ANNEXURE A APPLICATION FOR APPROVAL AS A BENEFIT ADMINISTRATOR IN TERMS OF SECTION 13B OF THE PENSION FUNDS ACT, 1956 1. Name of administrator: 2. Date on which the entity will commence business or has commenced benefit administration business : 3. Financial year end of the administrator:.. 4. Type of administration being applied for (mark with an X): Type of administrator Benefit administrator, will the benefit administrator administer the following funds: Retirement Annuity Funds Preservation Funds Umbrella Funds Beneficiary Funds Unclaimed Benefit Funds Other Indicate with an X 5. Responsbile person Full names and surnames Date appointed Date resigned ID/Passport No. Contact Number Fax number Email Address Position held *Note: The duly completed and signed form attached hereto as Appendix I of Annexure A must accompany this application
6. Corporate status (mark with an X): Company Close Corporation Partnership Other (provide details) Additional details: Other information Registration number ito section 13B South African Revenue Services number FAIS registration number FAIS level of approval Corporate status registration number Number 7. General information Physical address where business is being conducted Postal address Telephone details Fax details 8. Fascilitation (Trust) Accounts The following fascilitation (trust) accounts in terms of Condition 15 of the relevant Board Notice will be administered on behalf of funds: Type of Trust Account The purpose for which the trust accounts are maintained 9. Number of registered and unregistered pension funds currently being administered: Registered Unregistered Total Number of funds beginning last year Number of funds gained (lost) Number of funds currently being administered
10. The following information regarding the administrator must accompany the application for approval: Appendix III: Details of company group structure major subsidiaries (more of 20% shareholding) and associated entities (more than 20% shareholding), including consolidated and non-consolidated structures. If applicable, details of any alliances and joint ventures. Appendix IV: Organogram a. Directors of s13b licence holding entity b. Managing executives of s13b licence holder 11. Where applicable, copies of the following agreements must be submitted with the application for approval: a. Standard service level agreements b. Outsourcing agreements Administration Asset management Life office agreement(s) c. Disaster recovery-agreements d. Fidelity and PI cover e. Any other agreements that you may deem relevant
APPENDIX I TO ANNEXURE A Detail of the Responsible Person 1. Full names:.... 2. Surname:.. 3. Identity Number:. 4. Passport Number:. 5. Contact Number:... 6. Cellular Number:..... 7. E-mail address:...... 8. Physical Address:.. 9. Postal Address:.. 10. Qualifications:.... Qualification Institution/School City/Address Date obtained Student No. Certificate No. Exam No. Copy of Certificate/Diplom a attached? (Yes/No) Qualification 1 Qualification 2 Qualification 3 11. Relevant experience in the retirement fund industry:
12. Business References / Previous employers relevant to retirement fund experience (please provide 4): 13. Have you within a period of five years preceding the date of appointment as responsible person been found guilty in any criminal proceedings or liable in any civil proceedings by a court of law (whether in the Republic or elsewhere) of having acted fraudulently, dishonestly, unprofessionally, dishonourably or in breach of a fiduciary duty? 14. Have you within a period of five years preceding the date of appointment as responsible person been found guilty by any statutory professional body or voluntary professional body (whether in the Republic or elsewhere) of an act of dishonesty, negligence, incompetence or mismanagement, sufficiently impugn the honesty and integrity as responsible person?
15. Have you within a period of five years preceding the date of appointment as responsible person: a. been found guilty by any regulatory or supervisory body (whether in the Republic or elsewhere); b. your authorisation to carry on business refused, suspended or withdrawn by any such body; on account of an act of dishonesty, negligence, incompetence or mismanagement sufficiently impugn your honesty and integrity? 16. Has any licence which was granted by any regulatory or supervisory body referred to in 14 above been withdrawn or suspended by such body on account of an act of dishonesty, negligence, incompetence or mismanagement within a period of five years preceding the date of appointment as responsible person? 17. Have you at any time prior to the date of appointment been disqualified or prohibited by any court of law (whether in the Republic or elsewhere) from taking part in the management of any company or other statutorily created or regulatory body, irrespective whether such disqualification has since been lifted or not? 18. Have your estate ever been sequestrated or have you been a director, shareholder or otherwise involved in a business which at the time was placed under judicial management or liquidation? If so, have you been rehabilitated since?
19. Have you ever been barred from or entry into any profession or occupation? I, (full names), the appointed responsible person for the. Fund, hereby certify that the abovementioned information is true, correct and complete. I hereby give consent for the Registrar, if he so requires, to obtain a police clearance, perform reference checks and verify qualifications as disclosed above. I undertake to advise the registrar of any important changes to the above information. APPLICANT DATE The administrator has appointed.. as responsible person of the abovementioned administrator and in the process have ensured that the person has the relevant knowledge and expertise and that he/she is fit and proper to act in such capacity to the administrator. CHAIRPERSON: ADMINISTRATOR DATE
APPENDIX II TO ANNEXURE A Detail in respect of the public company, individuals with a shareholding of 20% or more, partners of a partnership and members of a closed corporation must complete this Annexure and be submitted together with the application for approval in terms of section 13B: 1. Full names:.... 2. Surname:.. 3. Identity Number:. 4. Contact Number:... 5. Cellular Number:...... 6. E-mail address:..... 7. Physical Address:.. 8. Postal Address:.. 9. Qualifications:.... Qualification: Institution/School: City/Address: Date obtained: Student No.: Certificate No.: Exam No.: Copy of Certificate/Diploma attached? (Yes/No) Qualification 1 Qualification 2 Qualification 3 10. Relevant experience in the retirement fund industry:.....
11. Business References / Previous employers (please provide 4): 12. Have you within a period of five years preceding the date of appointment as responsible person been found guilty in any criminal proceedings or liable in any civil proceedings by a court of law (whether in the Republic or elsewhere) of having acted fraudulently, dishonestly, unprofessionally, dishonourably or in breach of a fiduciary duty? 13. Have you within a period of five years preceding the date of appointment as responsible person been found guilty by any statutory professional body or voluntary professional body (whether in the Republic or elsewhere) of an act of dishonesty, negligence, incompetence or mismanagement, sufficiently impugn the honesty and integrity as responsible person?
14. Have you within a period of five years preceding the date of appointment as responsible person: a. been found guilty by any regulatory or supervisory body (whether in the Republic or elsewhere); b. your authorisation to carry on business refused, suspended or withdrawn by any such body; on account of an act of dishonesty, negligence, incompetence or mismanagement sufficiently impugn your honesty and integrity? 15. Has any licence which was granted by any regulatory or supervisory body referred to in 14 above been withdrawn or suspended by such body on account of an act of dishonesty, negligence, incompetence or mismanagement within a period of five years preceding the date of appointment as responsible person? 16. Have you at any time prior to the date of appointment been disqualified or prohibited by any court of law (whether in the Republic or elsewhere) from taking part in the management of any company or other statutorily created or regulatory body, irrespective whether such disqualification has since been lifted or not? 17. Have your estate ever been sequestrated or have you been a director, shareholder or otherwise involved in a business which at the time was placed under judicial management or liquidation? If so, have you been rehabilitated since?
18. Have you ever been barred from or entry into any profession or occupation? I hereby certify that the abovementioned information is true, correct and complete. I hereby give consent for the Registrar to obtain a police clearance, perform reference checks and verify qualifications in respect of myself. I undertake to advise the registrar of any important changes to the above information. APPLICANT DATE
APPENDIX III TO ANNEXURE A Appendix III to Annexure A Detail in respect shareholding by companies with a shareholding of 20% or more. This Annexure must be completed by all shareholder companies with a shareholding of 20% or more and must be submitted with the application for approval in terms of section 13B: 1. Registered name of company:... 2. Registration No. of company:. 3. Physical Address of company:... 4. Postal address of company:... 5. Name and capacity of contact person:... 6. Contact Number:.... 7. Cellular Number:...... 8. E-mail address:... 9. Shareholding by applicant:... 10. Any other information:..
APPENDIX IV TO ANNEXURE A 1.1 Directors/Owners of entity Full names and surnames Date appointed Date resigned ID/Passport No Contact Number Fax number Email Address Position held 1.2 Managing executives Managing executives (the chief executive officer of the approved administrator or where the administration of employee benefits is performed within a division of the approved administrator, such persons responsible for the management of the administrative functions reporting directly to such chief executive officer or person responsible for the management of the administrative functions) Full names and surnames Date appointed Date resigned ID/Passport Contact Number Fax number Email Address Position held