Hard Currency Structured Note

Application form

Please forward a completed Application form to your Offshore Stockbroker/Custodian with a copy to Absa Index and
Structured Solutions ‘AISS’ - aiss@absa.co.za. AISS do not require copies of FICA documentation.

Questions? Call 0861 345 223 (option 2) for assistance.

Section 1: Investor details

First name(s)

Surname (for individuals)

Registered name (for institutions)

Section 2: Stockbroker/Custodian details

Name of company

Investor Account number

Contact person

Email address

Telephone number

Section 3: Investment amount

Cash only – hard currency USD, EUR or GBP. Cash only deposits via electronic funds transfer (EFT) – Refer Section 4 for
Bank Account details.

10 000 minimum (increments of 1000 thereafter) USD

Note: Please confirm the minimmum investment amount with your
chosen Stockbroker/Custodian as they may have higher minimum
requirements

Hard currency structured note description *

SPX,SX5E Worst of Stepdown Autocall, 6.5% StepDown, Autocallable Annually, Auto-call Deferral: 36 Months, Term: 72months, 40% Soft
Principle Protection, Observation: European, Distributor/Advisor Fee - 2.88% paid upfront in USD.

* This is brief description of the Note being purchased. An indicative term sheet with complete details on the Note is available from Absa or
your Financial Adviser.

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Section 4: Bank account details
Currency: USD
Main Correspondent (Nostro Bank): Citibank NA
Nostro Agent BIC (F57A): CITIUS33
Beneficiary Bank: Absa Bank Limited
Beneficiary Bank BIC (F58A): ABSAZAJJXXX
IBAN/Account Number/Clearing Code: 10953008
Euroclear Acc details: 18440
Reference: Investors full name as it appears on the application form

Currency: EUR
Main Correspondent (Nostro Bank): Societe Generale
Nostro Agent BIC (F57A): SOGEFRPP
Beneficiary Bank: Absa Bank Limited
Beneficiary Bank BIC (F58A): ABSAZAJJXXX
IBAN/Account Number/Clearing Code: 003014382170
Euroclear Acc details: 18440
Reference: Investors full name as it appears on the application form

Currency: GBP
Main Correspondent (Nostro Bank): Barclays Bank Plc, London, United Kingdom
Nostro Agent BIC (F57A): BARCGB22
Beneficiary Bank: Absa Bank Limited
Beneficiary Bank BIC (F58A): ABSAZAJJXXX
IBAN/Account Number/Clearing Code: GB13BARC20325380642592
Euroclear Acc details: 18440
Reference: Investors full name as it appears on the application form

Please ensure you reference your payment per above. Failure to do so, will result in your funds being returned to the
remitting bank. Absa Bank Limited will not accept responsibility for incorrectly referenced payments which will result
in non-allocation of funds, nor will they be held liable should any consequential loss occur.

Payments must come from the account of the Investor/s. No third party payments will be accepted.

Section 5: Investment Professional

This section provides us with the details of your Investment Professional.

First name(s)

Surname (for individuals)

Registered company name

FSCA number FAIS Cat 1.8 license (Shares) required

Email address

Telephone number

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Section 6: Declaration and signature
I, the undersigned investor hereby confirm that I have read and understood the application form and investment schedule
and agree to be bound by the terms and conditions thereof and warrant that the particulars supplied above are true and
correct.
I hereby agree and acknowledge that Absa Corporate & Institutional Banking “Absa CIB”, a subsidiary of Absa Bank Limited,
is a product supplier as defined by the Financial Advisory and Intermediary Services Act (FAIS) and as such;
Absa CIB will not render any investment advice in respect of this investment. The selection of this investment will be made
entirely at my discretion;
Absa CIB shall bear no responsibility for, nor guarantee the performance of the investment, and Absa CIB will not be liable for
any losses I may incur as a result of acting on inadequate, insufficient or inappropriate advice.

Investor signature

Date Place

Investment Professional Signature

Date Place

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