ForeignExchangeApp Outward NED.dot 09Jan14 | SD2



|Please ([pic]) where applicable. |

|Non-Nedbank client (FICA documentation required) |

|Branch name |      |

|TRAVEL INFORMATION |

| Are you paying for the forex and are you travelling alone? OR | | |

| Are you paying for the forex but are not travelling? OR |Number of third parties travelling |  |(Complete Third-party Travel form.)|

| Are you paying for the forex and are you travelling with third parties? |Number of third parties travelling |  |(Complete Third-party Travel form.)|

|PAYER'S DETAILS |

| Entity |

|Entity name* |      |Trading name |      |

|Are you an International Headquarters Company (IHQ)? | Yes | No | |

|If 'Yes', provide IHQ number | |  |  |  | | |

|Residential status* | Resident | Non-resident |

|Omnibus |      |Registration|D |

|authorisation| |date | |

|number | | | |

| Individual |

|Title: | Mr | Mrs | Miss |

|Residential status* | Resident | Non-resident |Identity/Temporary-permit no* |      |

|Tax no |      |Email |      |

| | | | |

|Gender | Male | Female |

|Physical address line 1* |      |Postal address line 1* |      |

|Physical address line 2 |      |Postal address line 2 |      |

|Suburb* |      |Suburb* |      |

|City* |      |City* |      |

|Province* |      |Province* |      |

|Postcode* |      |Postcode* |      |

|Country* |      |Country* |      |

|PAYMENT AND COLLECTION DETAILS |

|Bank |      |Branch |  |  |  |

|Card expiry date |D |

|Title: | Mr | Mrs | Miss |

|Residential status* | Resident | Non-resident |Identity/Temporary-permit no* |      |

|Tax no |      |Email |      |

|Passport no |      |Country where passport was issued |      |

| | | | |

|Passport expiry date |D |D |M |M |

|Physical address |Postal address | Same as physical address |

|Physical address line 1* |      |Postal address line 1* |      |

|Physical address line 2 |      |Postal address line 2 |      |

|Suburb* |      |Suburb* |      |

|City* |      |City* |      |

|Province* |      |Province* |      |

|Postcode* |      |Postcode* |      |

|Country* |      |Country* |      |

|Contact person's first name* |      |Contact person's surname* |      |

|Telephone |      |Fax |      |

|Email |      |

|DETAILS OF JOURNEY |

|Country of destination |      | |

| | | | |

|Date of departure |

|CURRENCY ALLOCATION |

|If the travel allowance is applied for on behalf of other travellers, complete the following: |

| |NAME |AMOUNT |CURRENCY |

|Traveller 1 |      |      |      |

|Traveller 2 |      |      |      |

|Traveller 3 |      |      |      |

|Traveller 4 |      |      |      |

|Traveller 5 |      |      |      |

|Traveller 6 |      |      |      |

|TYPE OF TRAVEL |

| 250 Business travel for non-residents | 255 Business travel for residents |

| 251 Holiday travel for non-residents | 256 Holiday travel for residents |

|NO EXCHANGE PROCEEDS (NEP) REQUIREMENTS |

|Required for residents in the common monetary area who depart with goods in their possession with a value exceeding the limit in terms of |

|Exchange Control Rulings. | Yes (complete NEP form) | Not applicable |

|PREPAID TRAVEL CARDS |

| American Express® GlobalTravel Card | USD | GBP | EUR |

|Amount to be loaded onto card |      |[NOTE: Should this be an option for two different kinds of card?] |

| American Express® GlobalTravel Card (complete both the below): |

|Your mother's maiden name |      |Last four digits of your identity number |      |

|Do you require a travel topup service transaction on the American Express® GlobalTravel Card? | Yes No |

|By indicating 'Yes' you acknowledge the following: |

|Travel topup service transactions can only take place during South African banking hours. Any request received after 15:00 South African time (GMT +2) will be |

|processed the next working day. |

|Due to the nature of a travel topup service transaction Nedbank will not be able to advise you of the exchange rate that will be used when foreign exchange is |

|loaded onto the American Express® GlobalTravel Card. |

|Nedbank may debit available funds from your Nedbank account. |

|Nedbank will not be liable for any debit orders that may subsequently be dishonoured due to insufficient funds in your account. |

|Further fees may be charged to your account should it become overdrawn. |

|Only a Nedbank account can be debited for funds as part of the travel topup service. If you do not have a Nedbank account, please nominate a Nedbank |

|accountholder, who will be required to come into Nedbank to pay funds directly into your American Express® GlobalTravel Card. |

|First name |      |Surname |      |

| |

|FOREIGN BANKNOTES AND TRAVELLERS CHEQUES |

|Currency |Banknotes – amount |Travellers cheques – amount |

|USD |      |      |

|GBP |      |      |

|EUR |      |      |

|OTHER |      |      |

|TRAVEL INSURANCE |

|Please select the insurance option required: | Travel insurance | Topup travel insurance | Not required |

| |

|Amoun|  |  |  |

|t | | | |

|2 |I would like Nedbank to present exclusive offers from other organisations to me. | Yes | No |

|3 |Nedbank may request reputable research organisations to contact me. | Yes | No |

|4 |My preferred method of communication is as follows: | Email | SMS | Direct mail | Telephone | All |

| | | | |

|5 |Nedbank may use a method of communication other than that preferred by me as well as my personal information to market its products| Yes | No |

| |to me, including electronic marketing and telesales, until I give an instruction to the contrary. | | |

CONFIRMATION

1. Nedbank has explained this application form, the product and costs, where applicable, to me and I confirm that I fully understand the contents thereof and that I am completing it of my own free will.

2. I warrant that I have fully and truthfully answered all questions and responded to requests for information as part of the assessment process, and that I am not aware of any other information that may affect this application negatively.

3. Nedbank may undertake identity and fraud prevention checks and share information relating to this application with South African Fraud Prevention Services.

4. All consent provided in this document will survive any contractual relationship that I have with Nedbank, unless I provide written notice to Nedbank that I have cancelled such consent.

|TRAVEL DECLARATION |

I/We hereby declare as follows:

• Nedbank Limited informed me/us of the requirements of regulation 2(4) and (5), namely that the currency available to me/us may only be used for the purpose stated.

• I/We will travel within 60 days of the date of my/our request for foreign exchange.

• I/We will not purchase foreign exchange from an authorised dealer in excess of the current discretionary allowance in terms of the current Exchange Control Rulings.

• In the event of my/our trip being cancelled, I/we will refund all foreign exchange accorded to me/us to an authorised dealer within 30 days of cancellation thereof.

• I/We will offer for sale to an authorised dealer, within 30 days of my/our return to South Africa, all unused foreign currency purchased for the trip, which will be converted to South African rand.

|INDEMNITIES |

Any quotation, indication, communication or notification in any form by Nedbank of the exchange rate is merely indicative of the rate at that time, and is subject to change without notice and will not be binding on Nedbank, unless confirmed by Nedbank in writing. Further note that exchange control procedures may cause delays and that Nedbank will not be liable for any claims, losses and/or damages due to these delays.

PAYER'S DECLARATION

I hereby declare that:

• the information furnished above is true and correct in all respects;

• the currency applied for will be used only for the specific purpose stated;

• any documentation required in terms of the SARB Rulings and Regulations presented in support of this transaction is authentic in all respects;

• the conclusion of this transaction in itself or in conjunction with other transactions of this type will not result in the overall limit imposed in terms of the SARB Rulings and Regulations being exceeded;

• I am aware that the information relating to this transaction will be provided to the SARB, the South African Revenue Service, the Financial Intelligence Centre and the Financial Services Board; and

• the content hereof is known and understood by me.

|Signed at |      |on |     / |     / |      |

| |(place) | |(day) |(month) |(year) |

|Applicant | |Spouse | |

|Who attests to the above |(if married in community of property) |Who attests to the above |

|Legal guardian | |Surety, guarantor or coapplicant | |

|(if unemancipated minor) |Who attests to the above | |Who attests to the above |

|Signature of administrator | | | |

(if under administration)

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