Name of Company in which shares/stock are held

SANLAM LIMITED

Address

MobileNumber

Email

LandlineNumber

S L M Z

Please complete the below information to assist us in locating your shareholding.

(Please select relevant account type)Type of Account:

Sanlam Namibia Shareholders

Number

Date of

SA ID

Birth

Namibian IDNumber

(DD/MM/YYYY)

If Non Individual Shareholder. What is your relationship to the entity?

Full Names of Registered Holder:

(ONLY TO BE COMPLETED IF INDIVIDUAL ACCOUNT TYPE WAS SELECTED)

Shareholder Reference No. Company Code(SRN)

Please start the Shareholder Reference Number (SRN)with a capital 'U' 'D' or 'C' - If unknown, leave blank.

(Example: U1234567890)

Full Names of Person to be Contacted: