Durban:P O Box 1504, Suite 7HeritagePark, 51 Norfolk Terrace, Westville, 3630, South Africa. Tel: 031-2669959 Fax: 031-2669918
Johannesburg:Ground Floor, Block B, The Ambridge, Vrede Avenue, Bryanston, 2067, South Africa. Tel: +27-11-7061008 Fax: 011-7067370
Cape Town:22 Bray Road, Kenilworth, Cape Town, 7708, South Africa. Tel: +27 21 761 3839 Fax: +27-21-761 6320
Port Shepstone: First Floor, The Emporium, 978 Marine Drive, Shelly Beach, 4265. Tel: 039-3151020 Fax: 039-3151025
Lusaka: Plot12c, Off Kabulonga Road, Lusaka, Zambia. Tel: +260-211-267731/32 Fax: +260-211-267733
Reg. No. 2000/010831/07 Registered financial services provider FSP768
Directors: P F C Morgans (Managing), E N Molver
APPOINTMENT OF SERVICING AGENT
SURNAME (client): / SURNAME (joint client):FORENAMES (client): / FORENAMES (joint client):
IDENTITY NUMBER (client): / IDENTITY NUMBER (joint client):
TELEPHONE NUMBERS:
POSTAL ADDRESS: / PHYSICAL ADDRESS:
I/we confirm that Asset Protection International FSP Number 768 is appointed as my servicing intermediary and authorise them or any their representatives or staff to obtain information from any investment manager, unit trust manager, long-term insurer, administrative FSP or other financial institution to enable them to advise me/us to the best of their ability.
Sound and proper financial advice can only be provided with full disclosure of relevant information relating to appropriate personal, including private, information for the purposes of determining and advising on my/our financial situation and financial product experience and objectives, in the process of acquiring, servicing or maintaining any financial products, including but not limited to any information relating to or interest in any investment, long-term insurance, unit trust or any other financial products or services, with any financial institution; and
My/our interests shall be best served if that information is made available to authorised financial service providers with a legitimate interest in receiving such information for those purposes.
I/we herewith give consent for the investment manager, unit trust manager, long-term insurer, administrative FSP or other financial institution possessing such information to release such information to Asset Protection International, including via The Financial Services Exchange (Pty) Ltd, trading as Astute, or any other institution providing a mechanism for the transmission of such information, and I/we confirm that such Authorised User shall be acting on my/our behalf or in my/our interest and I/we waive any right to privacy only as stated for the purposes above.
All future fees payable on my/our investments and financial products in terms of the existing fee arrangement in place with the respective product provider are to be paid to Asset Protection Internationalfrom date hereof until further notification.
I/we further acknowledge that this appointment as financial intermediary will remain effective until cancelled by me/us in writing.
______
Signature of ClientSignature of joint Clientif applicable
Date:
______
______
Signature of API RepresentativeName of API Representative
AUTHORITY TO OBTAIN INFORMATION
SURNAME (client): / SURNAME (joint client):FORENAMES (client): / FORENAMES (joint client):
IDENTITY NUMBER (client): / IDENTITY NUMBER (joint client):
TELEPHONE NUMBERS:
POSTAL ADDRESS: / PHYSICAL ADDRESS:
I/we confirm that Asset Protection International FSP Number 768 is authorised to obtain information from any investment manager, unit trust manager, long-term insurer, administrative FSP or other financial institution to enable them to advise me/us to the best of their ability.
Sound and proper financial advice can only be provided with full disclosure of relevant information relating to appropriate personal, including private, information for the purposes of determining and advising on my/our financial situation and financial product experience and objectives, in the process of acquiring, servicing or maintaining any financial products, including but not limited to any information relating to or interest in any investment, long-term insurance, unit trust or any other financial products or services, with any financial institution; and
My/our interests shall be best served if that information is made available to authorised financial service providers with a legitimate interest in receiving such information for those purposes.
I/we herewith give consent for the investment manager, unit trust manager, long-term insurer, administrative FSP or other financial institution possessing such information to release such information to Asset Protection International, including via The Financial Services Exchange (Pty) Ltd, trading as Astute, or any other institution providing a mechanism for the transmission of such information, and I/we confirm that such Authorised User shall be acting on my/our behalf or in my/our interest and I/we waive any right to privacy only as stated for the purposes above.
I/we further acknowledge that this consent to obtain information on my behalf will remain effective until cancelled by me/us in writing.
______
Signature of ClientSignature of joint Clientif applicable
Date:
______
______
Signature of API RepresentativeName of API Representative
Durban:P O Box 1504, Suite 7HeritagePark, 51 Norfolk Terrace, Westville, 3630, South Africa. Tel: 031-2669959 Fax: 031-2669918
Johannesburg:Ground Floor, Block B, The Ambridge, Vrede Avenue, Bryanston, 2067, South Africa. Tel: +27-11-7061008 Fax: 011-7067370
Cape Town:22 Bray Road, Kenilworth, Cape Town, 7708, South Africa. Tel: +27 21 761 3839 Fax: +27-21-761 6320
Port Shepstone: First Floor, The Emporium, 978 Marine Drive, Shelly Beach, 4265. Tel: 039-3151020 Fax: 039-3151025
Lusaka: Plot12c, Off Kabulonga Road, Lusaka, Zambia. Tel: +260-211-267731/32 Fax: +260-211-267733
Reg. No. 2000/010831/07 Registered financial services provider FSP768
Directors: P F C Morgans (Managing), E N Molver