LIBERTY IMPORTANT INFORMATION RELATING TO SERVICING CHANGES Date: 19/05/2016 Prepared by: AKAN Contract Number: (0025769976 Contract Type: RETIREMENT ANNUITY BUILDER (200_AP_RA) ‘Option Date (01/04/2037 ‘Owner Name: MR CG ALFONS: LIFE ASSURED DETAILS Life assured Nama: MR CG ALFONS Date of Birt osyizyise1 CHANGES ‘This servicing change is based on an Ad Hoc Contrioution Payment of R 602 222.00 made on 19/05/2036. Investment Value before change on 19/05/2016: R61 263.25 Investment Value after change on 19/05/2016: R653 465.25 EFFECT OF REQUESTED CHANGES ON ESCALATION, CHARGES AND PROJECTIONS: Illustrative Monthly Contribution Wustrative Surrender / Retirement Values At age Next @ ®) 36 500.00 37 - 500.00 38 TT 500.00 33 500.00 _ | 20 ___ 500.00 _ 500.00 [_ 5214 967.08 at _ 500.00 8434 377.36 65 500.00 13 619 237.61 70 500.00 19 966 979.61 Notes ‘The information contained in this document is ony valid If generated by Liberty's ‘What IF Quotation system and is for the exclusive use of a client contemplating changes to the above contract Tf any transaction occurs between the date of this decument and the actual processing of the change that has an ‘effect on the surrender value of the contract, this will impact on the contribution/benefits shown. [Any application for changes to the original contract wil Be subject to Liberty's acceptance procedures. \Values as set out in this document are calculated on the assumotion that al contributions are paid in accordance ith the provisions ofthis contract ‘The actual commission payable may be different to the commission amount quoted, ‘This Quote is valid if processed today only. Illustrative values assume no further growth where values are shown within the next 12 months. llustrative values shown after 12 months are based on an assumed future growth rate of 10% being maintained. wee Page 1083 UACE 1D : AAKI605 Lise aru eo none SNE SU Py en eae coma shy, Wa OF Sok YO Shan Seo oa Dre ea Utne hrc dat tne 30 i eeHiustrative values assume that the Ad Hoc Contribution Payment is received from a Voluntary source. Hf the Ad Hoc Contribution is received from a Compulsory source (i.e another retirement fund), te Tlustrative ‘values willbe different, as a lower amount of commizsion is payable. Ifa premium is increased outside of an agreed escalation (an Automatic Contribution Increase or ACI), if an ACI is ‘added or increased, if a change in ACI is made based on CPI (Consumer Prica Index), or iF tne promium frequency is changad, this change wil cause the portolla choice on your policy to have to comply with the asset limits set out in regulation 28 of the Pension Funds Act. Liberty will monitor the exposure to the various categories of assets every. quarter. Market movements may cause a combination of portolls to become non-compliant in the future, If this appens you wnll be notifies and given the opportunity to revise the portfolio selecion to comply with regulatory limits. {If you fall to do so by the next quarterly check, Liberty will mave the portion oF assets that are non-compliant t0 2 money market er balanced fund. You willbe notified of this change and given the opportunity to revise your portfolio cho, Charges and fees [Ad hoe Contribution Charge: R 0,00 ‘Note that the Rand amount of the Ad hoc Contribution Charge will change if the ad hac contribution is increased or decreased, (On Retirement Annuities, the regulated commission payable to an independent financial adviser for these policy changes is R 15 055.55, This amount plus a 14% loading will be deducted from the Investment value. “The commission reflacted above assumes that the Ad Hoc Contribution payment is from a Voluntary source. If the Ad Hoc Contribution payment is received from a Compulsory source (e. another retirement fund), tha commission is restricted to 2 maximum of 1.5% of tha Ad Hoc Contribution. No commission will Be pald on Section 14 transfers from ‘retirement annuity to anther retirement annuity. ‘On Investment Plans/Flexible Investment Plans, an Initial Advice Fee will be deducted from the investment value if you have signed @ mandate authorising your financial adviser to receive this fee. If your financial adviser isa representative of Liberty Group Ltd, the amount of commission payable will differ as he/ she may receive other benefits not drecty related to this policy. Claim notification procedures In the event of a claim arising, please contact your financial adviser for the required documentation or our Call Centre, ‘on 0860 456 789. Replacement Information You may not be advised to cancel a contract to enable you to purchase a new contract or amend an existing contract, nies: '2)_ The financial adviser Identifies the contract as a replacement contract. 'b) The impications of cancellation of the contract are disclosed to Vou, such as: ‘The influence on your Benefits under the old contract. ‘The adsitional costs incurred with the replacement. ‘The insurer that issued the original contract may contact you, You are advised to discuss the matter with its representative. wee Page 2of 3 UACF 1D : AAKI805‘Should you have any queries or complaints regarding your contract, please first contact your financial adviser and discuss the problem with hinvher. IF the matter is not handled to your satisfaction, you can contact the Liberty Customer Relations Department on ‘telephone (014) 408 3316 or fax (011) 408 aad, Liberty's Compliance Officer can also be contacted an: groupcompliance@aliberty.co.za {In the event that the dispute is still not resolved to your satisfaction, you may refer any dispute to the: ‘Ombudsman for Registrar for Long Term FAIS Ombud Long Term Insurance Ms Noluntu Bam. Insurance Financial Services Board PO Box 74571 Private Bag x05 PO Box 35655 LYNNWOOD RIDGE CLAREMONT MENLO PaRic 9040 7735 o102 E-mail address: info@aisombud.co.23 Tei: (021) 657-5009 Tel: (012) 428-9000 Tel: 0860 324.766 Fax: (021) 674-0951 Fax: (012) 347 0221 Fax: (012) 348-2447 Tollfree: 0860 103 236 Toll free: 0800 110.463 Cooling orf 1, after effecting this change, you for any reason decide that you no longer require it, you are free to withdraw from fe at any time within 30 days of the date on which you receive details ofthe change, provided you have not yet claimed lunder the contract, the event insured against has not yet occurred, and you meet Liberty Life's underviiting criteria at the time (if applicable). If you decide to withdraw, Lberty Life is entitled to deduct an amount in respect of any cover ‘you may have enjoyed or in respect of any decrease in investment value of your investment. ve read the quote and I “FZ the plications ofthis proposed change. owe: _ A O8 | 20K Signature: | 7 — — wee Page 3 0f3 UACF ID: Aak1605Liberty Contract Details Page | of | @uiserry ure Retirement Annuity Builder uote me contact mbar asres07s Preauc ype RETIREMENT ANNUITY BUILDER (200_RP_RA) a mene Date of commencement cxyowyanos Opeon oats cuca owner Ros avons Racreee 1 Siiseive oasis 75 tire assured ce nrons osnznioe. cnetiay INAroRs womier 00.00% Service consultant 2570019145653 ne ontect numbers semis ex7s009 Business Phone Ganson “flome Phome ee itera asec "at adores Sino atronenunnoe.con coottbtton 500.00 HowTLY by OEE ORDER Seoeoay a advo bate Suer016 account Holder ca nirons Senco Srancn Se SRAARD BANK OF SOUTH AFRICA CAPE TOM recount Noraber daoonransense Your vestments sll seting price) 2h ef TetaL |” mand vatue | numberof Units [acpxcElsion HOS Cons | si75m90-—[ si Mane | amare —| aes Investment % RA Excelsior Mod Cons (G) 100.00 Values as at 21/06/2016 Total Investment Value 62698.18 Gross Death value 62698.18, Paid Up Death Value 57692.33 Illustrative Value as at 817211.00 01/04/2037 ‘The values shown on this statement are valid only forthe date shown above and wil be affected as a result of pencing trade (c). Ne other guarantee of values is expressed or mplled. Values payable may be resected by legislation. No account Nae been taken of transactions and/or investment amounts not yet processed. Unt prices forthe current day may not have been Uneaten st the time of thie eummary ang values must be viewad with caution. Any future values shown are not guaranteed 2nd assume that nothing has or will change on the policy. ‘Should values not be displayed, please load a Werkflow request to the relevant servicing are. (Compass / SxB0908) &.. 2016/06/21 https:/www.blueprintonline.co.za/serv/BPOnline/BPO_EnqCpp.asp?Consultln«