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					                                                                               Application to purchase foreign currency
                                                                               Cross Border foreign exchange transaction reporting
                                                                              (Bank sale to customer)
Transaction                                                          Value                                Standard                                              Bank
                  Teletransmission
required                                                             Date                                 Bank Branch                                           branch no.
Spot Cover/                                                                                                                                 Exchange
FEC number(s)                                                                                                                               rate
DETAILS OF                                                       Remit Foreign                 Specify                      Foreign amount
REMITTANCE                                  A                   Currency amount                Currency                     to be remitted
SELECT AND COMPLETE                                        Remit Foreign Currency              Specify                      Rand equivalent
                                            B                                                                                                        R
ONLY ONE OPTION                                              equivalent of Rand                Currency                     to be remitted
                                                               Remit Rand amount                                            Rand amount
A, B, OR C                                  C                        in ZAR
                                                                                               Currency        ZAR
                                                                                                                            to be remitted
                                                                                                                                                     R

DETAILS OF DEBIT                My / Our Standard Bank
                                                                             OR
                                                                                       My / Our                                 Specify CFC
(indicate account type)         Current Account                                        CFC Account                                 Currency
Account number                                             Charges account                                           Amount to be debited
                                                                                                                                                   R
to be debited                                              number (if different)                                     (if known)
Resident           Name of individual or
Party              name of entity
Full residential / Business
                                  Street:                                                           Suburb:                                          City:
Address ( not P.O. Box)
Telephone, fax no. and e-
mail address of applicant
Identity no. of individual or                                                                              Individual / Entity/
registration no. of entity                                                                                 Exception
Contact name if entity:                                                               Tax number                                               VAT number
Name and Surname                                                                      of applicant**                                           of applicant**

Beneficiary Bankers                Name:                                                                                          SWIFT Code

sort code                          //                                                                    Branch Name

Street address                                                                                                                    Country

Beneficiary details                Beneficiary account                                                                                                 Individual / Entity/
                                                                 /
(in favor of)                      Number/IBAN                                                                                                         Exception
Name of individual or
                                                                                                                      Residing country:
name of entity
Beneficiary address

Sanction Screening                 Vessel name(s):                                        IMO number:                                             Flag details:

Details of        Invoice                                                                                Transport document
payment           number(s)                                                                              no.

                                     (MRN) Format : AAACCYYMMDD0000000                                   Import Payments
Import Payments
                                                                                                         Customs Client                Format: 12345678
Movement Reference                   Or (INVOICE) Format : INV000000                                     Number (CCN)
Number (MRN)
* see note, foot of page 2

Import permit                           Available              Not required         Additional information
Instructions for return of documents:              To be                       Mail back to                   Forward to SBSA                     Branch
(insert an X in the applicable block)              collected                   applicant                      branch (specify)                    name :
Note – per Exchange Control Rules and Regulations, all documentation pertaining to this transaction must be retained for a minimum period of 5 years.

                         1. (OUR) Applicant’s charges = All transaction charges, including foreign bank charges, are to be borne by the applicant.
                         2. (SHARE) Applicant’s and beneficiary’s charges = Standard Bank transaction charges are borne by the applicant. Foreign Bank transaction
Charges
                         charges are borne by the beneficiary.
                         3. (BEN) Beneficiary’s charges = All transaction charges, including those imposed by Standard Bank, are to be borne by the beneficiary.
                                   Category Code
Balance of payment details                                                                             Country of origin of goods (e.g. USA)
                                   (Selected from attached list)
                            Composite transactions                                                             Additional details required for category 901 and 999
Category                       Amount                                                       Category details or Loan Ref.

Category                       Amount                                                       Category details or Loan Ref.

Category                       Amount                                                       Category details or Loan Ref.
Exchange Control               Application
                                                                                            Dated
approval obtained              number
Original document submitted                                          I am not in possession of the original documents
I/We apply to purchase/transfer as indicated above. I/We declare that the information provided by me/us is complete and correct. I/We attest that this purchase/transfer is not related to the
following countries, namely; Iran, Cuba, Burma or Sudan. I/We hereby declare and acknowledge that should I/we not be in possession of the original document, I/we will not seek payment on the
original document once it becomes available. I/We undertake to keep the original document for a minimum of 5 (five) years. I/We hereby acknowledge that the bank is not liable for errors,
omissions or delays in transmissions arising from circumstances beyond its control. I/We acknowledge that I/we cannot hold the bank liable for non-receipt of funds by the recipient where the
sovereign rules and regulations affect the transmission of the funds or the funds received by the recipient's bank or agent. I/We confirm that the confidential information pertaining to our banking
details/transactions in the banks possession may be used and retained by the bank in order for the bank to comply with any of its obligations in terms of local and international legislation and
standards. I/We understand that it is my/our responsibility to inform the bank of all changes to the details of the entity on whose behalf I/we am/are acting, whether it be contact details or other
details relevant to such entity. I/We acknowledge that the bank will not be liable for any losses and damages suffered by me/us, as a result of the bank processing the above instructions.
For and on behalf of                                                    Signature(s) of applicant / authorised signatory(ies)                            Date




00039068      11 July 2011               The Standard Bank of South Africa Limited Reg. No. 1962/000738/06                            Registered Bank                                           1
                                                   BOP categories for purchases of foreign currency
                                                   NB. This page is a reference guide to BOP categories for your convenience. The
                                                   printing of this form is not a Bank requirement. Please do not include this page when
                                                   submitting your application form to the Bank.

Adjustments                                        Computer related expenses                       Transfers of a capital nature
100     Adjustments related to                     313     Data and new related                    601     Government
        merchandise trade                          314     News agency fees                        602     Non-Government sector – cash
Merchandise Imports                                Other business services                                 linked to fixed assets
101     Advance payments                           315     Merchanting                             603     non government sector –
102     Free on Board (F.O.B)                      316     Operational leasing                             donations for fixed investments
103     Cost, Insurance and Freight                Professional, management and                    604     non governmental sector –
        (C.I.F)                                    technical services                                      inheritance taxes
104     Repair                                     317     Legal, accounting, management           6051111Acquisition/disposal (patents,
105     Procured in ports                                  consulting                                      copyrights, trademarks,
107     Trade Finance                              318     Advertising and market                          franchises
108     Advance payments in terms of                       research                                606     Foreign investment by resident
        imports undertaking                        319     Research and development                        individual in respect of cross-
109     F.O.B in terms of imports                  320     Architectural, engineering and                  border flows
        undertaking                                        other technical                         607     Investment by a resident
110     C.I.F in terms of imports                  321     Agricultural, mining and other                  individual originating from a
        undertaking                                        processing                                      local source into an account
111     Software imports via internet              Personal, cultural and recreational                     conducted in foreign currency
112     Imports less than R500                     services                                                held at an authorized dealer in
113     Imports via the South African              323     Audiovisual and related services                South Africa
        Post Office                                324     Cultural and recreational               608     Foreign investment by a
114     Diamond payments not in terms              Government Services                                     resident individual in respect of
        of imports undertaking                     325     Diplomatic transfers                            cross- border flows originating
115     Diamond Payments in terms of               Medical Services                                        from a foreign currency account
        import undertaking                         326     Medical and dental services                     held at an authorized dealer in
116     Goods purchased by residents               Income                                                  South Africa
        for manufacturing or                       401     Dividends                               Financial transactions
        consumption outside South                  402     Interest not in respect of loans        701     Shares
        Africa                                     403     Branch profits                          702     Bonds
Gold Imports                                       404     Compensation of employees               703     Money market instruments
201     Payments                                           including migrant workers               704     Foreign portfolio investments –
202     Hedging                                    405     Commission or brokerage                         investment by resident
203     Payments in terms of gold                  406     Rental                                          institutional investors
        imports undertaking                        407     Interest in respect of loans            705     Bank prudential
Services related to travel by non-                 Transfers – current                             706     Inward listed securities
residents                                          501     Gifts                                   Deposits/Derivatives
260     Travel related payments to third           502     Annual contributions                    804     Options
        parties                                    503     Contributions to social security        805     Futures
Services related to transportation                         schemes                                 806     Warrants
301     Freight                                    504     Contributions – charitable,             Other/Miscellaneous payments
302     Passenger fares                                    religious, scientific and cultural      901     Details of payments not
Services related to travel by residents            505     Pension payments                                classified above
303     Business travel – residents                506     Annuities                               902     Adjustments not related to
304     Holiday travel – residents                 507     Payments by immigrants                          merchandise trade
Services related to study                          508     Inheritances                            903     Rand Collections for the credit
305     Tuition fees                               509     Alimony                                         of Vostro accounts
306     Study loans                                510     Income Tax                              950     Reversal of transaction
Other Services                                     511     Premiums paid (nonlife/short                    (monetary value) previously
307     Telecommunications                                 term insurance                                  reported and accepted by SARB
308     Postal and courier                         512     Claims (non-life/short term             998     Loan made by resident to a non
309     Construction                                       insurance)                                      resident
310     Insurance                                                                                  999     Repayment by resident of a loan
311     Financial                                                                                          (capital portion) received from a
312     Copyright, royalties and patent                                                                    non-resident
        fees

NOTES:
*
To enable the South African Reserve Bank to achieve a matching process between payments for goods imported and the receipt of goods in the
Republic, importers must supply a Movement Reference Number (MRN) for each payment to Standard Bank, which can be linked to the SAD 500
Customs Declaration Form and/or Customs release notification in respect of goods received in the Republic.

Or

In cases where a bill of entry number is not available and an MRN cannot be compiled, the invoice number which represents the payment offshore
must be supplied. A prefix INV must be supplied followed by the invoice number related to the payment effected, i.e. INV000000. The invoice
number supplied by the importer to Standard Bank must also be supplied to Customs. In the case of bulk payments against multiple invoices, only
one invoice number must be consistently supplied to Customs and to Standard Bank.

** For trade related items both Tax numbers are compulsory

00039068   11 July 2011        The Standard Bank of South Africa Limited Reg. No. 1962/000738/06   Registered Bank                           2

				
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