WITHDRAWAL FORM Application to make a withdrawal - Afken-Home

WITHDRAWAL FORM Application to make a withdrawal - Afken-Home

WF 09/07 WITHDRAWAL FORM Application to make a withdrawal from a Discovery Endowment Policy 155 West Street, Sandton PO Box 3888, Rivonia 2128 Tel: 0...

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WF 09/07

WITHDRAWAL FORM Application to make a withdrawal from a Discovery Endowment Policy 155 West Street, Sandton PO Box 3888, Rivonia 2128 Tel: 0860 00 LIFE (0860 00 54 33) www.discovery.co.za

REG NO 1966/03901/06

Email [email protected]

Discovery Life is an authorised financial services provider.

YOU CAN USE THIS FORM TO MAKE ONE OF THE FOLLOWING TRANSACTIONS 1. Make a partial withdrawal from the fund value of your Discovery Endowment Policy 2. Withdraw the full fund value of your Discovery Endowment Policy which will also terminate the policy. If you terminate your Discovery Endowment Policy and your policy is linked to your LIFE PLAN or Discovery retirement Optimiser, you must tell us if you are only terminating the policy or also the LIFE PLAN.





Part-withdrawal or If full withdrawal:



Full withdrawal Termination of Endowment Policy only or

Termination of both Endowment Policy and LIFE PLAN

HOW TO COMPLETE THIS FORM 1. 2. 3. 4. 5.

Please ensure that you receive a blank form and that none of the sections have been completed. Please complete all the sections in full. Please complete one letter per block in black ink. Please make a cross (X) where you need to select an option. If you make any changes to any of the information already completed on the form, please ensure that the policy owner initial the change before submitting the form. Please return the completed form to Discovery Life. Please ensure that your financial adviser keeps a copy of the form.

PLEASE FAX THE COMPLETED FORM TO DISCOVERY LIFE ON 0860 54 33 39 OR (011) 539-2009

1. DETAILS OF OWNER Title

Surname

First name(s)

Initials

Company/Trust name ID or passport number Telephone (H)

(W)

Fax

Cell

Email address Postal address

Code

If the policy is owned by a trust, please provide the following documents:

If the policy is owned by a company or close corporation, please provide the following documents:

• The trust deed

• A  copy of the company or CC registration listing the registered directors/partners

• A  current and valid letter of appointment issued by the Master of the High Court, setting out who has been appointed as trustee • A  resolution signed by the designated trustees, authorising certain trustee(s) to act on behalf of the trust. This is required when the document will not be signed by all the trustees Page 1 of 4

• A  resolution signed by registered directors or partners authorising certain director(s) or partners to act on behalf of the company or CC. This is required when the document will not be signed by all the appointed directors or partners • A certified copy of ID of the authorised signatory 79735

2. DETAILS OF POLICY Policy number Has this policy been ceded or is it subject to any other encumbrance✝✝?

YES

NO

If YES, please specify

Important: If the policy has been ceded, the following will apply: • If the policy has been ceded in terms of an ante-nuptial contract, the spouse must co-sign this form. • If the policy has been ceded as collateral, the cessionary doesn't need to sign the document, but must be notified of the withdrawal. • If the cession was an absolute cession, only the cessionary (new owner) can sign this document. If the previous cession on the policy has been cancelled, proof of the cancellation of the cession must accompany this form. ✝✝ Refer to 'Notes' or page 4 of this form.

3. DETAILS OF WITHDRAWAL Withdrawal of full fund value I/we request Discovery Life to repurchase all units from my/our policy. I understand that my policy will be terminated. Withdrawal of portion of fund value I/we request Discovery Life to repurchase all units from my/our policy.

Please select a rand amount OR number of units OR a percentage of the value of the fund(s) you want Discovery Life to repurchase units from: Fund name

Rand amount

Number of units

Percentage (%)

4. POLICY OWNER’S BANKING DETAILS IMPORTANT: 1. It is essential that you provide us with the correct banking details into which Discovery Life must pay the withdrawal amount. Discovery Life will not be legally responsible if you supplied us with incorrect banking details. 2. If the bank account details have changed from what Discovery Life has on record, Dicovery Life can only make a payment once you provide us with the new banking details and proof of the bank account in the form of a cancelled cheque or bank statement not older than three months. 3. For security reasons, we only make payments into the policy owner’s bank account. 4. Discovery Life will not make a payment to third parties, home loans, credit cards or investment accounts. 5. Payment will only be made by electronic funds transfer. No cheque payments will be made. Name of account holder in full Name of bank Branch name Branch code Account type Account number Page 2 of 4

5. PROCEDURES Please read the following carefully. This explains the procedures and processes that will impact the withdrawal from your investment: 1. Discovery Life will not attend to the request to withdraw from your investment unless we receive a fully completed form. 2. If we receive a valid and fully completed request to withdraw on a specific date, the unit prices we use to determine the value of the withdrawal will be those as at the evening before Discovery Life received a fully completed withdrawal form and when all the outstanding requirements have been met. If we receive your instruction on a weekend or public holiday, the prices of the next working day will apply. 3.

Payment will normally be made within five working days after receipt of a valid withdrawal form. However, the payment could be delayed with the time banks require for clearing cheques, direct deposits and debit-orders. This is as follows: • Cheques and direct deposits: 21 days • Debit orders for recurring premiums: 45 days • Debit order for a once-off payment: 60 days

4. If you cancel the debit order on the policy and stop paying premiums, Discovery Life will apply the same conditions and terms to the repurchase of units delayed by the above clearance periods, as applicable to the original repurchase. 5. Discovery Life requires you to change or cancel any debit order on the policy in writing. We can only affect the request to change or cancel a debit order 30 days after receipt of the written request.

6. RESTRICTIONS ON WITHDRAWALS The following restrictions apply to withdrawal from an endowment policy. These are mainly regulated by legislation: 1. You are only allowed to make one withdrawal from an endowment policy in the first five years of the policy. This could be a full or partial withdrawal. However, even if you only make a partial withdrawal, you will not be allowed to make another withdrawal before the end of the original five-year term. 2. The amount you may withdraw from the policy in the first five years is limited: a. The amount you withdraw may not exceed the total of all premiums paid increased with interest compounded at 5% per year. Please note that this amount could be different from the actual withdrawal value✝✝ on your policy, which is determined by the value of the underlying units of the portfolios in your investment fund. b. If the difference between your actual withdrawal value and the amount determined in terms of the maximum you are allowed to withdraw is less than R2 500, you may withdraw the full amount. c. If the difference between the actual withdrawal value and the total of all paid premiums plus compound interest✝✝ of 5% per year is more than R2 500, you will only be able to access the rest of the withdrawal value after five years. 3. If you stopped paying premiums previously and the policy was made paid-up, the withdrawal value will be based on the paid-up value at the time, which in turn might have been limited to a percentage of your fund value. This has been explained in your policy contract. You are not allowed to make any withdrawal from a retirement annuity before the age of 55, unless you suffer ill-health. If you want to access your Discovery retirement Optimiser or Retirement Annuity after the age of 55, the process involves early access to the maturity benefits. This form does not effect such a request, and you are requested to please consult your financial adviser in this regard or phone Discovery Life on 0860 00 54 33. ✝✝ Refer to 'Notes' or page 4 of this form.

7. CONDITIONS AND TERMS 1. Discovery Life will not be legally responsible for any losses incurred during the time it takes to action this withdrawal form. 2. Discovery Life will not be legally responsible for any losses incurred due to incorrect information supplied by either the policy owner or financial adviser. 3. Even if Discovery Life quoted you a withdrawal value on a specific date, the actual value that will apply to the withdrawal is determined by the portfolio value as at the evening before Discovery Life received a fully completed withdrawal form.

8. COMPLAINT’S PROCEDURE If you have any query or complaint regarding your policy or the withdrawal value or process, please discuss it with your financial adviser first. If the matter is not handled to your satisfaction, or is not related to any advice you received, please contact our compliance department at [email protected] discovery.co.za or on (011) 529 1321 or Discovery Life contact centre on 0860 00 54 33. If your complaint is not resolved to your satisfaction by Discovery Life, you may contact the under-mentioned bodies for assistance: Long-term Insurance Ombudsman The Honourable Judge Brian Galgut Private Bag X45, Claremont 7735 Sanclare Building, 3rd Floor 21 Dreyer Street, Claremont, Cape Town, 7700 (021) 657 5000 / 0860 103 236 [email protected] www.ombud.co.za Page  of 4

The FAIS Ombud Charles Pillai Celtis House, Eastwood Office Park Lynnwood Road, Pretoria PO Box 74571, Lynnwood Ridge 0040 (012) 470 9080 / (012) 428 8000 [email protected] www.faisombud.co.za

9. POLICY OWNER DECLARATION 1. I/we declare that we are the legal owner(s) of the policy. 2. I/we declare my/our estate has not been declared insolvent. 3. I/we confirm that we only signed this form after all the required details have been completed. 4. I/we acknowledge that Discovery Life will not be held liable for any adverse market conditions. 5. I/we am/are made my/our own independent decision as to whether to make this withdrawal from my/our investment. 6. FICA a. I/we hereby agree to provide all documentation and information required in terms of the Financial Intelligence Centre Act (No 38 of 2001). b. I/we understand that Discovery Life is prohibited from processing this transaction until such documentation and information has been received. 7. I/we acknowledge that my/our cellphone number and email address as provided at “Details of Owner” (Section 1) may be used for communication by Discovery Life. 8. I/we accept that if any money, plus accrued interest is payable to me/us, Discovery Life will determine the interest rate in accordance with its business practice. Policy owner signature

Co-owner signature

Date Y Y Y Y M M D D

Date

Y Y Y Y M M D D

✝✝ Refer to 'Notes' or page 4 of this form.

10. FINANCIAL ADVISER DETAILS I am a registered representative and represent a Financial Services Provider authorised by the Financial Services Board in terms of the Financial Advisory and Intermediary Services Act No. 37 of 2002. 1. Principal financial adviser Code Financial adviser house

Code

Discovery Consulting Services branch and consultant

Code

Bank reference number (if applicable) Work number

(Mandatory for all ABSA and FNB intermediaries.) Cell number

Signature of financial adviser

Email

Date signed Y Y Y Y M M D D

FICA declaration I warrant and confirm that I have established and verified the identities of the applicant(s), insured lives, premium payer(s), agent(s) and cessionary(ies), where applicable, with regard to this application/contract in terms of the Financial Intelligence Centre Act, 2001, read together with the Money Laundering Regulations. YES

NO

I have seen the original and attach the required FICA documents to this application.

NO

YES

✝✝ NOTES: 1. Encumbrance This means where somebody else or an institution has a claim on your endowment policy. This might happen for example when you cede your policy as security for a mortgage bond or for another type of loan. 2. Compound interest This is where interest is paid on top of the interest earned in the previous year. 3. How Discovery Life determines the withdrawal value: a. Market-linked Fund: To determine the withdrawal value of the part of your policy you have invested in the Market-linked Fund, Discovery Life multiplies the number of units you have in the different market-linked investment portfolios as at the evening we receive the Withdrawal Form with the unit prices of the different investment portfolios on that evening. b. Guaranteed-linked Fund: To determine the withdrawal value of the part of your policy you have invested in the Guaranteed-linked Fund, Discovery Life calculates the value of the premiums you paid plus accumulated interest. Page  of 4