Source of Wealth. (Please check the box to indicate your source of wealth and you may select more than one item) □ Employment Income Occupation: __________________________________________________________ Name of employer: __________________________________________________________ □ Business Profits Nature of the business: __________________________________________________________ Name of company: __________________________________________________________ □ Savings or Investment Income Nature and name of investment: ____________________________________________________ □ Business Profits Nature of assets: __________________________________________________________ Sale amount: __________________________________________________________ □ Retirement or Pension Income □ Trust/Inheritance □ Others Please specify: __________________________________________________________ __________________________________________________________
Source of Wealth. This section requires you to describe the source of wealth (source of wealth describes the activities which have generated your total wealth as a whole). Please note that we may request verification of your source of wealth during or post our application process. Sale of investment Bonus Salary Property sale Transfer from other service provider Assets of trust/investment company Inheritance Other If other, please specify:
Source of Wealth. This section requires you to describe the source of wealth (source of wealth describes the activities which have generated your total wealth as a whole). Please note that we may request verification of your source of wealth during or post our onboarding process.
Source of Wealth. (Inheritance, investments, sale of property, etc.)
Source of Wealth. (Please check the box to indicate your source of wealth and you may select more than one item) [ ] Employment Income Occupation ___________________________________________________________________________ Name of Employer ____________________________________________________________________ [ ] Business Profits: Nature of the business: _________________________________________________________________ Name of Company: _______________________________________________________________________ [ ] Savings/Investment Income Nature and Name of Investment: ____________________________________________ [ ] Sale of Assets Nature of Assets and sales amount: __________________________________ [ ] Retirement/Pension Income [ ] Trust/Inheritance [X] Other (please specify): FUND FROM HOLDING COMPANY Participating Shares being subscribed for: (Please tick one box only. If you wish to subscribe for Participating Shares of more than one Class, please complete a separate Subscription Agreement for each Class) [ ] [X] Class A Shares Class B Shares Subscription amount: The minimum initial investment per subscriber in the Fund is US$1,000,000 in the case of Class A Shares and US$100,000 in the case of Class B Shares, exclusive of any Subscription Fee US$ 7,206,000 Subscription Fee: A Subscription Fee up to 2% of the subscription amount will be charged on subscription of Class A Shares and Class B Shares US$ 144,120 Total Subscription Monies: US$ 7,350,120 Payment of subscription monies: Subscription monies will be paid from the following account and redemption money will be going back to that account: Name of Bank: Account No: Account Name: SWIFT Code: Bank Address: Correspondent Bank Name: Correspondent Bank Branch: Correspondent Bank SWIFT Code: Wire confirmations for subscriptions must match the information provided above and the account must be held in the name of the Subscriber. No third party payments will be accepted. If the Subscriber’s subscription is in kind: The Subscriber undertakes to transfer the following investments as accepted by the Directors as non-cash consideration to those accounts of the Fund. Submitted securities Number of securities Identification Number (ISIN, Common No., Cedel or Euroclear) Estimated total value as at applicable Valuation Day NASDAQ: GRNQ 3,000,000 CUSIP: 30000X000 US$7,206,000
Source of Wealth. I/We declare that the source of wealth for my/our subscription in the Fund is: The description set out above should be specific and contain details relating to the source from which the funds for the subscription for Participating Shares have been received. Generic descriptions like ‘savings’, ‘salary’, ‘investment income’, etc. will not be acceptable. The Administrator reserves the right to request for further clarifications or additional documentation, as may be deemed necessary, in order to ensure compliance with applicable anti-money laundering legislation. Beneficial Ownership Please check one of the following boxes:
Source of Wealth. Please insert below the details of the individual PEP’s Source of Wealth, being confirmation of the economic activity which has generated the net worth of the individual
Source of Wealth. This section requires you to describe the source of wealth (source of wealth describes the activities which have generated your total wealth as a whole). Please note that we may request verification of your source of wealth during or post our onboarding process. Sale of investment Bonus Salary Property sale Transfer from other service provider Assets of trust/investment company Inheritance Other If other, please specify: FNBGF V4.0 25.09.19 Please complete Annexure B which relates to which relates to which individual gets the biggest financial benefit from, or who owns or controls, this entity. FNB Stockbroking and Portfolio Management (Pty) Ltd. Registration number 1996/011732/07. A Subsidiary within the FirstRand Group of Companies. An Authorised Financial Services Provider (member of the JSE).
Source of Wealth. I/We declare that the source of wealth for my/our subscription in the Cell is: The description set out above should be specific and contain details relating to the source from which the funds for the subscription for Participating Shares have been received. Generic descriptions like ‘savings’, ‘salary’, ‘investment income’, etc. will not be acceptable. The Administrator reserves the right to request for further clarifications or additional documentation, as may be deemed necessary, in order to ensure compliance with applicable anti-money laundering legislation. Beneficial Ownership Please check one of the following boxes:
Source of Wealth. Source of Funds Please complete the Source of Wealth & Source of Funds declaration below for each individual regis- tered as a Shareholder or Ultimate Beneficial Owner, as applicable.
