MADISON ASSET UNIT TRUSTS GROUP/INSTITUTION APPLICATION FORM

Transcription

1 MADISON ASSET UNIT TRUSTS GROUP/INSTITUTION APPLICATION FORM

2 1. CLIENT DETAILS Type of Institution: Registered Company Registered Investment Group Other (Specify): Registered Name Registration Number Date of Registration Contact Details Postal Address & Postal Code Physical Address Address Telephone No. Work Cell Notifications (sms) Yes No Tax Status (Please Tick) : Taxable Exempt 2. CLIENT BANK DETAILS (Please note that the account given below will be used as your withdrawal account) Account Name Account Number Bank Name Branch

3 3. PRODUCT OFFERING Madison Asset has designed three funds to meet investor requirements because different investors have different investment objectives and requirements. An investor can invest in one or a combination of these three funds which are the Madison Asset Equity Fund, the Madison Asset Balanced Fund and the Madison Asset Money Market Fund. 4. FUND SELECTION Minimum Investment Amount: Kshs. 50,000 (Per Fund) NAME OF THE INVESTMENT PRODUCT Madison Asset Money Market Fund Madison Asset Balanced Fund Madison Asset Equity Fund Total INVESTMENT AMOUNT 5. SOURCE OF FUNDS: The funds for this investment are from: (please tick) Sale of an investment portfolio Gift or inheritance Disposal of property Savings Employment Other (Please specify) (Madison Asset reserves the right to seek further information on the source of funds being invested) 6. INCOME DISTRIBUTION Interest / dividends will automatically be reinvested monthly for the Madison Asset Money Market Fund, semi annually for the Madison Asset Equity Fund and quarterly for the Madison Asset Balanced Fund, Reinvestment will provide you with maximum compound growth. I do not wish for my interest/dividend to be reinvested (Tick if Applicable) 7. UNIT TRUSTS BANK ACCOUNT DETAILS Madison Asset Money Market Collection Account Equity Bank Limited Equity Centre Branch Madison Asset Equity Fund Collection Account Equity Bank Limited Equity Centre Branch Madison Balanced Fund Collection Account Equity Bank Limited Equity Centre Branch PLEASE NOTE: Cash is not accepted at the offices of Madison Asset and should not be paid to staff, agents or brokers. All Cheque/ Transfers should be paid to the respective fund bank accounts.

4 8. DECLARATION 1. I/We have read and understood the Information Memorandum, the charges made by Madison Asset Management Services Limited and the terms and conditions of this application. 2. I/We warrant that I am/we are duly authorised to apply for Madison Asset Unit Trusts on the Terms and Conditions set out in the Information Memorandum. 3. I/We confirm that the units are not being acquired directly or indirectly by or on behalf of any person restricted by law of any jurisdiction from acquiring such units and that I/We will not sell, transfer or otherwise dispose of any such units directly or indirectly to or for the account of such person. 4. I/We confirm that the money used for investments in the Madison Asset Unit Trust Funds is not arising out of the proceeds of any money laundering or other illicit activities. 5. I/We agree that Madison Asset is not responsible for any liability, losses or damages resulting from , sms, or fax instructions, except where such liability or loss results from negligence, or willful default of Madison Asset s part. 6. I/We warrant that all the information given in this proposal and in all documents which have been or will be signed by me in connection with the proposed application whether in my handwriting or not, is true and complete. 7. I/We the undersigned confirm that we have read and understood this declaration and its implications. AUTHORISED SIGNATORIES 1 FULL NAMES ID/ PASSPORT NO. DESIGNATION SPECIMEN SIGNATURE SIGNING MANDATE: (PLEASE TICK) Any one authorised signatory All the signatories Any two of the authorised signatories First named plus any other Other (Specify) Date:

5 9. DOCUMENTS REQUIRED FOR OFFICIAL USE ONLy 1. Certificate of Incorporation/Registration 2. Copies of signatories ID s/ Valid Passports 3. Utility Bill (not more than three months old): or Lease / rental agreement ; or Electricity account; or Water Bill 4. Proof of Banking Details (Note: Details on this document must be for the account provided above) Original cancelled cheque; or Bank statement (not more than three months): or Letter confirming banking details (certified) 5. Copy of tax exempt certificate (if non taxable) 6. A passport size photo of each signatory Investment Consultant: Code: Signature: Date: Compliance Officer: Signature:

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