Telephone: (011) 578-5333 FINAL TRUST CLAIM FORM Facsimile: (011) 578-5300 e-mail: pension@akafin.co.za N.B.: PLEASE ATTACH RECENT BANK STATEMENT (NOT OLDER THAN 3 X MONTHS)

TO : AKANI BENEFICIARY FUND

FROM : _________________________________________________

DATE : _________________________________________________

TRUST NO : _____________

CONTACT NO : __________________________

I, _______________________________________ with Identity Number: __________________________ being _______________________________ years old and out of school, do hereby apply for the release of my Trust that is in the care of Akani Beneficiary Fund. The money should be paid into my ___________________________________ bank account, No. ____________________________ and branch code __________________________. I understand that upon receipt of payment of the Trust I shall not be entitled to any further benefit from the Akani Beneficiary Fund and the Akani Beneficiary Fund shall have no further liability towards myself. _______________________________ APPLICANT’S SIGNATURE

PLEASE PRINT NAME IN FULL: _________________________________________________________

SIGNED AT _________________________ ON THIS __________ DAY OF __________________ 20...

I, ___________________________________ with Identity Number _______________________________ being the guardian of ___________________________________________________________, do hereby confirm that he is ___________________________________ years old and is no longer attending school. I further confirm that I am aware of his application for the release of his Trust and do hereby give my consent to this.

_______________________________ GUARDIAN’S SIGNATURE

PLEASE PRINT NAME IN FULL: _________________________________________________________

SIGNED AT _________________________ ON THIS __________ DAY OF __________________ 20...

DECLARATION BY COMMISSIONER OF OATHS I certify that the deponent has acknowledged that he / she knows and understands the contents of this declaration. Signed and sworn to / affirmed before me.

................................................................................................................. Commissioner of Oaths

Full name .......................................................................................................................................................................... Office ................................................................................. Place ................................................................................

(ex officio)