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(Contact us if you need help:Call 0860 000 654 between 07:30 - 17:30 (Mon - Fri) or Email: [email protected]
Make an informed decision:
▪ Read our Product Range brochure to make sure you have chosen the right product to suit your needs.
▪ Refer to the fund factsheets (minimum disclosure documents) and the Allan Gray Local Investment Platform
Fund List for information on the unit trusts we offer. Certain unit trusts are subject to availability.
Consider getting financial advice:
▪ Allan Gray does not provide financial advice. However, we believe in the merits of good independent advice.
▪ If you are not comfortable making your own investment decisions, consider using the services of an independent
financial adviser (IFA). To locate an IFA in your area, refer to the ‘Find an independent financial adviser’ section of
our website.
▪ Make sure you have your tax identification number on hand.
▪ Complete all the information on the form to ensure that there is no delay in processing your investment.
▪ Read and agree to the Endowment Terms and Conditions to understand the rules of your investment.
▪ You will need an investment overview to complete this form. This is available from your financial adviser or
the Client Service Centre.
You may need to complete additional forms, depending on the specifics of your investment:
▪ Would you like to phase in your investment? Complete the 'Phase-in instruction' form.
Send us the documents listed below:
Email: [email protected] or Fax: 0860 000 655 or +27 (0)21 415 2492
In certain instances we may contact you requesting additional documents.
Please make payment into the following Allan Gray bank account and send us proof of payment. We will not
accept cheque deposits.
Pre-approved beneficiary: Allan Gray Endowment
Account name: Allan Gray Life Limited
Bank: First National Bank
Branch code: 20-41-09 - Global Transactional Services Cape Town
Account type: Current
Account number: 620 555 231 98
Reference number: 13 digit SA ID number (South African residents)/passport number (if foreign national)
Please note that if instructions and documents are received:
▪ Before 14:00 on a business day, we will start processing on that day.
▪ After 14:00 on a business day, we will start processing on the next business day.
▪ On a weekend or public holiday, we will start processing on the next business day.
The cut-off for debit order processing is three business days before your selected debit order date.
Electronic collections occur on the next business day after we begin processing your application.
▪ We will process your instruction once we receive the required completed documents and the money reflects in the
Allan Gray Endowment bank account.
▪ You will receive confirmation once your instruction has been processed.
▪ You will receive an Allan Gray Online account with this investment and will be contacted to activate your
Allan Gray Online account within two business days of your instruction being processed.
We need the following documents for all
representatives acting on behalf of and the
contact person for the legal entity:
Completed Annexure B
Proof of authority (eg. power of attorney)
Copy of South African bar-coded ID or valid
passport (if foreign national)
Completed 'Endowment application for legal entities' form
FICA documents as set out in Annexure A
Resolution signed by all authorised signatories
Proof of bank details (eg. cancelled cheque or bank statement)
If a life assured is appointed, please provide a copy of the life
assured's South African bar-coded ID or valid passport (if foreign
national)
BEFORE YOU INVEST
STEP 1COMPLETE THE FORM &
AGREE TO THE Ts & Cs
STEP 2SEND DOCUMENTS
STEP 3MAKE PAYMENT
CUT-OFF TIMES
WHAT HAPPENS NEXT?
ENDOWMENT APPLICATION FOR LEGAL ENTITIES
D D M M Y Y Y Y
1 of 9Endowment application for legal entities
1. Please provide us with the legal entity details
Type of entity
Listed company Unlisted company Close corporation Partnership Non-profit organisation
Trust Retirement Fund Savings Club Other
Nature of entity
Please provide us with the nature of your business activities:
Agriculture, forestry and fishing Travel, tourism, accommodation and catering Wholesale, retail and motor trade
Mining and quarrying Transport, storage, courier and freight Electricity, water and gas
Estate, living and family trusts Information technology and telecoms Community and social activities
Healthcare, medical and education Government services, arms and state-owned Broadcasting and entertainment
Savings, stokvels and investments Financial, real estate and property services Business and professional services
Construction and civil engineering
Details of the legal entity
Registered name
Trading name
Registration number
Country of inception Date of inception
VAT number
Registered address (head office)
Postal code
Business operating address
If the same as the registered address (head office), please tick this box
Postal code
Postal address
If the same as the registered address (head office), please tick this box
If the same as the business operating address, please tick this box
Postal code
Politically exposed person
Is the application being made on behalf of a legal entity where the authorised representative(s), ultimate beneficial owner(s) or
any stakeholder of the applicant is a foreign prominent public official or a domestic prominent influential person? Yes No
If yes, please specify
Allan Gray Proprietary Limited is an authorised financial services provider.
No. 1.0 September 2020
ENDOWMENT APPLICATION FOR LEGAL ENTITIES
The Allan Gray Endowment is underwritten by Allan Gray Life Limited, Registration Number 1996/001752/06. Allan Gray Investment Services Proprietary Limited, an authorised administrative financial services provider, is the Administrator.
Bearer shares (only applicable to companies)
Bearer shares are physical share certificates that grant the holder ownership of a company.
Does the company have the ability to issue bearer shares? Yes No
If yes, has the company issued any bearer shares? Yes No
Details of the contact person
Title Surname
First name(s)
Nationality Telephone (w)
Mobile Fax
2. Please provide us with the legal entity’s tax information
▪ This section applies to all legal entities whether they are registered for tax or not.
▪ Please refer to our ‘Tax guide’ at the end of this form if you need help understanding the terms used in sections 2, 3 and 4.
▪ The South African Revenue Service (SARS) requires all financial services providers to collect tax information from their clients.
▪ A change in tax information completed on this application form will be applied to all existing investments from the date the
instruction is processed.
Please complete either section 2.1 or 2.2.
2.1 If the legal entity is a South African resident for tax purposes, please tick the box below
The legal entity is a resident for tax purposes in South Africa.
Tax identification number (TIN) provided to you by SARS
If the legal entity is unable to provide a TIN, please complete section 2.3 below.
2.2 If the legal entity is a non-South African resident for tax purposes, please tick the box below
The legal entity is not a resident for tax purposes in South Africa.
Country of residence for tax purposes
TIN provided to you by your tax authority
If the legal entity is unable to provide a TIN, please complete section 2.3 below.
2.3 If you are unable to provide a tax identification number (TIN), please provide us with a reason below
Where you are unable to provide a TIN or its functional equivalent (FE), please tick one of the following reasons:
Reason A: The legal entity has never registered for a TIN/FE with the tax authority
Reason B: I do not know the legal entity’s TIN/FE, but I will take steps to get this and submit it to Allan Gray
Reason C: The tax authority does not require the legal entity to provide a TIN/FE (does not apply to South African or
United States tax residents)
Reason D: The country does not issue TINs/FEs to its tax residents (does not apply to South African or United States tax residents)
Reason E: I am unable to obtain the legal entity’s TIN/FE (please specify)
2 of 9Endowment application for legal entities
No. 1.0 September 2020
2.4 Is the legal entity resident anywhere else for tax?
▪ If the legal entity has any tax information for countries in addition to the country indicated above, please list the additional
countries and the legal entity’s associated TIN, or its FE, below.
▪ If the legal entity does not have a TIN or its FE, please tick the reason (refer to section 2.3 above).
3. Is the legal entity a ‘US person’?
Does the legal entity or any controlling persons associated with this investment (e.g. authorised signatory) have a United States tax
number, residency or citizenship? Yes No
Additional documents may be required
If Allan Gray identifies, through the information provided on this application form, that the legal entity is considered a ‘US
reportable account’, you may be required to submit further documents. For more information, please see www.allangray.co.za.
4. What is the legal entity’s classification?
A legal entity must be classified as a financial institution or as a non-financial institution. Please complete either section 4.1 or 4.2
to confirm the legal entity’s classification.
4.1. Is the legal entity a financial institution?
If the legal entity has registered as a financial institution with the US Internal Revenue Service (IRS) and received a global
intermediary identification number (GIIN). Please provide the GIIN below.
If the legal entity is a financial institution but does not have a GIIN, please tick the appropriate box below:
The financial institution is an ‘exempt beneficial owner’
The financial institution is a ‘non-participating financial institution’
The financial institution is a ’deemed compliant financial institution’
4.2. Is the legal entity a non-financial institution?
If the legal entity is a non-financial institution, please tick the appropriate box below:
An ‘active non-financial institution’
A ‘passive non-financial institution’
Country Tax identification number (TIN) Reason for no TIN
A B C D E
A B C D E
A B C D E
3 of 9Endowment application for legal entities
No. 1.0 September 2020
How would you like to invest your money?
You must allocate your lump sum and/or monthly debit order into one or more unit trusts. Indicate the rand amount/percentage
per unit trust in the table below:
Please ensure that the amounts or percentages allocated across unit trusts add up to your total lump sum or monthly debit order amounts, or to 100%.
Unit trust Unit trust class Lump sum allocation Monthly debit order allocation
R or % R or %
R or % R or %
R or % R or %
R or % R or %
R or % R or %
R or % R or %
R or % R or %
R or % R or %
R or % R or %
R or % R or %
5. How much would you like to invest?
▪ You must invest a lump sum of at least R20 000 and/or commit to a debit order of at least R500 per month.
▪ Debit orders are restricted to a maximum of R1 000 000 per debit.
Lump sum amount R and/or Monthly debit order amount R
4 of 9Endowment application for legal entities
Would you like to pay your annual fees from the Allan Gray Money Market Fund?
You may choose to have your annual administration fees and annual financial adviser fees (if applicable) paid from the Allan Gray
Money Market Fund. If you choose to do so, please ensure that you have allocated a portion of your investment to the Allan Gray
Money Market Fund. If no option is selected, fees will be deducted from your selection of unit trusts.
If you would like to pay your annual fees from the Allan Gray Money Market Fund, please tick this box.
6. Where does the money come from?
This information is required by legislation and we need it in order to process your investment. Please make a selection below:
Existing Allan Gray account Capital/savings Company profit Donation
Other (specify)
Note: You may be required to submit proof.
No. 1.0 September 2020
5 of 9Endowment application for legal entities
M M Y Y Y Y
D D M M Y Y Y Y
7. How are you making payment?
Are you making a lump sum payment?
Lump sum amount of R
Which bank account is the money coming from? The legal entity’s bank account A third-party bank account
Note: You may be required to submit proof.
Select a payment option below:
Electronic/Internet transfer (EFT)Electronic/Internet transfers may take up to two days to appear in the Allan Gray bank account.
Collection by Allan Gray
Allan Gray will collect the full amount via a debit order by collecting in parts a maximum of R1 000 000 per day, for each consecutive day until the full amount has been collected. Units bought with a direct debit can only be withdrawn or switched after 32 business days.
Are you setting up a debit order?
Monthly debit order of R to start on the 1st or 15th of
Indicate by how much you would like your monthly debit order to increase each year:
0% 2.5% 5% 10% 15% 20%
Provide us with permission to debit your bank account
Complete this section if you are setting up a debit order or if you would like Allan Gray to collect your lump sum payment from
your bank account.
I authorise the Administrator to draw direct debits from the following South African bank account:
Name of account holder
Name of bank
Branch code
Account number
Type of account Current/Cheque Savings
Additional documents may be required:
▪ If the bank account holder is a third-party individual? Provide a copy of their ID and proof of their bank account details.
▪ If the bank account holder is a third-party legal entity? Provide copies of all the signatories’ IDs and a letter from the bank listing
the authorised signatories on the account.
Signature of bank account holder Date
No. 1.0 September 2020
9. Provide us with the details of your life/lives assured
▪ You may appoint one or more life/lives assured for this policy. Please refer to the Endowment Terms and Conditions for more
information on the options available when appointing lives assured.
▪ If you do not appoint a life assured now you will not be able to do so at a later stage.
▪ If there are more than two lives assured, attach a signed copy of this section to the application form.
If you do not want to appoint a life assured on this policy, please tick this box
If you want to appoint a life assured, please provide the total number of life/lives assured
Title Surname
Name(s)
ID number (passport number if foreign national)
Relationship Contact number
Title Surname
Name(s)
ID number (passport number if foreign national)
Relationship Contact number
10. How should we communicate with you?
We will send all communications to you via email. If you prefer post or do not have an email address, please tick this box.
Manage your investments online
You will receive an Allan Gray Online account with this investment. Allan Gray Online enables you to view your personal and
investment details (e.g. bank account details, account balance, transaction history) and manage your investments (e.g. perform
transactions) online. We need an email address to set up your online account.
If you do not want online access, please tick this box.
6 of 9Endowment application for legal entities
8. Provide us with the legal entity’s bank account details
▪ Please complete the section below to facilitate a smoother process for future withdrawals.
▪ We will make all payments electronically to a South African bank account in the investor’s name.
▪ We will not make any payments to credit cards, market-linked accounts or third-party bank accounts.
If the same as the bank account details in the previous section, please tick this box.
Name of account holder
Name of bank
Branch code
Account number
Type of account Current/Cheque Savings
No. 1.0 September 2020
D D M M Y Y Y Y
7 of 9Endowment application for legal entities
11. Investor declaration
▪ I confirm that all information provided in this form and all other documents signed by me in connection with this application,
whether in my handwriting or not, are correct.
▪ I am responsible for the accuracy and completeness of all answers, statements or other information provided by me or on my
behalf.
▪ I consent to Allan Gray processing my personal information according to the Terms and Conditions.
▪ I have not received advice from the Administrator regarding this application.
▪ I confirm that the Administrator may accept instructions from any authorised third party who has been authorised by me in
writing.
▪ I confirm that the Administrator may accept instructions in the prescribed format by fax or via other electronic means.
▪ I have read and understood the investment overview. The version number is compulsory for the application to be processed. This
is available from your financial adviser or our Client Service Centre. Investment overview version number:
▪ I have read, understood and agree to the latest Terms and Conditions.
▪ I agree that my contractual relationship with the Administrator will be subject to South African law and regulation (including but
not limited to exchange control and tax requirements).
▪ I confirm that if I am not a South African resident, my investment through the Administrator is based on my own initiative and
not due to any offer or solicitation by the Administrator.
▪ I acknowledge and consent to the Administrator sharing my tax information provided in sections 2, 3 and 4 with any other entity
in the Allan Gray group with whom I may have an investment account or product so that the entity can report my tax information
to SARS, where required. My most recent tax declaration will replace all previous declarations made.
▪ I acknowledge that SARS may share my tax information with my local tax authority to adhere to the Foreign Accounts Tax
Compliance Act (FATCA) and the Organisation for Economic Co-operation and Development’s (OECD) Common Reporting
Standard (CRS).
▪ I acknowledge that if the Administrator identifies through the information provided on this application form that the legal entity
falls into the definition of a ‘US person’, I may be required to submit further documents.
▪ I undertake to inform the Administrator in writing if the circumstances referred to in the declaration above change.
▪ Under penalties of perjury, I declare that I have examined the information completed in sections 2, 3 and 4 on this form and to
the best of my knowledge and belief it is true, correct, and complete.
Signature of representative (1) Signature of representative (2)
Date
If you have an independent financial adviser for this investment, please tick this box and complete the next section of this form.
No. 1.0 September 2020
D D M M Y Y Y Y
8 of 9Endowment application for legal entities
12. Complete this section if you have an independent financial adviser
Provide us with your financial adviser’s details
Name and surname of financial adviser
Name of financial services provider (FSP)
Financial adviser code
Financial adviser’s assistant dealing with this transaction
What negotiable fees must be paid to your financial adviser for this investment?
I agree to pay the following negotiated fees on this and all future transactions until otherwise specified:
Initial . %Maximum 3.0% (excluding VAT) deducted prior to the investment being made. Where the annual fees are more than 0.5%, initial fees are capped at 1.5%. If it is agreed that no initial fee is payable, please insert 0%.
Annual . %Maximum 1.0% (excluding VAT) of the investment account. Where the initial fee is more than 1.5%, the maximum annual fee is 0.5%. If no annual fee is payable, please insert 0%.
Who should we communicate with?
Who should we send your transaction confirmations to? Me Financial adviser Both
If no option is selected, your transaction confirmations will be sent to both you and your financial adviser.
Who should we send your statements and other communications to? Me Financial adviser Both
If no option is selected, your communications will be sent to you only.
Provide authorisation for your financial adviser to submit instructions on your behalf
You may authorise the financial services provider (FSP) to submit instructions for this investment on your behalf, either online or via
forms. If the FSP holds a ‘Category II’ licence with the Financial Sector Conduct Authority (FSCA), it is licensed to exercise discretion
and submit instructions on your behalf. To do this for all your investments, the FSP will need a mandate (instruction) from you.
Have you entered into a mandate with this FSP to exercise discretion and submit instructions on your behalf? Yes No
Alternatively, if your financial adviser holds a ‘Category I’ licence with the FSCA, they are not licensed to exercise discretion and submit
instructions on your behalf. However, you may authorise them to submit online instructions for this investment only on your behalf.
▪ Do you authorise this financial adviser to submit instructions (excluding withdrawals and regular withdrawals) on your behalf via
Allan Gray Online? Yes No
▪ Additionally, do you authorise this financial adviser to submit withdrawal instructions and to set up and change regular withdrawals
on your behalf via Allan Gray Online (where applicable)? Yes No
In all cases, money will be paid into your bank account that Allan Gray has on record and the bank account can only be changed with
your prior written consent.
13. Investor declaration for clients with a financial adviser
▪ I confirm that this financial adviser, as authorised representative of the FSP above, is my appointed financial adviser.
▪ I confirm that the Administrator may accept instructions from my financial adviser who has been appointed by me in writing.
▪ I confirm that my appointed financial adviser and any other third parties with whom I have an agreement to manage this investment
(e.g. a discretionary investment manager) will have access to my investment details via a secure electronic channel.
▪ I understand and agree that all instructions submitted by my financial adviser will be governed by the relevant and latest Terms and
Conditions in force as at the date the instruction is submitted.
▪ I acknowledge and agree that the Administrator will not be held liable for acting on any instructions submitted by my financial
adviser and I indemnify the Administrator from all direct or indirect claims (including claims for consequential damages) in this regard.
▪ I have read and agree to the investor declaration in section 11.
Signature of representative (1) Signature of representative (2)
Date
No. 1.0 September 2020
D D M M Y Y Y Y
9 of 9Endowment application for legal entities
14. This section must be completed by your financial adviser
Financial adviser FAIS declaration
▪ I have made the disclosures required in terms of the Financial Advisory and Intermediary Services (FAIS) Act, No. 37 of 2002 to
the investor.
▪ I have explained all fees that relate to this investment to the investor. I understand and accept that the investor may write to the
Administrator to cancel future fees.
Financial adviser online instruction declaration
▪ In the absence of a mandate, I acknowledge and agree that I will only act on my client’s instruction when submitting instructions
via Allan Gray Online.
▪ I have read, understood and agree to the Terms and Conditions applicable to submitting instructions via Allan Gray Online.
▪ I acknowledge and agree that the Administrator will not be held liable for acting on any instructions submitted by me, and I
indemnify the Administrator from all direct or indirect claims (including claims for consequential damages) in this regard.
▪ I understand that the Administrator reserves the right, at any time, to review my licence and/or to audit or request copies of my
client’s consent (whichever applicable) for instructions that I have submitted via Allan Gray Online.
Signature of financial adviser Date
No. 1.0 September 2020
Tax guideThe following definitions and explanations may help you complete the tax information sections of the form.
DWT/IWT
Term Definition Explanation
DWT Dividend withholding tax DWT is a tax imposed on shareholders on receipt of dividends. DWT is categorised as a withholding tax, as the tax is withheld and paid to SARS by the company paying the dividend or by a regulated intermediary.
IWT Interest withholding tax IWT will be applied to local interest distributed to non-South African residents for tax purposes. IWT is categorised as a withholding tax, as the tax is withheld and paid to SARS by the company paying the dividend or by a regulated intermediary.
TIN or its FE
Tax identification number (TIN) orits functional equivalent (FE) i.e. thenumber that functions as a TIN
The number that each jurisdiction issues to identify an organisation for tax purposes. The TIN could be called something different (FE) in different countries.
Examples:▪ SA: Income tax number issued by SARS.▪ US: Employer identification number▪ UK: National Insurance number or Unique Taxpayer Reference.
FATCA and CRS
Term Definition Explanation
Additional tax information
Global tax information Additional tax information relates to the disclosure of each tax jurisdiction where the investor could be liable to declare their assets and income - regardless of where the asset is housed, or income is earned.
CRS Common Reporting Standard The Common Reporting Standard calls on jurisdictions to obtain information from their financial institutions and automatically exchange that information with other jurisdictions on an annual basis.
FATCA Foreign Accounts Tax Compliance Act
FATCA stands for the Foreign Accounts Tax Compliance Act and is a United States (US) initiative aimed at reducing the potential for offshore tax evasion. FATCA requires that financial institutions outside the US provide the Inland Revenue Service (IRS) with financial account information they hold on US citizens.
Specified US person
Excludes certain types of investors from the definition of US Person and therefore excludes these investors from being a ‘US reportable account’
Is a US person, other than:▪ A corporation with stock that is regularly traded on one or more established
securities markets, and any entity related to such a corporation.▪ The United States government or governmental agency.▪ A dealer in securities, commodities or derivative financial instruments that is
registered under the laws of the US.▪ An entity that is a bank, a broker or common trust fund, an organisation
exempt from taxation, a real estate investment trust, a regulated company ora trust that is exempt from tax, as defined in the relevant US Internal RevenueCode.
US Acronym United States (of America)
US citizen A citizen of the United States of America
The term ‘US citizen’ means:▪ An individual born in the US▪ An individual who has a parent who is a US citizen▪ A former immigrant who has been naturalised as a US citizen▪ An individual born in Puerto Rico▪ An individual born in Guam▪ An individual born in the US Virgin Islands
FATCA and CRS
Term Definition Explanation
US person Defines which individuals and
organisations fall into the definition
‘US person’ means:
▪ An individual that is a US citizen or resident in the United States.
▪ A partnership or corporation organised in the US or under the laws of the US
or any state of the US.
▪ A trust, subject to the following cumulative requirements –
i) A court within the United States would have authority under applicable
law to render orders or judgements concerning substantially all issues
regarding administration of the trust (‘court test’); and
ii) One or more US persons have the authority to control all substantial
decisions of the trust, or an estate of the decedent that is a citizen or a
resident of the United States (‘control test’).
▪ This term shall be interpreted in accordance with the US Internal Revenue Code.
US
reportable
account
Financial account that falls in scope
by the FATCA legislation for reporting
to the IRS
Any account that is held by one or more specified US persons, or by a non-
US entity with one or more controlling persons that are specified US persons.
Entity classification
Term Definition Explanation
Active non-
financial
institution
A non-financial institution that
operates in an active trade or business
other than that of a financial business
An active non-financial institution is an entity that primarily earns active income
(e.g. by trade or sales).
Deemed
compliant
financial
institution
An investment entity that is exempt
from the FATCA requirements based
on the nature of the entity
Annex II of the Intergovernmental agreement provides for several categories
of investment entities (summarised below) that qualify as deemed compliant
financial institutions. Financial institutions described in Annex II(IV) are non-
reporting South African financial institutions that shall be treated as deemed
compliant fnancial institutions for purposes of section 1471 of the US Internal
Revenue Code.
Examples of deemed compliant financial institutions:
▪ Trustee-documented trust
▪ Sponsored investment entity and controlled foreign corporation
▪ Sponsored closely held Investment vehicle
▪ Investment advisors and investment managers
▪ Collective investment vehicle
Exempt
beneficial
owner
Entities that are exceptions to the
definition of financial institution
Certain entities are excluded from FATCA reporting based on the nature of their
business.
Examples of exempt beneficial owners are:
▪ The South African government, as well as any of its political subdivisions,
wholly-owned agencies and instrumentalities
▪ International organisations located in South Africa
▪ The South African Reserve Bank
▪ Treaty-qualified retirement fund
▪ Broad participation retirement fund
▪ Narrow participation retirement fund
▪ Pension fund of an exempt beneficial owner
▪ Certain investment entities wholly-owned by one or more of the above
Entity classification
Term Definition Explanation
Financial
institution
Any entity that:
▪ Accepts deposits in the ordinary
course of banking or a similar
business such as banks and credit
unions
▪ Holds financial assets for the
account of others as a substantial
portion of its business such as
brokerages or custodians
▪ Is engaged, or holding itself out
as being engaged, primarily in the
business of investing, reinvesting,
or trading in securities, partnership
interests, commodities, or any
interest. This includes a futures or
forward contract or option in such
securities, partnership interests, or
commodities such as mutual funds,
private equities and hedge funds
The sub-categories of financial institutions are:
▪ Custodial institution - is defined as any entity that holds, as a substantial portion
of its business, financial assets for the account of others.
▪ Depository institution - is defined as any entity that accepts deposits in the
ordinary course of a banking or similar business.
▪ Investment entity - is defined as an entity that conducts as a business (or is
managed by an entity that conducts as a business) investment portfolio
management, trading in money market instruments and other stocks/foreign
exchange/commodities and the management of funds on behalf of other
persons.
▪ Specified insurance company - an insurance company (or the holding company
of an insurance company) is a specified insurance company if it issues, or is
obligated to make payments pertaining to a cash value insurance contract or an
annuity contract. (The term ‘cash value insurance contract’ means an insurance
contract, other than an indemnity reinsurance contract between two insurance
companies, that has a cash value greater than $50 000.)
Exemptions:
▪ Deemed compliant financial institution - financial institution that is exempt
from withholding tax without entering into an IRS agreement
▪ Exempt beneficial owner - entities that are excluded from the definition of
financial institution
GIIN Global intermediary identification
number
The Inland Revenue Service (IRS) identification number issued to participating financial institutions.
Non-financial
institution
An entity that does not fit the
definition of a financial institution
In general, but not always, entities that are not in the financial services industry
will fall into one of two categories of non-financial foreign entities — active or
passive.
Non-
participating
financial
institution
A financial institution that does not
enter into an agreement with the
IRS and is not deemed compliant or
excepted
This relates to financial institutions that are not in a participating jurisdiction.
Participating
financial
institution
Financial institution that enters into an
agreement with the IRS to undertake
certain due diligence, withholding
and reporting requirements for US
account holders
A participating financial institution will have been issued a global intermediary
identification number (GIIN).
Passive
non-financial
institution
A non-financial institution that is in
receipt of passive income or holds
passive assets and does not fall under
any of the other FATCA classifications.
These entities does not perform the
business of a financial institution
A passive non-financial institution is an entity that primarily earns passive income
(e.g. interest, dividends, rents, royalties, etc.). An entity primarily earns passive
income if more than 50% of its gross income over the last three-year period is
passive income and where more than 50% of the entity’s assets produce, or are
held for the production of, passive income.
If you need more information, please visit the following websites
▪ DWT/IWT: http://www.sars.gov.za/
▪ FATCA: https://www.irs.gov/
▪ CRS: https://www.oecd.org/
Annexure ABefore we can enter into a transaction with you the Financial Intelligence Centre Act (FICA) as amended requires that we verify the identity of all members, directors and other representatives: ▪ Related party’s identity - we require a copy of your green bar-coded identity document/card (South African citizens) or a copy of a valid
passport (foreign nationals).
We require the following documents for legal entities:
Close corporations (CCs) – incorporated before the Act ▪ The Founding Statement and Certificate of Incorporation ▪ Where the CC has changed its members we require an amended Founding Statement stamped by the Registrar of Companies ▪ Proof of registered address ▪ A resolution on the CC’s letterhead signed by all members appointing the authorised signatories ▪ Identity documents for all members and authorised signatories ▪ Annexure B (attached to this application form) for all members and authorised signatories
Trusts ▪ The Trust Deed or a will in the case of a Testamentary Trust ▪ The Letter of Authority (if the trust is registered in South Africa) stamped by the Master of the High Court ▪ A resolution signed by all trustees appointing the authorised signatories of the Trust ▪ Identity documents for founders of the Trust, trustees, beneficiaries and authorised signatories ▪ Annexure B (attached to this application form) for founders of the Trust, trustees, beneficiaries and authorised signatories ▪ Where the founder or any trustee, beneficiary or any authorised signatory is deceased we require a copy of the death certificate. If a trustee
or signatory is deceased, we will need an updated letter of authority and resolution
SA companies ▪ Registration Certificate ▪ Where the company has changed its name we require the Certificate of Name Change ▪ Shareholder register ▪ Notice of registered office stamped by the Registrar of Companies and signed by the company secretary ▪ Where the company is a listed company we require proof of listing e.g. extract from Exchange’s website or license certificate or any other
automated verification provided by a reliable and independent third-party source ▪ A resolution on the company’s letterhead signed by all directors appointing the authorised signatories ▪ Identity documents for all directors, authorised signatories, CEO/MD and individuals holding 20% or more of the voting rights at a general
meeting ▪ Annexure B (attached to this application form) for all directors, authorised signatories, CEO/MD and individuals holding 20% or more voting
rights
Foreign companies ▪ Official documents from the foreign regulator witnessing incorporation, bearing the name, registered number and registered address ▪ Shareholder register ▪ A resolution on the company’s letterhead signed by all directors appointing the authorised signatories ▪ Identity documents for all directors, authorised signatories, CEO/MD and individuals holding 20% or more of the voting rights at a general
meeting ▪ Annexure B (attached to this application form) for all directors, authorised signatories, CEO/MD and individuals holding 20% or more voting
rights Partnerships ▪ A partnership agreement or signed letter from all the partners confirming the partnership ▪ A resolution signed by all partners appointing the authorised signatories ▪ Identity documents for all partners and authorised signatories ▪ Annexure B (attached to this application form) for all partners and authorised signatories
Other legal entities (e.g. clubs, associations, churches) ▪ The copy of the constitution or other founding documents for the legal entity ▪ A resolution signed by all members appointing the authorised signatories ▪ Proof of registered address ▪ Identity documents for the authorised signatories ▪ Annexure B (attached to this application form) for authorised signatories
Retirement funds ▪ Registration certificate from the Registrar of Pension Funds (FSCA) ▪ List of authorised signatories and specimen signatures ▪ Board resolution ▪ Identity documents for the authorised signatories ▪ Annexure B (attached to this application form) for authorised signatories
D D M M Y Y Y Y
Annexure B: Related party details if you are a natural personThe Financial Intelligence Centre Act 38 of 2001 as amended requires accountable institutions to verify the identity of their clients
and the South African Revenue Service (SARS) requires all financial services providers to collect tax information from their clients.
Please tick the boxes below to indicate the roles individuals play in your organisation. Each of these individuals must complete this
annexure (please attach copies of this section, if necessary):
Manager Member
Partner Authorised representative
Persons exercising executive control Natural person holding 20% or more of the voting shares
Trustee, beneficiary and/or founder of trust
Details of the related party
Title Surname
First name(s)
Date of birth Country of birth
ID number (passport number if foreign national)
Mobile Telephone (h)
Fax Telephone (w)
Residential address
Postal code
Postal address
If the same as the residential address, please tick this box
Postal code
I want secure online access to this investment Yes No
Politically exposed person
Are you a foreign prominent public official or a domestic prominent influential person? Yes No
If yes, please specify
Ultimate beneficial owner
The natural persons who directly or indirectly own 20% or more of the legal entity or who will ultimately derive economic benefit
from it. These are natural persons who ultimately control or have ultimate effective control of the legal entity.
Are you the ultimate beneficial owner? Yes No
Do you exercise control over the management of the legal entity? Yes No
D D M M Y Y Y Y
Tax information for the related party
Please list below each country in which you are a resident for tax purposes, as well as your associated tax identification
number or its
functional
equivalent.
Please refer to the ‘Tax guide’ if you need assistance with completing this section.
Please indicate the appropriate reason if you are not able to provide the tax identification number (TIN) or its functional equivalent
(FE).
▪ Reason A: I have never registered for a TIN/FE with my tax authority
▪ Reason B: I do not know my TIN/FE, but I will take steps to get this and submit it to Allan Gray
▪ Reason C: My tax authority does not require me to provide a TIN/FE (does not apply to South African or United States tax residents)
▪ Reason D: My country does not issue TINs/FEs to its tax residents (does not apply to South African or United States tax residents)
▪ Reason E: I am unable to obtain a TIN/FE
Is the related party a ‘US person’?
Do you have a United States tax number, residency or citizenship? Yes No
Declaration by the related party
Under penalties of perjury, I declare that I have examined the information completed in this annexure and, to the best of my
knowledge, believe it is true, correct, and complete.
Signature Date
A B C D E
A B C D E
A B C D E
Country Tax identification number (TIN) Reason for no TIN
D D M M Y Y Y Y
Annexure B: Related party details if you are a legal entityThe Financial Intelligence Centre Act 38 of 2001 as amended requires accountable institutions to verify the identity of their clients
and the South African Revenue Service (SARS) requires all financial services providers to collect tax information from their clients.
Details of the related party
Capacity
Registered name
Date of inception Country of inception
Registration number
Telephone (w) Fax
Registered address (Head office)
Postal code
Postal address
If the same as the registered address, please tick this box
Postal code
I want secure online access to this investment Yes No
Politically exposed person
Is the application being made on behalf of a legal entity where the authorised representative(s), ultimate beneficial owner(s) or any
stakeholder of the applicant is a foreign prominent public official or a domestic prominent influential person? Yes No
If yes, please specify
Bearer shares (only applicable to companies)
Bearer shares are physical share certificates that grant the holder ownership of a company.
Does the company have the ability to issue bearer shares? Yes No
If yes, has the company issued any bearer shares? Yes No
Tax information for the related party
Please list below each country in which the legal entity is a resident for tax purposes, as well as the associated tax identification
number or its functional equivalent. Please refer to the ‘Tax guide’ if you need assistance with completing this section.
Please indicate the appropriate reason if the legal entity is not able to provide the tax Identification number (TIN) or its functional
equivalent (FE).
▪ Reason A: The legal entity has never registered for a TIN/FE with the tax authority
▪ Reason B: I do not know the legal entity’s TIN/FE, but I will take steps to get this and submit it to Allan Gray
▪ Reason C: The tax authority does not require the legal entity to provide a TIN/FE (does not apply to South African or United States
tax residents)
▪ Reason D: The country does not issue TINs/FEs to its tax residents (does not apply to South African or United States tax residents)
▪ Reason E: I am unable to obtain the legal entity’s TIN/FE
A B C D E
A B C D E
A B C D E
Country Tax identification number (TIN) Reason for no TIN
Legal entity classification for the related party
A legal entity must be classified as a financial institution or as a non-financial institution. Please tick the boxes below to indicate
the legal entity classification:
Financial institution. Please provide us with your GIIN . . .
If the legal entity is a financial institution but does not have a GIIN, please tick the appropriate box below:
The financial institution is an ‘exempt beneficial owner’
The financial institution is a ‘non-participating financial institution’
The financial institution is a ‘deemed compliant financial institution’
If the legal entity is a non-financial institution, please tick the appropriate box below:
An ‘active non-financial institution’
A ‘passive non-financial institution’
Is the related party a ‘US person’?
Does the legal entity have a United States tax number, residency or citizenship? Yes
No
Declaration by the related party
Under penalties of perjury, I declare that I have examined the information completed in this annexure and, to the best of my
knowledge, believe it is true, correct, and complete.
Signature of authorised representative Date D D M M Y Y Y Y
