eQvest Ltd - eQvest – Public Offer Application Form (NEW)

eQvest – Public Offer Application Form (NEW)

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Investor Acknowledgement

Do you, the Investor (or the individual authorised to act on behalf of the Investor), confirm that you fully understand the following and do not require further explanation?*

Application Form
The Investment
eQvest’s Prospectus
Portfolio Manager Mandate

YES

NO

If you have any questions, queries, or require advice, please feel free to contact us at 0122850996 or reach out via email at info@eqvest.co.za

Contact Details

Email Address*

Phone Number*

Title*

First Name*

Middle Name

Last Name*

Resident status*

Citizenship*

Country of birth*

ID or passport number

If applicable, foreign ID number:

South African tax reference number:

If applicable, full particulars of your financial advisor

Company Name:

Full Name

Email:

All communication must be sent to: Please tick the appropriate option.

Client Only

Advisor Only

Both

Details of Employment

Job Title

Occupation:

Employer:

Employer nature of business/Industry:

Is the investor Retired or Unemployed:

Yes

No

If retired or a pensioner, indicate previous employment:

Occupation jurisdiction (if not SA):

Banking Details

Name of Bank*

Account Type*

Bank account number*

Address Information

Address Line 1*

Address Line 2

Unit / Building

Suburb *

Town*

Province*

Postal code*

Foreign Account Tax Compliance

“DPIP” - Domestic Prominent Influential Person, this definition includes all senior government officials and politicians, royals and traditional leaders, senior civil servants, judges, ambassadors, and high-ranking officers in the military. This also includes senior officials in companies who are doing business with the government.

“FPPO” - Foreign Prominent Public Official is a foreign person who is royalty, or a senior government official, or a senior politician, or a senior executive of a state-owned entity, or a high-ranking member of the military.

Is the Client a South African citizen?*

Yes

No

Do you have tax liabilities or tax residence outside South Africa?*

Yes

No

Do you hold any citizenship or nationalities outside of South Africa?*

Yes

No

Are you a DPIP or a FPPO?*

Yes

No

Are you affiliated to a DPIP or FPPO through a family member and/or an associate?*

Yes

No

Are you a US citizen/ US person/US national?*

Yes

No

Foreign tax country(ies)

Foreign Tax country(ies) Identification Number (TIN)

Comment if TIN not applicable

If you do not have a tax country at all, please explain

Source of funds of the Investor

(please select the relevant option)

Please provide a source for the funds being invested.*

Investment Summary

Share Subscription	Description	Minimum Subscription	Targeted Rate of Return	Once Off Fee	Minimum Investment Period	Investment Horizon
Class 1	MZANZI MEDIA AND ENTERTAINMENT FUND	Minimum subscription required for participation by an investor in the Offer is 10 (ten) shares which amounts to a minimum subscription payment of R1 000,00 (One thousand Rand)	18% — 24%	3%	6 months	3 — 5 years
Class 2	MEDIA CATALOGUE CORPORATION	Minimum subscription required for participation by an investor in the Offer is 10 (ten) shares which amounts to a minimum subscription payment of R1 000,00 (One thousand Rand)	22% — 26%	3%	3 years	5 — 7 years

Investment Details

Class 1 — MZANZI MEDIA AND ENTERTAINMENT FUND

Minimum subscription required for participation by an investor in the Offer is 10 (ten) shares

Amount the Investor will be investing

Note: 10 (ten) Shares = R1 000,00 (One thousand Rand)

Class 2 — MEDIA CATALOGUE CORPORATION

Minimum subscription required for participation by an investor in the Offer is 10 (ten) shares

Amount the Investor will be investing

Note: 10 (ten) Shares = R1 000,00 (One thousand Rand)

Reffered By

Name of Referrer

Email of Referrer

Referring Company/Brokerage (if applicable)

Contact number for Referrer