RSA Check Proposal Number: a slaisie] slzi7i2 Existing Contract Number: -Ltttittt14 6 o_pmuTuAL Please note, 2 wiltten instucticn to invest must be received and accepied by Old Mutual Life Assurance Company South ‘Africa Limited (Olé Mutual) on any business day be‘ore 16:00 (South African time). Any instructons received after 16:00 Shall be processed on the next business cay. (ld Mutual Life Assurance Company (South Afica) Limited, Registration Number 1993/004643/06, A licensed FSP and ife OLD MUTUAL INVEST Finalisor Application Wo: 404 ears 4z|s|s| 4|s\0|1| :|e|z|2 ols|2\7| 7 0|7|3| 4|ol4i3| 2 Finalizor Version: 10.27.0 ‘Agent's Finalisor Version: 10.27.0 ‘OmuQuote No: QR00402 - sevings plan tax ree ‘omuquote Version number: 10.27.0 ‘Quote Date: 28/02/2023 eee as a ‘Quote Expire Date: 01/03/2023 Sales Center Branch: Thohoyandou Sales Co-ordinator Freeze Date ond Time: 20/2/2023 11:09 a ossseo2304 Date sent to Branch: 29/02/2023 11:11 Salas Co-ordinator Stop order Start Date gat cy Email Addvessr QCOETHohoyandou@eldmutusl.com Option: st of thefolloning mon ‘Assurance Replacement: No ene tp malus athe postal adress competed forthe at Contracting Panty under te Chants INTRODUCER INFORMATION / ADVISER REMUNERATION SHARING Agency Distribution: 100% Joyce Ramakuwela ‘Adviser Code! ex9792 Sales Centre: 3834 Introducer Type: Primary Distribution channel: (Old Matuel Personal Financial Advice ‘%e Remuneration Split: 100% ( Equivalent o 100% of distribution group's commission } % Figure Split 100% ( Equivalent to 100% of distribution group's figure ) Date of Birth: 01/03/1970 1D Number, 7003010684088‘CLIENT DETAILS Ms M Netshirambe lient Seq No: Role(s): 1 Contracting Party Advice Client Life Covered Payer Comezpandance Client Netshirembe First Name(2): Matodst Prefesred Name/Nickname(s): Matodzi Date of Birth: 04/11/1964 ender: Female Country of Birth: South Airica Nationality: South Attica Marital Stat Single Prefered correspondence language: English Race: Not Specified Smoker Statues Non-Smoker ‘Age Next Birthday: 38 fib Tyee [1D Type Countiy of fssue [ID TypeNumber [ID Type Date of issue [1D Type Date of Expy identity [South Africa je411020815089 Home Address: (Current) octal Address: (Current) Cellphone Number: pt in for Rewards ‘Tax Residency Declaration NO252TSHISAULU VILLAGE Shayzndima Thohoyandou (0545 Seuth Afics PO Box 1242 Shayandims Thohoyandou 0845 South Aficz South Aica - 27 - 0721905726 No [Country oF Tax Residency [Tax Reference Number [fax Reason South fica PRODUCT DETAILS Licence:LIFE “This application is foran insurance contract issued and underwritten by Old Mutual Life Assura Company (South Africa) Limited, registrazion number 1399/004643/06 (Olé Mutual), a licensed Financial Services Provider. ‘Tax Free Plan (3) (Regular Investment) Life Covered's no: 1 Life Covered's Name: Ms Watodsi Netshirsmbe ‘Amount payable: 500.00 per month Frequency: Monthly ‘Annual increase % Level (Increase Month: April) [increase Vear 2024) Date of Entry: 1/04/2023 Investment Fund Details Fund tame Allocation Amount ld Mutual Moderate Belonced Fund B1 Claes (Old 100% utual Invest) Remuneration: Asand-when advice fee: o% ‘Ongoing advice Fee: 113% Financial planning fee (once-off fromthe s00.00 first amount payable): PAYMENT DETAILS ‘Stop Order: ‘Stop Order Payer Detail: ‘Company Details Department Name: Employee/Pension/Reference/Force Numbert Paying For: MNetshirambe Norther Prevince INP: Education Ares & Culture ‘Tex Free Plan (Regular Investment) (3) ‘SOURCE OF FUNDS: Ms M Netshirambe1) Lhave hnown the investor for 2.) Have the funds for this investment hoon raiced from liquidation of part afan evicting investment portilio? iu) Have the funds fer this investment bean rsisad from digposal ef property or other 2il,) Have the funds for this invastmant bean raised from a gift or inheritance from a third pansy? 2iv.) Have the funds for this investment been rsised from another sour: '3) Has this information been provided from a source other than your knowledge of the ‘ADDITIONAL LEGISLATION INFORIAATION Me M Netchirambe Role(s): Contracting Party Advice Client Life Covered Payer [address Type: [core of [Care of Fulltame [address [Home Address: (Current): [vo INO 252 TSHISAULU VILLAGE Shayandima Thohoyandou Postal Adéress: (Curent): [No [PO Box 1242 Shayandims Thoheyardou ‘Married in community of property: No Income Verification Source of Income Salary Source of Funds Salary Employment Position Generel Employes!Non-menagement Industry None Tax Residency Declaration [country of Tax Residency [Fax Reference Number [fax Reason [South Aficw jocsi7aai45 Payer Details: Stop order Ms M Netshirambe Role(s): Contracting Party Advice Client Life Covered Payer Account Holder: M netshirambe Payment Method: Stop Order Personal Details: ‘urna Natshirembe First Name(s): Matodzi Preferred Name/Nickname(s): Matodsi Fenale Country of Birth: South Airica ‘nationality: south atric Marital Status: Single Prefered correspondence language: English Race: Not specites ‘Smoker Status: Non-Smoker ‘Age Next Birthday: 58 [ID Type [ID Type Countiy oF fssue _[IDTypeNumber [ID Type ate of issue [1D Type Date of Expiry identity [South Africa jo41 1020815085 ‘Tax Residency Declaration [country oF Tax Residency [Fax Reference Number [fax Reason [South Arics| [ossi793145 [Address Type: [core of [Care of Fulltame [addressome Address: (Current INO 252 TSHISAULU VILLAGE Shayandima Thohoyandou Pactal Addroce: (Current) [PO Bow 1242 Stayandima Thohayardou Cellphone number: south aca - 27 - 0721903728