F8 : 3

HOW TO COMPLETE THE EXCHANGE

CONTROL QUESTIONNARIE

Do not complete SECTION A, the fun will supply this information.

SECTIONBhastobecompletedbyyoutheapplicantIbeneficiary.

Fromquestions1-3youhavetoselectONLYONEofthethree

questionsandcompleteitfully

ALLthequestionsonthebackoftheformhavetobecompleted.

Ifyoucan'tremember,arenotsureordon'tknow,you should indicate

itonthequestionnairei.e.notsureordon'tknowandnot leave

answerspaceblank.

PLEASENOTETHATNOTIPPEXORALTERATIONSWILLBE

ACCEPTEDONTHEEXCHANGECONTROLQUESTIONNAIRE.

Wetrusttheaboveisofassistance.

F8 : 2

1

INFORMATIONREQUIREDBYTHEEXCHANGECONTROLAUTHORITIES:

Asyouarenowresidentoutside themonetaryareaoftheRepublicofSouthAfrica,andinordertosatisfyGovernmentRegulations,thefollowinginformationisrequiredbeforewecantransferfundstoyourorder:

SectionA

Pension / Providentfullname:______

Pension / ProvidentFundNumberorIdentityNumber:______

Fullnamesofbeneficiary:______

Amountduetothebeneficiary:______

Monthly / Quarterly / Half-yearpension / LumpSum:______

AmountDuetobeneficiaryinrespectofarrearpension

Payments:______

Periodduringwhichthearrearshaveaccrued:______

Section B – Declaration by beneficiary:

1.Fullnames(Mr/Mrs/Miss)(Initialsarenotacceptable) :______

2. PresentAddress:______

:______

3. StateCountryofwhichyouareapermanentresident.:______

4. DateofyourarrivalinSouthAfrica:______

5. Thedateofpermanent departurefromSouthAfrica:______

PLEASESELECTTHE APPLICABLE OPTION:

  1. If youhaveemigratedfromtheRepublicofSouthAfrica,pleasestatethefollowing:

a)Dateofemigration

b)FullnameandaddressoftheSouthAfrican Bank:______

thatattendedtoyouremigration:______

c)amountofforeignexchangereceivedat

timeofemigration(ifNil,pleasestate):______

d)listofremainingblockedSouthAfrican

assets(ifNil,pleasestate):______

e)(formarriedwomenonly)Thefullnames

ofyourhusband.(Initialsarenotacceptable):______

  1. If youareaSouthAfricanCitizenwhoistemporarilyresidentoutsideoftheRepublic,pleasestatethefollowing:

a)Dateofdeparture:______

b)Intendeddateofreturn:______

c)ReasonforabsencefromtheRepublic:______

d)Amountofforeignexchangereceivedatand / orsinceyourdeparture

byyourselfand / oryourwife / husband:______

e)Nameandaddressofbankthatarrangedthe

TransferofFunds:______

  1. IfyouwerenotborninSouthAfricai.e.ifyouimmigratedtoSouthAfricaandhavenowreturnedabroad,pleasestatethefollowing:

a)ThecountryfromwhichyouemigratedtoSouthAfrica:______

b)Dateofarrivalin SouthAfrica:______

c)If yourimmigrationwasplacedonrecord,:______

pleasegivethenameandaddressofthe:______

SouthAfricanBank which attended this:______

on your behalf:______

d)IfyouimportedfundsintoSouth Africaatthe

timeofarrival,orthereafter,pleasestatethe

amountofforeigncurrencyimported:______

2

Thefollowing questionsmustbeansweredbyALLapplicants:

  1. Fromwhichcountrywerethepensionfund

Contributionspaid?:______

  1. Ifthecontributionshaveatanytimesince

Emigration beenpaidfromfundsinSouthAfrica,

fromwhatsourcewasthemoney obtained?:______

  1. State(ifpossible)

a)Dateofcommencementofcontributions

tothe Pension / providentfund. :______

b)Wherewereyouresidentatthetime? :______

  1. Currencyofbenefits?:______
  2. Yournationality: South African______
  3. Whymoneyisbeingremitted? :______
  4. Whatamountofforeignexchangedidyouavail

OfWhenleavingSouthAfrica?:______

  1. Wasasettlingin / emigrationallowanceavailed

on your departure? :______

  1. Bankandbranchthroughwhichabovetransactions

Effected:______

  1. Accountnumberswithabovebank :______
  2. Pleasefurnishdetailsofanyotherassets,ifany,

heldbyyouinSouthAfrica.Statethenameofthe

Institutionorpersonwho controlsthese assets

onyourbehalf :______

  1. WouldyoulikeyourFundstobeinvestedinSouth

Africa? :______

  1. IsityourintentiontoreturntoSouthAfrica? :______
  2. Wereyouatemporaryorpermanentresidentof

SouthAfrica? :______

  1. Wereyouemployedonacontractbasis,ifso

PleaseStipulatetheperiodofemployment

residency :______

SIGNATURE:______DATE:______

NB: Shouldyouwishyourfundstobetransferred,thenpleaseprovideuswithdetailsofyour

OverseasBANKERS:

NAME: …………………………………………………………………………………..

ADDRESS: ………………………………………………………………………………

BANK ACCOUNT NUMBER: …………………………………………………………

This order will remain in place until cancelled by you.

SIGNATURE:______DATE:______

IMPORTANT:Pleaseattachacertifiedcopyofyourpassportorcertificateconfirmingcitizenshipofthecountryofresidence.

If youareentitledtoreceiveaWidow / er'sPension / ProvidentBenefitandyourlatehusband / wifewasthecontributingmember,wewillrequireacertifiedcopyofhis / herdeathcertificateinadditiontotheabovedocuments

COPIES AND FAXED COPIES ARE NOT ACCEPTABLE.