Addendum to Application to sell foreign currency

Cross border foreign exchange transaction reporting

(Bank purchase from customer)

This form must be completed in conjunction with form 00039055 (Application to sell foreign currency) attached
A separate form 00039055 is required for each foreign cheque, draft and traveller’s cheque
Please process on collection basis / Foreign cheques drawn in foreign currency Drafts drawn in foreign currency / Traveller’s cheques
Account to be credited or debited as detailed out in the below General Conditions section
Account name / Account number
Type of account / If a Customer Foreign Currency (CFC) account, specify currency
Conversion or Currency Exchange instructions (Quote Forward Exchange Contract / SPOT details, if applicable)
Contact details
Contact name / Contact number
Details of instruments (meaning foreign cheques, drafts and traveller’s cheques) to be processed on collection basis
Drawer of foreign cheques or drafts or name of traveller’s cheques company / Cheque serial number including any prefixes / Bank and Branch / Currency / Amount
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General Conditions
I (meaning the duly authorised signatory and/or account holder) hereby request The Standard Bank of South Africa Limited (“Standard Bank”) to process on collection basis and present for collection and clearance the foreign cheque(s) drawn in foreign currency and/or drafts drawn in foreign currency and/or traveller’s cheques as listed above (the “instrument(s)”). I acknowledge that any charges associated with the conversion and clearance of such instrument(s) will be deducted by Standard Bank from the instrument(s) amount prior to crediting my nominated bank account. I accept that Standard Bank will not be able to advise the date when the proceeds of the instrument(s) (the “funds”) and converted amount will be credited into my nominated bank account, until the drawer’s bank advises and avails the funds to Standard Bank. I hereby acknowledge that Standard Bank will not be liable for omissions or delays in transmission of funds arising from circumstances beyond its control.
I indemnify and hold Standard Bank harmless against any losses or damages of whatsoever nature (whether direct, indirect and/or consequential) including reputational damages caused by or arising from Standard Bank’s agreement to enter into the collection arrangement. Should any or all instrument(s) come back unpaid up to 3 (three) years for United States instrument(s) and 7 (seven) years for United States Treasury instrument(s) respectively including any or all instrument(s) previously believed to have been cleared, I irrevocably authorise Standard Bank to debit my nominated bank account with the local currency equivalent to the instrument(s) returned unpaid. Standard Bank’s sight selling rate on the date of debiting of my nominated bank account will apply in the event of any of the above-mentioned instrument(s) being returned unpaid and any losses suffered by Standard Bank or costs associated with the unpaid instrument(s) will be for my account and debited against my nominated bank account accordingly. While acting in good-faith and with reasonable care, Standard Bank will not be responsible for ensuring that I have lawful title to the instrument(s) presented to Standard Bank and it will at no time guarantee payment and clearance or confirm that any instrument(s) will not be unpaid post receipt of funds. Whilst making every effort to ensure safekeeping, Standard Bank cannot be held responsible for instrument(s) lost, stolen or destroyed while in any stage of collection. I understand that Standard Bank expects information furnished by me to be true and correct and has no duty or responsibility to verify such information.
I accept that the onus is on me to ensure that the person or company which tendered the instrument(s) to me had the legal capacity to tender the instrument(s) as payment(s) and I bear all risks associated with any and all fraudulent instrument(s). The instrument(s) presented by me to Standard Bank will be subject to the regulation(s) and legislation(s) applicable to the instrument(s) from time to time. I understand that I have to complete and sign a separate indemnity in the event of me presenting United States Treasury instrument(s) for collection.
Signature(s) – Authorised Signatures must match specimens on record at Standard Bank
For and on behalf of : / Signature(s) /

Date stamp

00143352 20 June 2013 The Standard Bank of South Africa Limited Reg. No. 1962/000738/06 Registered Bank

Please use this form in conjunction with form 00143352 (foreign cheque deposit form) for foreign cheque deposits
Select type of transaction / Inward Telegraphic TransferForeign Bill for CollectionLetter of CreditForeign Cheque deposited (for collection)
Customer details and account to be credited
Name and surname of individual or name of entity / For individuals, select gender / Male Female
Physical address including suburb, city and province / Suburb: / City: / Province: EC - Eastern CapeFS - Free StateGP - GautengZN - Kwa-Zulu NatalLP - LimpopoMP - MpumalangaNC - Northern CapeWC - Western Cape
Postal address / Postal code:
Registration no./ identity no./ temporary resident permit no.)
Contact name (name and surname), telephone, fax no. and e mail address of applicant / Contact name (if entity) : / Telephone :
Fax : / e-mail :
Individual / Entity / EntityIndividual / For Individuals – insert date of birth / (yyyy-mm-dd)
Tax number of applicant / VAT Number
Industry sector code / 01 - Financial Corporate02 - Non Financial Corporate03 - General Government04 - Household / Industrial classification number / 01-Agri Hunt Forest Fis02 - Mining & Quarrying03 - Manufacturing04 - Electric Gas Water05 - Construction06 - Wholesale Retail Tra07 - Transp Storage Comms08 - Fin Intermediation09 - Community Social Per10 - Private Household
Bank name
Account number / Branch number
Type of account to be credited / Current / Savings / Investment / Foreign Currency account (CFC) / If CFC account, specify the currency
Transaction and conversion details
Value date (yyyy-mm-dd) / Currency / Amount received
Exchange rate / Spot Cover or FEC number(s)
Details of transfer / Country of destination of goods (exports)
If export, list product(s)
Exporters Customs Code Number (CCN) / format: 12345678
Exchange Control
approval obtained / Yes No / SARB authority no. / e-docs No.
Internal authority number / Date
Remitter details
Full name of remitter / For individuals – select gender
Male Female
Remitter’s physical address / Suburb: / City:
Country: / Individual, Entity / IndividualEntity
Balance of payment (BOP) details - BOP categories and sub-categories’ list is available on our website www.standardbank.co.za/bizconnect
Note - For payments on behalf of third parties, please complete Addendum to this Application.
BOP / Composite transactions / Section of the rulings / If loan, loan ref no. / Tenor of loan / Interest rate / Unique Consignment Ref No. if applicable (UCR)
Category / Sub-category / / / Amount : / %
Category / Sub-category / / / Amount : / %
Category / Sub-category / / / Amount : / %
Category / Sub-category / / / Amount : / %
If BOP Category selected above is 830 (other), please provide details
Declaration and acknowledgement
I/We wish to sell foreign currency as indicated above and declare that the information provided by me/us is in all respects both true and correct. I/We hereby acknowledge that Standard Bank will not be liable for omissions or delays in transmissions arising from circumstances beyond it’s control. I/We understand that it is my/our responsibility to inform Standard Bank of all changes to my/our details and/or changes to the details of the entity on whose behalf I/We are acting, whether it be contact details or any other relevant changes.
I/We, hereby further declare that:
- I/We have read this document and understand the contents hereof;
- The currency received will only be used for the purpose stated herein;
- The documentation presented in support of this application is in all respects authentic;
- I/We have been informed of the limits applicable to the above transaction and confirm that this limit will not be exceeded as a result of the conclusion of the transaction; and
- I/We consent to this information being provided to the South African Revenue Service and/or Financial Intelligence Centre.
Signature (Signatures must match specimens on record at the bank)
For and on behalf of / Signature of applicant/ authorised signatory (ies) / Date (yyyy - mm - dd )

00039055 20 June 2013V3 The Standard Bank of South Africa Limited Reg. No. 1962/000738/06 Registered Bank


Addendum to Application to sell foreign currency

Cross border foreign exchange transaction reporting

(Bank purchase from customer)

Please complete details of third parties on whose behalf you are acting. Please complete a separate page for each third party
Name and surname of individual or name of entity
Identity / registration / permit number (permit number only for foreign nationals temporarily resident in South Africa)
For individuals - please select appropriate gender / Male Female
For individuals – please provide date of birth
Physical address (not Postal address) / Address line 1:
Address line 2: / Suburb:
Province: / Country:
Postal address / Postal address line 1:
Postal address line 2:
Postal code:
Third party tax number / Third party VAT number
Name of contact person (if entity)
Third party Customs Client Number (CCN)
Third party contact details / Telephone number:
Email address:

00039055 20 June 2013V3 The Standard Bank of South Africa Limited Reg. No. 1962/000738/06 Registered Bank