Please complete all fields marked (*) / Voltooi asseblief alle velde gemerk (*)
Mr Mrs Dr Ms Prof Rev Title/Titel (*) (Investor or representative in case of an entity)
Full names/Volle name (*)
Surname/Van (*) Initials/VL (*)
Pref language / Taalvoorkeur English Afrikaans
Physical Address / Woonadres
Postal Address / Posadres (= Physical address?)
Work Tel / Werk Tel (+27 12 548 6727)
Home Tel / Huis Tel +27 12 548 6727
Fax no / Faks no +27 12 548 6727
Email / Epos (*)
Standard Bank Nedbank ABSA Bank First National Bank Ou Mutual ABN Amro Mercantile Lisbon Saambou Bank Peoples Bank Boland Bank Permanent NBS Bank BOE Bank of Athens Bank Windhoek Citibank Fidelity Habib Overseas HBZ Investec Ithala Standard Lesotho Bank Meeg Bank Nedbank Swaziland Perm PEP Reserve Bank Standard Lesotho Standard Swaziland Swabou Unibank CAPITEC RSA HSBC OTHER RSA OTHER INTL Bank (*) Branch / Tak (*)
Branch Code / Takkode (*)
Account Number / Rekening Nommer (*)
Name of account holder / Naam van rekeninghouer (*)
Cheque / Tjek Savings / Spaar Transmissie / Transmission Other Type account / Tipe rekening (*)
None / Geen RBK Batebestuur (Edms) Bpk Brokerage / Makelaarshuis
(Please ensure that the following are faxed to +27 (0) 86 680 5803 or email to admin@xodusgoud.co.za / Faks asb volgende dokumente na 086 680 5803 of epos na admin@xodusgoud.co.za )
Certified copy of ID / Gesertifiseerder afskrif van ID
Proof of Residence / Bewys van fisiese adres
Proof of bank account / Bewys van bankrekening
I hereby apply for membership of the above mentioned Co-operative, I also apply for the acquisition of one share at the amount of R1. I understand that this co-operative is a investor’s co-operative which is going to invest any amount, invested in it by members, in physical gold. I understand and accept that consequently all funds that I may invest in the co-operative could increase or decrease in value in accordance to the fluctuation in value of gold in the gold pool. I confirm that I subject myself to the stipulations of the current statute and rules and/or regulations, as well as any amendments which could, periodically (in future) be brought about to the statute, the rules and/or regulations, legally.
Ek doen hiermee aansoek om lidmaatskap van bogenoemde koöperasie en daarmee saam ook aansoek om eenaandeel te bekom teen die bedrag van R1. Ek verstaan dat die koöperasie 'n beleggingskoöperasie is wat enige gelde wat lede daarin belê, in fisiese goud gaan belê. Ek verstaan en aanvaar gevolglik dat alle geld wat ek in die koöperasie mag belê, in waarde kan toeneem of afneem na gelang van fluktuasies in waarde van die goud in die goudpoel. Ek bevestig dat ek my onderwerp aan die bepalings van die huidige statuut en reëls en/of regulasies, asook enige wysigings wat in die toekoms van tyd tot tyd aan die statuut, die reëls en/of regulasies wetlik aangebring mag word
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