Declaration

I hereby declare that:

1. I have read this document and know and understand the contents thereof;

2. The information furnished above is in all respects both true and correct;

3. The currency or transfer of value applied for will only be used for the specific purpose stated herein;

4. The documentation presented in support of this application is in all respects authentic;

5. I have been informed of the limit applicable to the above transaction and confirm that this limit will not be exceeded as a result of the conclusion of this transaction; and

6. I consent to this information being provided to the South African Revenue Service and/or the Financial Intelligence Centre.