Application form: prospectus 1 of 2020

APPLICATION FORM: PROSPECTUS 1 OF 2020

In respect of offer of 19 861 787 ordinary Class A shares for an amount equal to R100 (one hundred rand) per share in terms of a public prospectus.
This application form is for the use of invited applicants only.

INSTRUCTIONS:

Applications may be made on this application form only. Copies or reproductions of the application form will be accepted.
Applications are irrevocable and may not be withdrawn once submitted.
The minimum investment per investor in terms of this prospectus is R100 000.
No receipts will be issued for application forms and monies received. Applications will only be regarded as complete once the relevant EFT or cheque payment has been effected.
The directors accept no responsibility, nor will they be held liable, for any damages or loss suffered by any applicant as a result of an illegible irrevocable undertaking to subscribe or otherwise, pursuant to payment being made or purporting to be made, nor will such parties be liable for any damages or loss suffered by any applicant should Destinata or the directors be unable, for any reason whatsoever, to reconcile a payment or purported payment with a particular application. In the case of any dispute regarding alleged payment, Destinata and the directors, reserve the right to determine in their sole discretion what evidence constitutes satisfactory proof of payment.

DESTINATA CAPITAL LIMITED

Registration number: 2017/340362/06
VCC number: VCC-0073
FSP Number: 48729

DESTINATA BANKING DETAILS

Account name: Destinata Capital Limited
Account number: 40 9324 5875
Bank: ABSA Bank Limited
Branch: 632 005
Account type: Current

Application Form: Prospectus 3 of 2020

SUBSCRIBER DETAILS:

Name of applicant

ID / Registration number

Tax Reference Number

Total Rand value of offer shares applied for

Number of offer shares applied for

Price per offer share

Full names of authorized signatory

(If applicant is a legal entity)

Capacity of signatory

(If applicant is a legal entity)

Telephone

Email *

Deposit reference number *

*Please ensure that the deposit reference number entered above is quoted when making payment. The reference should read “DCL – “and your name.

Address *

Address

City

State/Province

Zip/Postal

Country

FICA DECLARATION:

Source of funds: *

In terms of section 42 of the Financial Intelligence Centre Act 38 of 2001 (“FICA”), an accountable institution must develop, document, maintain and implement a programme for anti-money laundering and counterterrorist financing risk management and compliance. For this reason all Investors have to declare FULL source of funds:

SUBSCRIBER BANKING DETAILS:

Account name

Account number

Bank

Branch

Account type

ACKNOWLEDGEMENTS AND UNDERTAKINGS BY APPLICANT:

Acknowledgements *

I / We undertake to pay the subscription amount to Destinata Capital Limited on date of or before delivering the application.

I / We warrant that the subscription price will be payable from a reputable source and shall not be in contravention of the Financial Intelligence Centre Act

I / We acknowledge and accept that the directors of Destinata reserve the right to accept or refuse any application for subscription, either in whole or in part, or to abate any or all application(s) (whether or not received timeously) in such manner as they may in their sole and absolute discretion determine, and further may accept or reject, in whole or in part, any application should the terms and conditions set out in this document not be fully complied with.

I warrant that the information set out below is true and correct.

I have been provided with the factual information, being the prospectus in terms of which the offer shares are offered for subscription, and understand that I have not been provided with advice as to the appropriateness of the investment to my particular needs or circumstances.

I have been duly and properly informed / advised of the full implications of my actions and, having considered same, hereby declare that I must obtain my own professional or investment advice, since the documents provided do not constitute investment advice, and that I should carefully consider whether the information / advice on its own is appropriate considering my objectives, financial situation and needs, to prevent the risk of concluding a transaction that is not appropriate to my needs, objectives and circumstances.

I agree to the terms and conditions

Terms & Conditions

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