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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 true 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      19 August 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   19 August 2011        The Standard Bank of South Africa Limited Reg. No. 1962/000738/06    Registered Bank                             2

				
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