NAMIBIA INVESTOR ADDRESS DECLARATION FORM

NAM FORM
NAMIBIA INVESTOR ADDRESS DECLARATION FORM
Prudential Namibia Unit Trusts Ltd (Registration Number: 2007/609) (The Manager) is an approved unit trust Management Company and a
subsidiary of Prudential Portfolio Managers (Namibia) (Pty) Ltd (Prudential Namibia) (Registration Number:1999/1850), who performs the asset
management for The Manager.
OUR CONTACT DETAILS
Tel: +264 61 259 223
Fax: +27 11 263 6144
Email: [email protected]
Web: www.prudential.co.za
Postal address:
PO Box 25743
Windhoek
Namibia
Physical address:
6 Feld Street
Windhoek
Namibia
WHEN AND HOW TO COMPLETE THIS FORM
•
This form is to be completed by both the investor and the person confirming the investor’s address, should the investor be unable to provide
proof of their residential address.
•
We will only accept confirmation from a co-habitee, employer or property owner.
•
This form must be stamped and signed by a Commissioner of Oaths or the application will be rejected.
•
Information written outside of the relevant fields will not be considered when processing your application.
DOCUMENT CHECKLIST
This completed application form, signed and dated by both parties
A copy of the co-habitee/property owner’s Namibia bar-coded ID/Smartcard (if Namibian resident) or valid passport (if foreign national)
Clear copy of a utility bill of the person confirming the investor’s address
WHAT HAPPENS NEXT
•
Please fax, or scan and e-mail a copy of this completed and signed application form accompanied by the supporting documentation to the
contact details listed above.
•
Processing can only happen once all the necessary documentation has been received. Failure to do so will cause a delay in your funds being
invested.
IMPORTANT INFORMATION
• Daily cut-off times: 09:00 am (Namibian time) for Prudential Namibian Money Market Fund
12:30 pm (Namibian time) for all other investment options
Investor initial
Prudential Namibia investor address declaration form | Page 1 of 3
Version 2.0: March 2015
1. DECLARATION BY INVESTOR
Existing Prudential Investor Number
Title
First name(s)
Surname
Nationality
Date of birth
ID number
Passport expiry date
(Passport number if foreign national)
Place of birth
City
D
D
M
M
C
C
Y
Y
D
D
M
M
C
C
Y
Y
Country
Residential address
Country
Postal code
I declare that I live at the above address and cannot provide an acceptable utility bill or bank statement in my name that reflects this address
Signature of investor
Place
D
D
M
M
C
C
Y
Y
D
D
M
M
C
C
Y
Y
D
D
M
M
C
C
Y
Y
C
C
Y
Y
Date
2. DECLARATION BY THE PERSON CONFIRMING THE INVESTOR’S ADDRESS
Title
First name(s)
Surname
Nationality
Date of birth
ID number
Passport expiry date
(Passport number if foreign national)
Place of birth
City
Country
Residential address
Country
Postal code
I own the property at the above mentioned address
Yes
No
I reside at the above mentioned address
Yes
No
My relationship to the investor (e.g. spouse, guardian)
I confirm that the investor resides at
Country
Postal code
I declare that the above information is true and correct
Signature of co-habitee/
property owner
Place
D
D
M
M
Date
Prudential Namibia investor address declaration form | Page 2 of 3
Version 2.0: March 2015
Commissioner of Oaths
I certify that the deponent acknowledged that he/she knew and understood the contents of the above declaration that I duly administered the
oath contained in Regulation No. R1258 of July 1972, and that the deponent signed the declaration in my presence.
Signature of the
Commissioner of Oaths
Place
D
D
M
M
C
C
Y
Y
Date
Stamp of the
Commissioner of Oaths
Investor initial
Prudential Namibia investor address declaration form | Page 3 of 3
Version 2.0: March 2015