MTN Zakhele (RF) Limited APPLICATION FORM (BLACK PEOPLE)

MTN Zakhele (RF) Limited (MTN Zakhele) (Incorporated in the Republic of South Africa) (Registration number 2010/004693/06)

APPLICATION FORM (BLACK PEOPLE) [This is the form to be completed by Black People that are not already MTN Zakhele Shareholders and who want to apply to MTN Zakhele for approval to become a MTN Zakhele Shareholder] Instructions: 1) Fill in and complete this Application Form (this 'Form') in CAPITAL LETTERS and black ink. 2) Specific meanings (definitions) have been given to some words and phrases in this Form. These words and phrases start with a capital letter. The only defined words that do not always have a capital letter are the words 'you', 'we' and 'us'. A list of defined words and phrases, and also the meanings we have given them, is contained in Annexure A attached to this Form. Sometimes the definitions of a word or phrase can also be found in the body of this Form (in the same way that we have defined this Form (Black People) as this 'Form' in paragraph 1 above). The words and phrases that have been defined will have the same meaning wherever they are used in this Form. 3) You may only complete this Form if you qualify as a BEE Participant. 4) If you make changes or corrections to the information that you fill or complete in this Form, you must put your full signature next to the changes and corrections. 5) When you give this Form to MTN Zakhele (RF) Limited ('MTN Zakhele', 'we' or 'us'), you must also give the appropriate Supporting Documents listed below. The Supporting Documents you will need to give will depend on the type of change you are making in this Form. The list of the Supporting Documents that you must give MTN Zakhele, is at the end of this Form. 6) You must give this Form (properly completed and signed), together with the Supporting Documents, to MTN Zakhele by email or fax or post or delivered by hand. The email, fax, post and hand delivery details are: Fax: 086 674 3260 Email: [email protected] Physical address: 13th Floor Rennie House, 19 Ameshoff Street, Braamfontein, 2001, South Africa Postal address: MTN Zakhele Shareholder Services, P.O Box 4844, Johannesburg, 2000. 7) Any Supporting Documents delivered by hand or by post may be originals or certified copies. Any Supporting Documents sent by email, fax or other electronic means must be certified copies. 8) Any Supporting Documents sent by fax or other electronic means, must be sent with a fax cover sheet which includes the information set out in Annexure B attached to this Form. 9) Copies can be certified at any South African Police Station. 10) If you have any questions regarding the contents of this Form, please contact the MTN Zakhele Shareholder Services at the details above. Or you can phone MTN Zakhele at 083 123 6869. Applicants are advised to familiarise themselves with the following important documents which set out the terms and conditions which apply to the MTN Zakhele Shares: i) The Prospectus, which summarises certain key terms and conditions of the issue of the MTN Zakhele Shares; ii) The Relationship Agreement which regulates, amongst other things, the rights and obligations of MTN Zakhele, MTN and MTN Zakhele Shareholders; and iii) The MTN Zakhele Constitutional Document, which is the memorandum of incorporation of MTN Zakhele. Copies of the Definitions Schedule, the Prospectus, the Relationship Agreement and the MTN Zakhele

MTN Zakhele (RF) Limited APPLICATION FORM (BLACK PEOPLE) Constitutional Document are available on the MTN Zakhele website www.mtnz.co.za or can be requested from MTN Zakhele Shareholder Services. APPLICANT DETAILS Full name of Applicant:

□ Mr □ Mrs □ Miss □ Dr □ Rev Gender: □ Male □ Female Title:

Identity number of Applicant:

CONTACT DETAILS FOR APPLICANT E-mail address: Cell phone number: Office phone number: Fax number: Postal address: Physical address:

Postal Code:

DETAILS OF PARENT/GUARDIAN IF APPLICANT IS UNDER 18 YEARS OR IF THE PERSON SIGNING THIS FORM IS SIGNING IN A REPRESENTATIVE CAPACITY

□ Birth parent of minor □Other (Please specify below) □ Legal guardian Title: □ Mr □ Mrs □ Miss □ Prof □ Dr □ Rev Capacity:

Full names: ID Number: Email address: Cell phone number: Office phone number: Home phone number: Fax number: Residential address: Postal address:

BANK ACCOUNT DETAILS FOR APPLICANT Name of bank account holder: Name of South African Bank: Name of bank branch:

Bank account number:

Bank branch code:

Account type:

NOTE:

We cannot accept banking details in the name of a third party

Cheque*

Savings*

(* - please tick one)

MTN Zakhele (RF) Limited APPLICATION FORM (BLACK PEOPLE) Please also ensure that the Bank Verification section below is completed.

BANK VERIFICATION I confirm that the above information about the abovementioned Applicant's account at this Bank is correct

BANK STAMP HERE Signed on behalf of Bank THIS MUST BE COMPLETED BY YOUR BANK

I hereby authorize MTN Zakhele (RF) Limited to act in accordance with my instructions set out above.

Declaration and Agreement: To: MTN Zakhele Limited

By signing this Form: I, the undersigned and the person identified as the Applicant in this Form (or the person signing this Form in a Representative Capacity), confirm to MTN Zakhele that I have full legal capacity and that I am duly authorised to contract and, having read and understood the Prospectus, hereby apply to become a BEE Participant of MTN Zakhele. I warrant to MTN Zakhele that I am a Black Person as defined in the Definitions Schedule and that all of the information provided by me in this Form (including all Supporting Documents) is true and correct in all respects. I acknowledge to MTN Zakhele that I have been informed that various restrictions are imposed upon the Disposal and/or Encumbrance of MTN Zakhele Shares as set out in the Relationship Agreement and summarised in paragraph 10 of Part A of the Prospectus. I undertake to MTN Zakhele and MTN that, if MTN Zakhele Shares are transferred to me, I will comply with the terms of the MTN Zakhele Constitutional Document including all the restrictions contained in the MTN Zakhele Constitutional Document, and I confirm and agree in favour of MTN Zakhele and MTN that I am and will be bound by the provisions of the Relationship Agreement. I understand that if I contravene these restrictions and/or breach the terms of the Relationship Agreement I may have action taken against me which may result in me losing any benefit which I would otherwise have had in my investment in MTN Zakhele. I acknowledge that MTN Zakhele will rely on the truthfulness and completeness of the information provided and statements made by me when making its decision to accept this Form. I hereby acknowledge that I have read the terms of the Relationship Agreement and agree and undertake that, with immediate effect from the date of acquisition of any MTN Zakhele Shares, I will be bound by all of the provisions of the Relationship Agreement and the MTN Zakhele Constitutional Document and all the terms thereof will be enforceable against me by the relevant parties to the Relationship Agreement as from such date of such acquisition. I agree that MTN Zakhele is entitled to verify my details and that I am obliged to assist in such verification promptly when requested to do so.

MTN Zakhele (RF) Limited APPLICATION FORM (BLACK PEOPLE) Day

Signature:

Month

Year

Name:

Capacity:

If you are signing this Form on behalf of an Applicant, please indicate which capacity, for example, a legal guardian or parent of a minor (under 18 years) or in any other representative capacity identified in the Supporting Documents section below ('Representative Capacity') __________________________ (Insert capacity)

IMPORTANT: By signing this Form you confirm that the details contained in this Form are true and correct. Once you have signed this Form, you will not be able to say later that the details that you put in this Form were not true and correct when you gave us this Form. We may also have claims and rights against you because of the details that you put in this Form. By signing this Form in a Representative Capacity, you provide the warranties and undertakings and acknowledgements set out in this Form. You also conclude the Relationship Agreement on behalf of the Applicant.

MTN Zakhele (RF) Limited APPLICATION FORM (BLACK PEOPLE) SUPPORTING DOCUMENTS A.

THE APPLICANT MUST PROVIDE THE FOLLOWING SUPPORTING DOCUMENTS:

Identity document: Affidavit:

Bank Account Details:

Proof of physical address:

B.

The green bar-coded South African Identity Document or passport reflecting the South African identity number or a certified copy An affidavit attached as Schedule 1 to this Form, signed by a Black Person confirming he/she is a Black Person (or signed by a parent or guardian of the Applicant, confirming that the Applicant is a Black Person). Provide details of the Applicant's active transactional bank account into which MTN Zakhele may pay purchase prices, dividends and any other payments. Obtain a stamp on the Form from the Applicant's bank verifying the transactional bank account details. Provide a certified copy of any one of the following documents reflecting the Applicant's name and physical address and unless otherwise stated, these documents must be less than three months old:  Utility bill.  Current lease or rental agreement reflecting that you are the tenant.  Bank statement.  Municipal rates and taxes invoice.  Current copy of valid television licence.  Mortgage bond statement.  Land-line or cellular telephone account.  Tax return (less than one year old).  Correspondence from a body corporate or shareblock association reflecting you as owner/tenant/occupant.  Payslip or salary advice.  A letter from a tribal chief where you live. If the Applicant is a minor and the proof of residential address is in the name of the parent or guardian, the parent or guardian must provide a declaration stating that the minor is residing at the relevant address.

IF YOU ARE SIGNING THIS FORM IN A REPRESENTATIVE CAPACITY, YOU MUST ALSO PROVIDE THE FOLLOWING SUPPORTING DOCUMENTS:

Power of attorney:

Minors:

To sign under a Power of Attorney, you must provide the Power of Attorney together with a certified copy of the registered holder’s green bar-coded South African Identity Document or passport reflecting the registered holder's identity number. Minors must be assisted by their parents or guardians. Minors must submit their green bar-coded South African Identity Document or their birth certificate; provided that the minor’s South African identity number is printed on the birth certificate. A passport will be accepted if the minor’s South African identity number is reflected thereon. The parent or guardian must also submit their green bar-coded South African Identity Document or passport reflecting their identity number.

MTN Zakhele (RF) Limited APPLICATION FORM (BLACK PEOPLE) Schedule 1

AFFIDAVIT (BLACK PERSON) _________________________________________________________________________ by Black Person (or parent or guardian of a minor which is a Black Person) confirming that he/she is a Black Person

I, the undersigned:

_________________________________________________________

Identity number:

_________________________________________________________

Residing at:

_________________________________________________________

do hereby make oath and state that:

1.

I have read the terms of the agreement titled "Relationship Agreement" dated 16 March 2010 (as amended, substituted or novated from time to time) between MTN Zakhele (RF) Limited (MTN Zakhele), MTN Group Limited and the holders of ordinary shares in MTN Zakhele (Relationship Agreement), which is available on the following website: [email protected].

2.

I am /

[insert the name of the minor, or delete this option] is a

Black Person, as defined in the Relationship Agreement.

________________________________ Deponent

I CERTIFY that this Affidavit was SIGNED and SWORN to before me at _______________________ on this the _________ day of ________________________ 20______ the Deponent having acknowledged that he/she knows and understands the content of this Affidavit, the Regulations contained in Government Notice No 1258 of 21 July 1972 and R1648 of 19 August 1977, having been complied with.

________________________________ Commissioner of Oaths Full names: Business address: Designation: Capacity:

MTN Zakhele (RF) Limited APPLICATION FORM (BLACK PEOPLE) Annexure A

DEFINITIONS SCHEDULE "Applicant"

a Black Person or Black Group which does not own MTN Zakhele Shares who applies to MTN Zakhele for approval to become a MTN Zakhele Shareholder;

"Application Form"

means:  for a Black Person, the form called the "Application Form (Black People)" that MTN Zakhele requires a Black Person to sign as part of the Application Process;  for a Black Group, the form called the "Application Form (Black Groups)" that MTN Zakhele requires a Black Group to sign as part of the Application Process;

"Application Process"

the process that MTN Zakhele requires an Applicant to follow to apply for approval to become an MTN Zakhele Shareholder;

"Authority"

any government or governmental, administrative, fiscal or judicial authority, body, court, department, commission, tribunal, registry or any state owned, controlled or legislatively constituted authority which principally performs public, governmental or regulatory functions and/or which is responsible for applying national security, foreign investment, exchange control, telecommunications, merger control or other competition or antitrust legislation or regulations, in South Africa, including without limitation the Independent Communications Authority of South Africa;

"Authorised Representative"

is the individual that a Black Group appoints to use the Trading Platform for the Black Group. This person is appointed under an Authorising Resolution and by following the process in paragraph 2.2 of 'Section B: How to start using the Trading Platform ' of the Trading Platform Terms and Conditions;

"Authorising Resolution"

a valid resolution in the form of the standard resolution, called "Authorising resolution for Black Group", which is attached as Schedule 1 to the Pre-Registration Form or to the Change of Details Form for Black Groups;

"BEE"

black economic empowerment;

"BBBEE Act"

the Broad-Based Black Economic Empowerment Act, 53 of 2003, and any regulations and codes of good practice published thereunder (including the Codes);

"BEE Legislation"

each and all of (i) the BBBEE Act, (ii) any codes of good practice and/or any transformation charters issued under sections 9 and/or 12 of the BBBEE Act applicable to the MTN SA Group, (iii) any communications sector legislation (including the EC Act) and any regulations published under such legislation and any Licence conditions made pursuant to such legislation from time to time, as applicable to the MTN SA Group, and (iv) any other charter, law, condition of a material Licence, regulation or (mandatory or voluntary) practice pursuant to which ownership and/or control by black people in the MTN SA Group is measured or a requirement relating thereto is imposed on it, or its rights, interests and/or obligations are affected thereby whether directly or through its customers;

"BEE Ownership Documents"

in relation to a Black Group a declaration of its BEE Status, which declaration must be dated and signed by an authorised person and must be accompanied by: (i) a list of all of the Black People who, both directly or indirectly, hold an Effective Interest in the Black Group including their names, identity numbers, nationality, gender and effective percentage economic (and, if different, voting) interest held. Indirect

MTN Zakhele (RF) Limited APPLICATION FORM (BLACK PEOPLE) interests held by Black People require a detailed organogram; and (ii) the green barcoded South African Identity Document or passport showing the South African identity number of all of the Black People who, both directly or indirectly, hold an Effective Interest in the Black Group; “BEE Participants”

individually and collectively (as the context may dictate), a Black Person or a Black Group, that is eligible to subscribe for and directly and beneficially, own MTN Zakhele Shares pursuant to the BIC Public Offer, or are thereafter permitted to own MTN Zakhele Shares in terms of the provisions of the Relationship Agreement;

"BEE Status"

in relation to a Black Group, the Black Group’s percentage ownership and percentage economic interest by Black People (by shareholding, membership, beneficiary interest and/or other comparable interest, as the case may be, having regard to the juristic nature of the relevant Black Group) and the Black Group’s percentage representation by Black People at board or trustee or other similar governing body, as measured under the BEE Legislation and, in relation to a natural person, whether or not that person qualifies as a Black Person;

"BIC Public Offer"

the public offering in terms of which Black People and Black Groups are invited to subscribe for and beneficially own MTN Zakhele Shares, subject to the qualification criteria of such offer as set out in the prospectus published in respect of the offer;

"Black Group"

a Black Company or a Black Entity;

"Black Company"

a company incorporated in accordance with the laws of South Africa which is a "BEE controlled company" and a "BEE owned company" (for comparable term) as defined from time to time under the BEE Legislation, which definitions, as at the date of the Prospectus, are summarised as follows for convenience: a company having a shareholding in which one or more Black Person/s:  beneficially owns or own, on an effective flow-through basis (as such term is contemplated in the Codes and which, for the avoidance of doubt, excludes measurement utilising the modified flow-through principle), more than 50% of the ordinary share or other equity interest of such company;  is or are entitled to an effective flow-through basis (as such term is contemplated in the Codes and which, for the avoidance of doubt, excludes measument utilising the modified flow-through principle), more than 50% of all economic interest in relation to such ordinary shares or other equity interest of such company; and  controls or control, on an effective flow-through basis (as such term is contemplated in the Codes and which, for the avoidance of doubt, excludes measurement utilising the modified flow-through principle), more than 50% of all exercisable voting rights in relation to the ordinary shares and/or other equity interst of such company, excercisable by members in general meeting or otherwise, and a reference to "company" shall be applied appropriately to a close corporation or other such incorporated entity;

"Black Entity"

(i) a vesting trust; (ii) a broad-based ownership scheme and (iii) an unincorporated entity or association, including a partnership, joint venture, syndicate or Stokvel, in each case under (i) to (iii) as may be determined from time to time (generally or in relation to any particular Black Entity or category of Black Entities) by MTN in its sole discretion as an entity which qualifies under the BEE Legislation (and the Codes in particular) for recognition and measurement or ownership, economic interest and control by Black People such that the MTN SA Group may claim recognition of such ownership, economic interest and control under the BEE Legislation as being held by a majority of Black People;

MTN Zakhele (RF) Limited APPLICATION FORM (BLACK PEOPLE)

“Black People” or “Black Person”

“black people” (or comparable term) as defined from time to time under the BEE Legislation; provided that where the BEE Legislation contains more than one definition of “black people” (or comparable term) and such definitions are not the same, then the term “black people” shall mean (and be restricted to) the class of persons who satisfy the relevant criteria in every such definition. As at the Signature Date of the Relationship Agreement (by way of summary and without in any way being construed as an interpretation of the Codes), “Black People” were defined under the BBBEE Act read with Schedule 1 of the Codes, as being African, Coloured (including Chinese) or Indian persons who are natural persons and who: (a) are citizens of South Africa by birth or descent; or (b) are citizens of South Africa by naturalisation before the commencement date of the Constitution of the Republic of South Africa, Act 200 of 1993 (“Interim Constitution”) or (c) became citizens of South Africa after the commencement date of the Interim Constitution, but who, but for the apartheid policy that had been in place prior to that date, would have been entitled to acquire citizenship by naturalisation prior to that date; “Black” shall have a similar meaning when used as an adjective;

"Call Centre"

the call centre established by MTN Zakhele for the Trading Platform which can be contacted at the phone number: 083 123 6869;

"Change of Details Form"

means:  for a Black Person, the form called the "Change of Details Form (Black People)" that MTN Zakhele requires a Black Person to sign as part of the Change of Details Process;  for Black Groups, the form called the "Change of Details Form (Black Groups)" that MTN Zakhele requires a Black Group to sign as part of the Change of Details Process;

"Change of Details Process"

the process that a MTN Zakhele Shareholder must follow to change, correct, complete or update the information that MTN Zakhele has for them. This process is set out in paragraph 4 of 'Section B: How to start using the Trading Platform 'in the Trading Platform Terms and Conditions;

"Codes"

the Codes of Good Practice on Broad Based Black Economic Empowerment issued by the Minister of Trade and Industry on 9 February 2007 in terms of Section 9 of the BBBEE Act;

"Dispose"

sell, alienate, donate, exchange, distribute, transfer or in any manner whatsoever dispose of, whether voluntarily or involuntarily, or enter into any arrangement or transaction whatsoever which may have the same or a similar effect as any of the aforementioned sale, alienation, donation, exchange, distribution, transfer or disposal (including but not limited to any transaction, or series of arrangements or transactions, or the cession of any rights or the granting of any option or any similar transaction/s which would have the same economic effect), or realise any value in respect of, and “Sale”, “Disposal” and “Sold” shall be construed accordingly;

"Effective Interest"

any one or more of a direct or indirect ownership, economic or control interest, measured on a fully diluted basis and without any deeming rule or deeming provision being applied;

"Encumbrance"

in relation to any property, includes any pledge, security cession, charge, hypothecation, lien, subordination, mortgage, option over, right of retention or any other encumbrance whatsoever, or any form of hedging or similar derivative instrument of any nature whatsoever of or over or in respect of that property or class of property (or any part or proceeds thereof), or any lending of that property, and the words “Encumber”, “Encumbered” and “Encumbering” shall have corresponding meanings;

MTN Zakhele (RF) Limited APPLICATION FORM (BLACK PEOPLE)

"Group Shareholder Number"

the unique number we give to you if you are a Black Group that is a MTN Zakhele Shareholder;

"MTN"

MTN Group Limited (Registration number 1994/009584/06), a limited liability public company duly incorporated in South Africa, whose ordinary shares are listed on the JSE;

"MTN SA Group"

each and all of (i) Mobile Telephone Networks (Proprietary) Limited, MTN Service Provider (Proprietary) Limited and MTN Business Solutions (Proprietary) Limited and each of its and their South African subsidiaries from time and (ii) any other South African operating subsidiary of any of MTN, Mobile Telephone Networks Holdings (Proprietary) Limited and/or MTN International (Proprietary) Limited designated in writing by MTN to MTN Zakhele from time to time;

"MTN Zakhele" or "we" or "us"

MTN Zakhele Limited (Registration number 2010/004693/06), a public company incorporated in accordance with the laws of South Africa, the special purpose vehicle created to effect the MTN Zakhele Offer and related aspects of the MTN BEE Transaction;

"MTN Zakhele Constitutional Documents"

the memorandum of incorporation of MTN Zakhele;

"MTN Zakhele Share"

an ordinary share issued by MTN Zakhele;

"MTN Zakhele Shareholder"

a registered owner of MTN Zakhele Shares;

"MTN Zakhele Shareholder Services"

the service for MTN Zakhele Shareholders established by MTN Zakhele, to provide assistance to MTN Zakhele Shareholders for the Application Process, the PreRegistration Process and the Trading Platform and can be contacted as follows: Phone: 083 123 6869 Fax: 086 674 3260 Email: [email protected] Physical address: 13th Floor Rennie House, 19 Ameshoff Street, Braamfontein, 2001, South Africa Postal address: MTN Zakhele Shareholder Services, P.O Box 4844, Johannesburg, 2000 Website: www.mtnz.co.za;

"Pre-Registration Form" "Pre-Registration Process"

the form called the "Pre-Registration Form (Black Groups)" that MTN Zakhele requires a Black Group to sign as part of the Pre-Registration Process; the process that a Black Group must follow before the Black Group is able to register to use the Trading Platform and to buy and sell MTN Zakhele Shares on the Trading Platform. This process is set out in paragraph 1.2 of 'Section B: How to start using the Trading Platform' in the Trading Platform Terms and Conditions;

"Prospectus"

the MTN Zakhele prospectus issued on 30 August 2010 in terms of which members of the Black Public were invited to subscribe for MTN Zakhele Shares;

“Relationship Agreement”

the agreement entitled “Relationship Agreement” concluded between MTN Zakhele and MTN on 12 July 2010 and all MTN Zakhele Shareholders, regulating, inter alia, the rights and obligations of these parties relating to the holding of MTN shares by MTN Zakhele and the holding of MTN Zakhele Shares by the MTN Zakhele Shareholders;

MTN Zakhele (RF) Limited APPLICATION FORM (BLACK PEOPLE)

"Shareholder"

a MTN Zakhele Shareholder;

"Share"

a MTN Zakhele Share;

"Supporting Documents"

means:  for the Pre-Registration Process: all documents which are required to be given to MTN Zakhele by a MTN Zakhele Shareholder as part of the Pre-Registration Process. These documents are listed in the Pre-Registration Form and must be given to MTN Zakhele together with the Pre-Registration Form;  for the Application Process: all documents which are required to be given to MTN Zakhele by an Applicant as part of the Application Process. These documents are listed in the Application Form and must be given to MTN Zakhele together with the Application Form;  for a change of details by a Black Person or Black Group: all documents which are required to be given to MTN Zakhele as part of the Change of Details Process. These documents are listed in the Change of Details Form and must be given to MTN Zakhele together with the Change of Details Form;

"Trading Platform"

the electronic trading system set up by MTN Zakhele for the buying and selling of MTN Zakhele Shares through a website or through a call centre. This electronic trading system can be used through the website: www.mtnz.co.za, or through the MTN Zakhele call centre at 083 123 6869. This electronic trading system, website and call centre all together form the Trading platform;

"Trading Platform Terms and Conditions"

the terms and conditions of MTN Zakhele that apply to the Trading Platform that are contained in the document with the name 'Trading Platform Terms and Conditions'. The Trading Platform Terms and Conditions can be obtained on the MTN Zakhele Website: www.mtnz.co.za:  by asking through the MTN Zakhele Call Centre: 083 123 6869; or  by asking in an e-mail to: [email protected];

"Valid BEE Ownership Certificate"

a BEE ownership certificate based on a Black Group's current shareholding, issued within the previous 12 months and issued by a Valid BEE Verification Agency;

"Valid BEE Verification Agency"

a BEE verification agency that has applied for and been granted accreditation from the South African National Accreditation System or such other agency acceptable to MTN in its sole discretion.

MTN Zakhele (RF) Limited APPLICATION FORM (BLACK PEOPLE) Annexure B

ELECTRONIC TRANSMISSION COVER SHEET No. of pages (including this):

Subject: Electronic document transmission

Identity number of sender (if applicable ): Sender's Shareholder number (if known): Email address: Cell phone number: Office phone number: Home phone number: Fax number: SENDER'S POSTAL ADDRESS

POSTAL CODE:

SENDER'S PHYSICAL ADDRESS

POSTAL CODE:

I hereby submit documents for the attention of MTN Zakhele (RF) Limited Day

Month

Year

Signature

THIS COVER SHEET MUST BE USED FOR ALL ELECTRONIC DOCUMENT TRANSMISSIONS THIS COVER SHEET MAY BE FAXED TO: 086 674 3260 OR E-MAILED TO: [email protected]