants are strictly for the tertiary education of students fromhouseholds earning less than R180 000 per annum and who are younger than 35 years. NAME/SSURNAMEIDENTITY NUMBERGENDER FEMALE MALEDATE OF BIRTH--DDMMYYYYRACE BLACK COLOURED INDIAN WHITEIS THE BENEFICIARY'S HOUSEHOLD INCOME MORE THAN R180 000 PER ANNUM? The beneficiary's household income refers to thecombined income of the parents/ guardians of beneficiary.

6 YES NO INVESTMENT AMOUNT (ONCE OFF)R. DEBIT ORDER AMOUNT (MONTHLY)R. CHILD/NOMINATED STUDENT DETAILS The minimum investment amount for each child/ nominated student is R40. Fundisa grants are strictly for the tertiary education of students fromhouseholds earning less than R180 000 per annum and who are younger than 35 years. NAME/SSURNAMEIDENTITY NUMBERGENDER FEMALE MALEDATE OF BIRTH--DDMMYYYYRACE BLACK COLOURED INDIAN WHITEIS THE BENEFICIARY'S HOUSEHOLD INCOME MORE THAN R180 000 PER ANNUM? The beneficiary's household income refers to thecombined income of the parents/ guardians of beneficiary.

7 YES NO INVESTMENT AMOUNT (ONCE OFF)R. DEBIT ORDER AMOUNT (MONTHLY)R. STAUTINV0282016/12HX3144 Please note this form expires on 2017/06/30. Up to date forms are always available on 2 of 5 < - - P a g e B r e a k - - >DEBIT ORDER DETAILS FOR A ONCE-OFF DEBIT ORDER COLLECTIONONCE-OFF DEBIT DEBIT DATE--DDMMYYYYA maximum of R1 million may be debited from a Client's bank account within a 45 day period.

8 I authorise the Manager to arrange with my bank forthe payment of the investment amounts as indicated above, including amendments that may be made during the life of the investment on thespecific day as indicated. If an Client requests a once off collection of more than R1 million, the transaction will be loaded over three days at R1million per day to a maximum of R3 million rand. The normal 45 day clearing period for once off collections will remain in force. Debits can only beloaded 2 business days after receiving the completed ORDER DETAILS FOR A RECURRING DEBIT ORDERDEBIT ORDER PREFERRED DATE COMMENCEMENT DATE--DDMMYYYYPAYMENT FREQUENCY MONTHLY QUARTERLY BI-ANNUALLY ANNUALLYBANKING DETAILS FOR A ONCE OFF/ RECURRING DEBIT ORDERNote: It is compulsory to furnish us with banking the bank details listed below for the following transactions: PURCHASES REPURCHASES INCOME DISTRIBUTION CASH FLOWP ayments to third party bank accounts are not allowed.

9 Payments can only be paid into an account in the name of the CODEACCOUNT NUMBERACCOUNT TYPE CHEQUE SAVINGS TRANSMISSIONSTANDARD bank ATM CARDNUMBER Note: your Fundisa account will be linked to your ATM card allowing you to obtain HOLDER'S ID NUMBERACCOUNT HOLDER'S NAMESIGNATURE OF bank ACCOUNTHOLDER/ AUTHORISED SIGNATORYIf the debit order is funded by a 3rd party (spouse included):* For individuals: Certified copy of the third party s identity document with a specimen signature.* For entities: Standard bank bank account mandate * Other banks Letter from the bank confirming signing authority and a certified copy ofidentity document with a specimen signature of the SERVICE CHARGESTANLIB levies an annual service charge of (Excl.)

10 Vat) on the market value of the portfolio. STAUTINV0282016/12HX3144 Please note this form expires on 2017/06/30. Up to date forms are always available on 3 of 5 Eastern CapeBuffalo City TVET CollegeEast Cape Midlands TVET CollegeIkhala TVET College Ingwe TVET CollegeKing Hintsa TVET CollegeKing Sabatha Dalindyebo TVET CollegeLovedale TVET CollegeNelson Mandela Metropolitan UniversityPort Elizabeth TVET CollegeRhodes UniversityGautengCentral Johannesburg TVET CollegeEkurhuleni East TVET CollegeEkurhuleni West TVET CollegeSedibeng TVET CollegeSouth West Gauteng TVET CollegeTshwane North TVET CollegeTshwane South TVET