CLIENT DECLARATION FOR ONLINE INVESTMENT WITH OLD MUTUAL UNIT TRUSTS

This document contains the relevant disclosures for a standard unit trust investment received from
MISS. L.R MANAME (9507060515082) via
Old Mutual Unit Trusts’ direct application system on 13 Aug 2018 . Please sign and return this form to us along with copies of your supporting documents via
email or fax by 18 Aug 2018 .
Email to: [email protected] Fax to: +27 (0)21 509 7100

Details of your investment

Unit trust selection Investment Rand value Selected date Escalating at Distributions
type of debit order
Old Mutual Stable Growth Fund A Monthly recurring 500 2018-09-15 2% p.a. Reinvest

The transaction reference on your bank statement for this instruction will be OM UNITTRU followed by your unit trust fund account number.

Please read and sign this declaration

Please tick relevant block
I am solely responsible for my investment choices and their associated outcomes, and confirm that I have entered into this transaction:
Directly via the online application form on the Old Mutual Unit Trust website www.omut.co.za, or via a recorded call to the Unit Trust Service Centre
on 0860 234 234.

Telephonically, via a recorded call, with the assistance of an Old Mutual consultant.
Tax Residency Detail
As a financial institution we are obliged to comply with international agreements signed by our government aimed at combatting tax evasion. In terms of these agreements,
we are required to collect information regarding where you are resident for tax purposes including the related tax reference numbers. If you are resident for tax purposes
in a country other than South Africa, certain of your information will be reported to SARS who will automatically share this information with the participating countries
where required.
Each country has its own rules for whether a person is resident for tax purposes or not. It is possible to be resident for tax purposes in more than one country. Depending
on the rules of the country, tax residency may be determined by factors such as where you permanently live, where you were born, or if you live and work in the country
for more than half the year. If you are a US citizen or hold a US passport or green card, you will also be considered resident for tax purposes in the US even if you live
outside the US, unless you have given up your citizenship.
Please answer the following questions and complete your tax reference number(s) in the table below, along with details of your identifications and any other nationality or
citizenship, providing identification for each country for which you are a resident for tax purposes.

Income tax reference

number (TIN)
(* mandatory - If you do not have
an Income Tax reference number
Country of tax please select reason code (A/B/C) Foreign ID/
Yes No residence in table below) passport of country ID type
Are you a resident for Tax purposes in South Africa?
Are you a citizen and/or tax resident of the United States
of America?
If “Yes”, please provide the following information
Are you a resident for tax purposes in any other country?
If “Yes”, please provide the following information
Country 1
Country 2
Country 3
TIN reason code table

Reason Description Please tick ( ) Why is TIN unobtainable

A The country/jurisdiction does not issue TINs to its residents
The Account Holder is otherwise unable to obtain a TIN or
B equivalent number (Please explain why you are unable to obtain a
TIN if you have selected this reason)
No TIN is required. (Note. Only select this reason if the domestic
C law of the relevant jurisdiction does not require the collection of the
TIN issued by such jurisdiction)

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 CLIENT DECLARATION FOR ONLINE INVESTMENT WITH OLD MUTUAL UNIT TRUSTS

Investors in Shari’ah-compliant unit trusts (Old Mutual Albaraka Equity Fund and Old Mutual Albaraka Balanced Fund), read and sign
this section as well.
• I acknowledge that I have opted to invest into a Shari’ah-compliant unit trust, which means that it will be managed in accordance with the guidelines of the Shari’ah
Supervisory Board and having regard to the Shari’ah Standards of the Accounting and Auditing Organisation for Islamic Financial Institutions (AAOIFI).
• I agree that any income deemed to be non-permissible by the Shari’ah Supervisory Board will be paid to the charitable trust elected by the Shari’ah Supervisory
Board in line with the principles of Shari’ah and the supplemental deed of the unit trust.
• I acknowledge that this does not form part of my income and will not reflect on my tax certificate.
• I take note that in some instances, income may be reflected as “interest income” in line with current tax practices on my tax certificate, but accept that such income
is fully Shari’ah compliant and has been approved as such by the Shari’ah Supervisory Board.

D D M M C C Y Y

Date Signature of investor

Protection of Personal Information

Old Mutual would like to offer you ongoing financial services and may use your personal information to provide you with information about product or services that
may be suitable for your financial needs.

Please indicate here if you do not wish to receive this.

We may use your information or obtain information about you for the following purposes:
• Fraud prevention and detection
• Market research and statistical analysis
• Audit & record keeping purposes
• Compliance with legal & regulatory requirements
• Verifying your identity
• Sharing information with service providers we engage to process such information on our behalf or who renders services to us.
You may access the personal information that we hold and request us to correct any errors or to delete this information. To view our full privacy notice and to exercise
preferences, visit our website on www.oldmutual.co.za.

Disclaimer
We aim to treat our clients fairly by giving you the information you need in as simple a way as possible to enable you to make informed decisions about your investments.
• We believe in the value of sound advice and so recommend that you consult a financial adviser before buying or selling unit trusts. You may however, buy and sell
without the help of a financial adviser. If you do use a financial adviser, we remind you that they are entitled to certain negotiable adviser fees or commissions.
• You should ideally see unit trusts as a medium to long term investment. The fluctuations of particular investment strategies affect how a fund performs. Your fund value
may go up or down. Therefore, we cannot guarantee the investment capital or return of your investment. How a fund has performed in the past does not necessarily
indicate how it will perform in the future.
• Our cut-off time for client instructions (e.g. buying and selling) is at 15:00 each working day for all funds, except the Money Market Funds, which is at 13:00. These
are also the times we value our funds to determine the daily ruling price (other than at month-end when we value the Old Mutual Index Funds and Old Mutual Multi-
Managers Fund of Funds ranges at 17:00 close). Daily prices are available on our public website (www.omut.co.za) and in the media.
• The daily ruling price is based on the current market value of the fund’s assets plus income minus expenses (NAV of the portfolio) divided by the number of units in issue.
• The fund fees and costs that we charge for managing your investment is accessible on the relevant fund’s minimum disclosure document (MDD) or Table of fees and
charges, both available on our public website (www.omut.co.za), or from our contact centre (0860 234 234).
• Additional information on this proposed investment can be obtained, free of charge, from our public website or our contact centre.
• Funds may borrow to pay client disinvestments and may engage in scrip lending. A process of ring-fencing of withdrawal instructions and managed pay-outs over time
may be followed should excessive withdrawals from a fund place the fund under liquidity pressures.
• Old Mutual Unit Trusts has the right to close a portfolio to new investors in order to manage it more efficiently in accordance with its mandate.
• Old Mutual Unit Trust Managers (RF) (Pty) Ltd is a registered manager in terms of the Collective Investment Schemes Control Act 45 of 2002.
• Old Mutual is a member of the Association for Savings & Investment South Africa (ASISA).
Money Market Funds:
A Money Market Fund is not a bank deposit account. Its unit price aims to be constant but investment capital is not guaranteed. The total return is primarily made up of
interest (declared daily at 13:00) but may also include any gain/loss on any particular instrument. In most cases this will merely have the effect of increasing or decreasing
the daily yield, but in the case of abnormal losses, it can have the effect of reducing the capital value of the fund. The published yield is calculated using the average of
the fund’s previous seven days’ net income (and assumes all income was reinvested). This figure is then annualised, which is the weighted average compound growth rate.
Income Funds:
Income funds derive their income primarily from interest-bearing instruments as defined. The published yield is a current yield and is calculated daily. The value of underlying
assets of Income funds are marked to market on a daily basis.
Fund of Funds:
A fund of funds is a portfolio that invests in other funds in order to meet the investment objective of the fund of funds. Fund of funds can invest in local, foreign or offshore
funds which levy their own charges, and may result in a higher fee structure.
Feeder Funds:
A feeder fund is a portfolio that invests all of its capital in a single underlying fund. This underlying fund can be a local, foreign or offshore fund and levy its own charges
which may result in a higher fee structure.
Third-Party Named Funds (co-branded):
Old Mutual Unit Trust Managers (RF) (Pty) Ltd is the manager of Adviceworx and Old Mutual Multi-Managers suites of co-branded funds and retains full legal accountability.
Funds holding foreign assets:
Some funds hold assets in foreign countries and therefore may have risks, in these countries, regarding liquidity, the repatriation of funds, political and macro-economic
situations, foreign exchange, tax, settlement and the availability of information.

Page 2 of 3
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 CLIENT DECLARATION FOR ONLINE INVESTMENT WITH OLD MUTUAL UNIT TRUSTS

Declaration
Signed by Investor or appointed person acting on behalf of the Investor as completed on Page 2 of this form.
• I agree to accept the number of units sold to me by virtue of this application and I warrant that I have full power and authority to enter into and conclude this
transaction, with the necessary assistance where such assistance is a legal requirement.
• I am aware that this product offers no cooling-off rights.
• I know that the cost of buying units may include an initial charge plus VAT, depending on the amount invested and whether or not I use an intermediary, and that
there are no guarantees on my capital.
• I acknowledge that there are further allowable deductions from the unit trust/s (e.g. an annual service fee) that impact on the value of my investment. I am satisfied
that the facts provided are accurate and complete. I am aware of the unit trust’s/unit trusts’ objectives, risk factors, the charges and income distributions, as set
out in the unit trust fund fact sheet/s.
• I acknowledge that Old Mutual Unit Trust Managers (RF) (Pty) Ltd may borrow up to 10% of the portfolio to bridge insufficient liquidity.
• I have read and fully understood all the pages of this application form.
• I hereby authorise Old Mutual Unit Trust Managers (RF) (Pty) Ltd to debit the account mentioned above with the monthly amount/lump sum specified.
• I further authorise Old Mutual to accept instructions from me via facsimile (please delete if not applicable).
• We aim to treat our clients fairly by giving you the information you need in as simple a way as possible to enable you to make informed decisions about your
investments.
• I am aware that I may view the Effective Annual Cost (EAC) of my investment on www.omut.co.za. Once my investment has been processed, Old Mutual Unit Trust
Managers (RF) (Pty) Ltd will confirm the EAC to me in writing.
• I have read and am aware of the unit trust’s/unit trusts’ objectives, risk factors, the charges and income distributions, as set out in the unit trust fund fact sheet/s
(Minimum Disclosure Document).
• I warrant that all the information given in this form, and in the additional documentation specifically requested by Old Mutual Unit Trust Managers (RF) (Pty) Ltd,
as well as in any documentation which will be or has been supplied and signed by me in connection with this form, is true and correct and as per my instructions,
whether in my handwriting or not.
• I undertake to advise Old Mutual Unit Trust Managers (RF) (Pty) Ltd within 30 days should information contained in this form change.
• I understand that Old Mutual Unit Trust Managers (RF) (Pty) Ltd may be legally obliged to disclose information in this form and in any other documentation supplied
in connection with this contract to the South African Revenue Services and other legal authorities.

D D M M C C Y Y
Signed at (place) on (date)

Signature of contracting party Signature of contracting party

Contact Details

Old Mutual Unit Trust Managers (RF) (Pty) Ltd Old Mutual Investment Administrators (Pty) Ltd
(Registration no. 65/08471/07) (Registration no. 1988/003478/07)
Mutualpark, Jan Smuts Drive, Pinelands 7405, South Africa Mutualpark, Jan Smuts Drive, Pinelands 7405, South Africa
PO Box 207, Cape Town 8000, South Africa PO Box 5408, Cape Town 8000, South Africa
Telephone no.: +27(0)21 503 1770 Telephone no.: +27(0)21 503 1770
Helpline: 0860 234 234 Fax no.: +27(0)21 509 7100
Fax no.: +27(0)21 509 7100
Compliance Department: +27(0)21 503 1770
Internet address: www.omut.co.za
Email: [email protected] Professional indemnity cover and fidelity insurance cover are in place.

Complaints: Complaints may be directed to the Client Relationship Manager Old Mutual Investment Administrators (Pty) Ltd is a third party
at the above address. Our complaints process is available via our website administration and service provider to Old Mutual Unit Trust
www.omut.co.za or by contacting 0860 234 234. Managers (RF) (Pty) Ltd and is a licensed financial services provider.

Compliance Department: +27(0)21 503 1770

21022017