Corporate Application Form: Advisory & Discretionary

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1 Corporate Application Form: Advisory & Discretionary Merrion Stockbrokers Limited, trading as Merrion Private and Merrion Fixed Income, is regulated by the Central Bank of Ireland. Merrion Stockbrokers Limited (registered in Ireland under the number ) is a member of the Irish Stock Exchange and the London Stock Exchange. 1/17

2 Merrion Private Client Application Form SECTION 1: GENERAL INFORMATION SECTION 1A: ACCOUNT & SERVICE TYPE * Service Type: Please indicate your preferred service(s). Advisory Discretionary ADVISORY SERVICE Merrion Private ( Merrion ) provides an advisory service where the client assumes responsibility for the investment decisions taken and the structure and risk profile of the account. Merrion considers the client s specific circumstances and agrees a suitable investment strategy with the client. An advisory client is not obligated to act on any advice given by Merrion and is solely responsible for the investment decisions. DISCRETIONARY SERVICE Merrion provides a discretionary service where Merrion assumes the responsibility for the management of the investment portfolio e.g. the client delegates the investment decision-making to Merrion. Merrion aims to manage the portfolio in accordance with the client s investment objectives and an agreed investment strategy. Under a discretionary mandate, Merrion makes investment decisions on the client s behalf without the need for prior instruction. Our discretionary service is a comprehensive portfolio management service undertaken by our Portfolio Management team. The client receives regular portfolio reviews and valuations. SECTION 1B: GENERAL COMPANY INFORMATION * Company Name: *Registered Office: Correspondence Address (if different): *Telephone Number: * Website: *Country of Incorporation: *Date of Incorporation: / / *Incorporation/Registration/Regulatory Number: *Legal Entity Identifier (LEI): *Please provide a brief description of the company s primary activities: *Please provide anticipated level of trading activity: (number) trades per (timeframe e.g. week, month, quarter, year) 2/17 All questions marked with an asterisk* are mandatory.

3 SECTION 1C: DIRECTORS DETAILS *Please provide details of all shareholders who hold 25% or more of the company (BLOCK CAPITALS). DIRECTOR 1: *Title: Mr/Mrs/Miss/Other *Date of Birth: / / *Home Address: DIRECTOR 2: *Title: Mr/Mrs/Miss/Other *Date of Birth: / / *Home Address: SECTION 1D: SHAREHOLDERS DETAILS *Please provide details of all shareholders who hold 25% or more of the company (BLOCK CAPITALS). SHAREHOLDER 1: *Title: Mr/Mrs/Miss/Other *Full Name/Company Name: *Date of Birth/Incorporation: / / *Address: SHAREHOLDER 2: *Title: Mr/Mrs/Miss/Other *Full Name/Company Name: *Date of Birth/Incorporation: / / *Address: All questions marked with an asterisk* are mandatory. 3/17

4 Merrion Private SHAREHOLDER 3: *Title: Mr/Mrs/Miss/Other *Full Name/Company Name: *Date of Birth/Incorporation: / / *Address: SHAREHOLDER 4: *Title: Mr/Mrs/Miss/Other *Date of Birth/Incorporation: / / *Address: *SECTION 1E: BOARD RESOLUTION *Below resolution must be signed by the above 2 members of the Board of Directors. As directors of the above named entity, we certify that the following resolutions were duly passed at a Board Meeting held on: *Date: / / We hereby agree to an account(s) being opened with Merrion Stockbrokers Ltd for the purpose of securities dealing. We have read, understood and accepted the Client Asset Key Information Document ( CAKID ). The Board has appointed the authorised signatory(ies) as per section 1F to act on behalf of the entity in transacting and instructing payments on this account. Please note that this will constitute a legally binding contract. If you have any queries, please contact Merrion for clarification or consult your independent legal adviser. DIRECTOR 1: *Signature: *Date: / / 4/17 All questions marked with an asterisk* are mandatory.

5 DIRECTOR 2: *Signature: *Date: / / *SECTION 1F: BENEFICIAL OWNERSHIP: THE FOURTH EU ANTI-MONEY LAUNDERING DIRECTIVE (EU 2015/849) (AMLD4) Under the AMLD4, any individual owning 25% or more of the client company is defined as a Beneficial Owner. If the client company is owned by another entity, or series of entities, the same rule applies. Please provide the list of all individuals that ultimately own the client company. Please note that if no individual ultimately owns 25% or more of the company, the controlling persons of that corporate entity (CEO and directors) are deemed to be designated as the ultimate beneficial owners of the client company. BENEFICIAL OWNER 1: *Date of Birth: / / *Address: BENEFICIAL OWNER 2: *Date of Birth: / / *Address: BENEFICIAL OWNER 3: *Date of Birth: / / *Address: All questions marked with an asterisk* are mandatory. 5/17

6 Merrion Private BENEFICIAL OWNER 4: *Date of Birth: / / *Address: *SECTION 1G: AUTHORISED SIGNATORIES *Please indicate Authorised Signatory(ies) to act on behalf of the entity (BLOCK CAPITALS). *AUTHORISED SIGNATORY 1: *Position: *Signature: AUTHORISED SIGNATORY 2: *Position: *Signature: Please note that all instructions will be accepted from ANY of the above Authorised Signatories. If you wish to change this set-up e.g. accept only written instructions from both Authorised Signatories, please indicate this by a written instruction on your headed paper and signed by both directors as stated in Part 1C of this application. Please also note that you are responsible for notifying Merrion with immediate effect should one of the Authorised Signatories not be authorised to act on behalf of the entity. 6/17 All questions marked with an asterisk* are mandatory.

7 SECTION 2: KNOWLEDGE & EXPERIENCE Knowledge shall be based on the person(s) authorised to carry out the transactions on behalf of the entity. Therefore, Section 2B must be completed for ALL individuals authorised to carry out transactions on behalf of the entity. *SECTION 2A: QUALIFICATIONS / EDUCATION Does the authorised individual(s) have any professional education, qualifications or experience that are relevant to making investment decisions or are they a member of a relevant financial services professional body? AUTHORISED SIGNATORY 1: AUTHORISED SIGNATORY 2: *SECTION 2B: KNOWLEDGE / EXPERIENCE IN FINANCIAL INSTRUMENTS Please indicate the experience of each Authorised Signatory in relation to the following instruments based on the following scale: NONE BASIC GOOD EXTENSIVE No knowledge or understanding of the instruments General understanding of the instruments but limited experience Understanding of the instruments and some previous experience Dealt in instruments frequently and in significant size or their role requires knowledge of the instrument(s) FREQUENCY Please indicate (where relevant) if the Authorised Signatories carried out transactions in any of the instruments below, at an average frequency of 10 per quarter over the previous 4 quarters. AUTHORISED SIGNATORY 1: NON-COMPLEX INSTRUMENTS E.G.: NONE BASIC GOOD EXTENSIVE FREQUENCY Equities Bonds UCITS Investment Funds (Retail) COMPLEX INSTRUMENTS E.G.: Warrants Futures Options Contracts for Difference (CFDs) Non-UCITS Investment Funds (Qualified Investor) All questions marked with an asterisk* are mandatory. 7/17

8 Merrion Private AUTHORISED SIGNATORY 2: NON-COMPLEX INSTRUMENTS E.G.: NONE BASIC GOOD EXTENSIVE FREQUENCY Equities Bonds UCITS Investment Funds (Retail) COMPLEX INSTRUMENTS E.G.: Warrants Futures Options CFDs Non-UCITS Investment Funds (Qualified Investor) SECTION 3: INVESTMENT OBJECTIVES & RISK PROFILE Your answers to the following questions will enable us to understand investment objectives and risk profile of your entity and allow us to give you a better investment service. Without this information, we cannot provide advisory or portfolio managed (discretionary) services to your entity. *SECTION 3A: INVESTMENT OBJECTIVES Please indicate which of the following statements best describes the entity s investment objectives in relation to its Merrion investment(s). CAPITAL PRESERVATION INCOME INVESTOR GROWTH AND INCOME INVESTOR CAPITAL GROWTH INVESTOR TRADING AND SPECULATIVE INVESTOR The entity s investment objective is to preserve it s capital The entity prioritises income over capital appreciation The entity prioritises income with some capital appreciation over time The entity prioritises capital appreciation over income The entity prioritises maximum capital growth through speculative investment *TIME HORIZON Generally, the longer client money remains invested, the greater the potential for growth as market trends and fluctuations tend to smooth out over time. Bearing this and the entity s financial situation in mind, for how long is the entity planning to invest? Less than 1 year 1 3 years 3 5 years Over 5 years 8/17 All questions marked with an asterisk* are mandatory.

9 *SECTION 3B: RISK PROFILE Please indicate which of the following statements best describes the entity s requirements from its portfolio with Merrion. Please be aware that by seeking higher returns, you can expose your investments to greater volatility & risk of loss of your capital Designed for the investor whose main objective is to preserve their capital and who is comfortable with a very low level of volatility and capital risk within their Merrion portfolio. Designed for the investor whose main objective is for low capital growth and who is comfortable with a low level of volatility and capital risk within their Merrion portfolio. Designed for the investor whose main objective is for low to medium capital growth and who is comfortable with a low to moderate level of volatility and capital risk within their Merrion portfolio. Designed for the investor whose main objective is for medium capital growth and who is comfortable with a moderate level of volatility and capital risk within their Merrion portfolio. Designed for the investor whose main objective is for medium to high capital growth and who is comfortable with a moderate to high level of volatility and capital risk within their Merrion portfolio. Designed for the investor whose objective is high capital growth and who is comfortable with a high level of volatility and capital risk within their Merrion portfolio. Designed for the investor whose objective is very high capital growth and who is comfortable with a very high level of volatility and capital risk within their Merrion portfolio. SECTION 3C: INVESTMENT RESTRICTIONS Please specify if there are any investment restrictions you wish to apply to the account (e.g. ethical investments, non-tobacco, military stocks, etc.). If not completed, Merrion will treat this as not applicable. Please specify if there is anything else we need to consider, such as a large withdrawal within a number of years. If not completed, Merrion will treat this as not applicable. All questions marked with an asterisk* are mandatory. 9/17

10 Merrion Private *SECTION 4: CAPACITY FOR LOSS This section evaluates the entity s capacity for loss, meaning the ability to cope should the entity s investments suffer any fall in value, as well as the importance of the entity s current investments in meeting its investment objectives. Please consider all relevant factors against the entity s overall financial position, investment objectives and risk profile. Please indicate below how important this investment portfolio is to the entity s current overall financial situation. LOW CAPACITY The entity currently has no other investments and this is its main source of long term income. MEDIUM CAPACITY The entity currently has other investments/income which enable it to meet some of its key financial requirements. HIGH CAPACITY The entity currently has no reliance upon this portfolio to meet any of its financial requirements. *Please indicate what percentage of the entity s net investable assets its Merrion portfolio will account for. 0 10% 10 25% 25 50% 50 75% % Are there any other considerations that Merrion should take into account, which might impact on the entity s capacity for loss? If not completed, Merrion will treat this as not applicable. *SECTION 5: FINANCIAL STATUS In order to provide a service that is suited to the entity s financial circumstances, we need to understand the source and extent of the entity s regular income, net profits, assets, including liquid assets, investments and real property and regular financial commitments. *TOTAL REGULAR REVENUE ( PER ANNUM) 0 200, , , ,001 1,000,000 1,000,001 plus Tick the box(es) that indicates what this income is comprised of: Trading revenue Investment revenue Rental revenue Other - (please specify below) Other: 10/17 All questions marked with an asterisk* are mandatory.

11 *SECTION 5: FINANCIAL STATUS (CNTD) *NET PROFIT ( PER ANNUM) 0 200, , , ,001 1,000,000 1,000,001 plus *VALUE OF NET ASSETS ( PER MOST RECENT AUDITED FINANCIAL STATEMENTS) Please indicate the appropriate net values of the entity s assets. If left blank, Merrion will assume zero. Cash Deposits Property net of borrowings Shares, bonds and investment funds Other assets net of borrowings Other (please specify below) Other: Total net assets *TOTAL REGULAR FINANCIAL COMMITTMENTS ( PER ANNUM) Tick the appropriate box below to indicate what the financial committments are comprised of. Loan Repayments Other Financial Committments* *Other *SECTION 6: SOURCE OF OVERALL WEALTH Please indicate how the entity s overall wealth was accumulated (you may select more than one option). Retained Profits Equity All questions marked with an asterisk* are mandatory. 11/17

12 Merrion Private *SECTION 7: SECTION 7A: SOURCE OF FUNDS SOURCE OF FUNDS Please indicate the source of the entity s initial transfer to Merrion (you may select more than one option). Retained Profits Equity Debt (e.g. loans) *SECTION 7B: BANK DETAILS Please indicate the details of the entity s bank account from which you will transfer the funds to and from Merrion. Please note: this must be a bank account in the name of the entity as no third-party payment requests will be accepted. Bank Name/Branch: Account Name: BIC: IBAN: Currency: 12/17 All questions marked with an asterisk* are mandatory.

13 *SECTION 8: SECTION 8A: REPORTABLE INFORMATION COMMON REPORTING STANDARDS (CRS) The Standard for Automatic Exchange of Financial Account Information, also known as the Common Reporting Standard (CRS), is a single global standard on Automatic Exchange of Information (AEOI). It was approved by the Organisation for Economic Co-operation and Development (OECD) in February 2014 and draws on earlier work of the OECD and the EU, global anti-money laundering standards and, in particular, the Model FATCA Intergovernmental Agreement. The CRS sets out the financial information to be exchanged, the financial institutions required to report, along with common due diligence standards to be followed by financial institutions. Please note that in certain circumstances, where the entity is identified as a tax resident in country(s) outside of Ireland, we will be obliged to share this information with the relevant tax authority via the Irish Revenue. Self-certification to be completed by the entity. Please provide the full list of countries in which the entity is a tax resident along with the relevant Tax Identification Number (TIN). If the entity is resident for tax purposes in more than 3 countries, please provide details in writing. ENTITY TIN: Country: TIN: Country: TIN: Please note: If the entity is tax resident outside of Ireland, you will be required to complete our tax compliance self-certification form. 13/17

14 Merrion Private SECTION 8B: FOREIGN ACCOUNT TAX COMPLIANCE ACT (FATCA) The Foreign Account Tax Compliance Act (FATCA) is an initiative introduced by the US government aimed at combating tax evasion by US citizens, US tax resident individuals/entities and certain entities with US controlling persons, holding assets or investments through foreign accounts. Individual self-certification to be completed by investors, including joint holders. The Irish government signed an Inter-Governmental Agreement (IGA) with the US government, under which the Irish government agreed to apply the provisions of FATCA. The provisions of the IGA have been incorporated into Irish law. Under FATCA, financial institutions in Ireland are obliged to obtain and, when required, report specified information in relation to certain accounts held by US citizens, US tax resident individuals/entities and certain entities with US Controlling Persons to the Irish Revenue for onward transmission to the US Internal Revenue Service (IRS). For more information on FATCA see or Please note that in certain circumstances we may be obliged to share this information with the relevant tax authority(s). Self-certification to be completed by the Entity ENTITY We confirm that THE ENTITY and its BENEFICIAL OWNER(S) are incorporated or resident in the U.S. for tax purposes. YES NO Please note: If you tick YES, you will be required to complete our tax compliance self certification form. 14/17

15 *SECTION 9: DOCUMENTATION REQUIRED TO ACTIVATE A MERRION ACCOUNT: 1. Duly completed Client Application Form 2. **Certificate of Incorporation 3. **Memorandum & Articles of Association 4. **Latest Audited Financial Statements 5. **List of all directors including dates of birth and addresses (e.g. B1 Form) 6. **Beneficial ownership register or equivalent: list of all beneficial owners with 25% or more, including dates of birth and addresses (e.g. B1 Form) 7. AML* for 2 directors signing the application form 8. AML* for all beneficial owners with 25% or more 9. AML* for all authorised signatories * AML (anti-money laundering) documentation includes the following items: 1. Certified** proof of identification (e.g. passport, driving licence, identity card) 2. Two certified** proofs of address issued within the last 6 months, (e.g. bank statement, utility bill, government-issued correspondence) Please note: All documentation must be submitted and received by Merrion prior to the commencement of the business relationship. **All documentation e.g. proofs of identity and address must be certified and stamped to be a true copy of the original. The list of those who can certify documentation includes but is not limited to: Garda (police), practising chartered accountants, certified public accountants, notaries public, practising solicitors, embassy/consular staff, regulated financial/credit institution staff, Justice of Peace or Commissioner of Oaths. General Data Protection Regulation ( GDPR ) Your personal information is collected in response to your request for Merrion to provide investment services such as receiving and transmitting orders, executing orders, providing portfolio management services and/or investment advice (the Services ) to you. In line with the GDPR, Merrion will only collect data for a specific purpose, used it only for that purpose and retain it only for as long as it meets that purpose. Please review our Data Protection Notice at : for the detail on the purposes for which data is processed, the legal basis for processing, disclosure of your personal information and security and safeguarding arrangements concerning your personal information. 15/17

16 Merrion Private *SECTION 10: DECLARATIONS Please confirm by ticking the circle. *Please note that this will constitute a legally binding contract. If you have any queries, please contact Merrion for clarification or consult your independent legal advisor. We confirm that the information provided is true and accurate and that Merrion may rely solely on this information. We acknowledge that any false declaration may result in the loss of our right to hold Merrion responsible for any failure to comply with its obligations in relation to assessment of the suitability of the service to be provided. We confirm that we will provide all documentation as requested by Merrion, whether as part of the application process or ongoing monitoring. We acknowledge that Merrion may forward such requests at any stage and that any failure to provide additional documentation/information may result in delay of processing of our application as well as future payments. We also confirm that Merrion will be notified as soon as possible in relation to any material changes to my/our circumstances. We acknowledge that Merrion may request additional information and/or documentation to confirm the entity s tax status. We agree to comply at all times with such a request from Merrion within the time specified by Merrion in its request. We have read, understood and accepted the Client Asset Key Information Document ( CAKID ). We have read, understood and accepted the Terms of Business and consent to be bound by them. Please review our Terms of Business at : We hereby agree to an account(s) being opened with Merrion Stockbrokers Ltd. DIRECTOR 1 Signature: Date: / / DIRECTOR 2 Signature: Date: / / Consent I/we agree to have Merrion and/or its affiliates contact me regarding investment opportunities.i/we understand that I/we can withdraw that consent at any time by writing to, Data Protection, Consent Merrion Private, Heritage House, 23 St Stephen s Green, Dublin 2, Ireland. 16/17

17 Heritage House 23 St. Stephen s Green Dublin 2 D02 AR55 T F E info@merrion-capital.com Merrion Stockbrokers Limited, trading as Merrion Private and Merrion Fixed Income, is regulated by the Central Bank of Ireland. Merrion Stockbrokers Limited (registered in Ireland under the number ) is a member of the Irish Stock Exchange and the London Stock Exchange. 17/17

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