Driver code 14

Please note that the above bank details need to be used for future debit order transactions.

Signed at on this day of 2015 Account holder signature : Office Use

Signature on file verified by

Full name : Signature : Date :

Acc Name

Bank

Branch code

Acc number

Johannesburg (Sales): Ground Floor, Knox Titanium Vault Building, 1 River Street, Killarney, JHB Tel: 011-***-**** • Fax: 011-***-**** • E-mail: *******@**********.**.** Cape Town (Sales): The Business Centre, No 1 Bridgeway Road, Bridgeway Precinct, Century City, Cape Town Tel: 021-***-**** • Fax: 086-***-**** • E-mail: *****@**********.**.** George (Head Office): Sect. 2, Milkwood Village, Beacon Road, Wilderness, 6560 Tel: 044-***-**** • Fax: 044-***-**** • E-mail: *******@**********.**.** POSTAL ADDRESS: PO Box 92, Wilderness, 6560

WEB: www.investgold.co.za

REG: 2000/054382/23, VAT: 489*******

Consultant: Tanja Nel

(C) 083-***-****

(F) 086-***-****

*****@**********.**.**