Legg Mason Alternative Funds ICAV Initial Application Form

Transcription

1 APPLICATION CHECKLIST THIS ORIGINAL DULY COMPLETED FORM (THIS APPLICATION ) MUST BE RETURNED TO: STATE STREET FUND SERVICES (IRELAND) LIMITED (THE ADMINISTRATOR ). SHARES WILL BE ISSUED IN REGISTERED ACCOUNT FORM ONLY. This package cntains the frms that applicants ( Applicants ) must cmplete t buy Shares f the sub-funds (the Funds ) f Legg Masn Alternative Funds ICAV (the ICAV ), including an accunt applicatin and related frms. Unless therwise defined herein, all capitalised terms have the same meaning as set ut in the current prspectus (the Prspectus ) f the ICAV. Step 1: Step 2: Cmplete and sign this Applicatin, including any applicable Schedules. Send cmpleted Applicatin and the additinal dcuments required by sectin 9 t: State Street Fund Services (Ireland) Limited, 78 Sir Jhn Rgersn s Quay, Dublin 2, Ireland, Tel: Fax: A prperly cmpleted and signed cpy f the Applicatin may be sent in advance f the riginal, via fax at fr expedited prcessing f the purchase request. The riginal Applicatin must be sent in hard cpy t the Administratr immediately thereafter at the abve address. Failure t prvide riginal applicatin and all necessary custmer due diligence ( CDD ) dcumentatin in the requested frmat may result in deductin f tax due t the Irish Finance Act requirements utlined in the Anti-Mney Laundering sectin and/r will result in withhlding f the prceeds in the event f a redemptin and rejectin f any additinal subscriptin requests. If an Applicant subscribes fr Shares f any Share Class with Plus (e) in its name, the Applicant shuld nte that all r part f fees and expenses will be charged t the capital f the Share Class. This will have the effect f lwering the capital value f the Applicant s investment. If an Applicant subscribes fr Shares f any Share Class with Plus in its name, the Applicant shuld nte that dividends may paid frm the capital f the Share Class. This will have the effect f lwering the capital value f the Applicant s investment. If an Applicant subscribes in the name f an entity An authrised signatry list must be prvided at the time f the accunt pening fr the investing entity in whse name the accunt is being pened. The Applicatin Frm must be signed in accrdance with the mandate n the authrised signatry list. The ICAV is an investment cmpany with variable capital incrprated with limited liability in Ireland with registered number and established as an umbrella fund with segregated liability between sub-funds. Its registered address is: Arthur Cx Building, Earlsfrt Terrace, Dublin 2, Ireland. The ICAV, its Funds and Share Classes are nly registered r authrised fr sale t the general public in certain jurisdictins, and even in such jurisdictins, nly certain f the Funds and Share Classes theref may be registered fr public sale. Fr mre infrmatin, please cntact yur Legg Masn representative r yur brker. KEY INVESTOR INFORMATION DOCUMENT If the Applicant has nt received the current Key Investr Infrmatin Dcument (the KIID ) fr the Fund(s) and share class(es) t which this Applicatin relates, r is unsure as t whether it is the apprpriate r current versin, please cntact yur brker r ther adviser, Legg Masn representative r Legg Masn Investments (Eurpe) Limited, 201 Bishpsgate, Lndn, EC2M 3AB, United Kingdm. The ICAV will require cnfirmatin that the Applicant has received the relevant KIID prir t subsequent subscriptins in the Funds. Institutinal and crprate clients may cnsent t receiving the current KIIDs fr the Funds and share classes via the fllwing website: by prviding an address in sectin REGISTRATION DETAILS Please fill in the whle frm in BLOCK CAPITALS using black r blue ink Registered Sharehlder Name * Accunt Designatin (if any) Registered Address (we are unable t accept a PO Bx addressr C/O address) Cuntry Pstcde Tax Identificatin Number ** February 2018

2 1. REGISTRATION DETAILS (cntinued) Sharehlder Cntact Name (if different than the Registered Sharehlder Name supplied abve) Sharehlder Type (e.g. Individual, Jint Accunt, Entity, Other) Occupatin r Purpse f Entity Mailing Address (if different than the Registered Address supplied abve) Cuntry Pstcde Date f Birth (dd/mm/yyyy) (fr individual investrs) Place f Birth (fr individual investrs) Telephne Number Surce f funds Hw the cash was realised fr the investment(s) e.g. emplyment, savings, prceeds f sale, crprate dividends, inheritance, ther (please specify) Remitting Bank Details As per bank accunt details fr redemptins & dividends cmpleted in sectin 5. OR please cmplete the details belw Remitting Bank Name Remitting Bank Address Accunt Hlder Name T receive dealing cnfirmatins and financial reprts via and/r fax, in lieu f regular mail, please prvide address and/r fax numbers belw. address Fax Number Accunt Number Designatin Dividend payment ptin fr Sharehlders in Distributing Share Classes (if a bx is nt ticked r the details nt cmplete, dividends will be autmatically reinvested in additinal Shares) Pay dividends in cash *** (fr direct bank accunt depsit, cmplete sectin 5) Reinvest dividends in additinal shares * Add (nminee) if a nminee accunt. ** I/we acknwledge that due t Eurpean Unin taxatin f savings incme requirements I am/we are required t prvide prf f my/ur tax identificatin number and date and place f birth and that this infrmatin will be used if I am/we are subject t the terms f the Eurpean Unin taxatin f savings incme legislatin. *** Payment f dividend in nn-base currency will require three days prcessing. By default, dividends are paid in the currency in which the subscriptin was made. 2 February 2018

3 2. IMPORTANT INFORMATION FOR NOMINEE ACCOUNTS (Distributrs and Institutinal Clients Only) If the sharehlding is registered in a nminee name, please print clearly the name f the underlying client. Client Name Permanent Residential Address (we are unable t accept a PO Bx r C/O address) Cuntry Pstcde Tax Identificatin Number Telephne Number Facsimile Number Surce f funds Hw the cash was realised fr the investment(s) e.g. emplyment, savings, prceeds f sale, crprate dividends, inheritance, ther (please specify) Remitting Bank Details As per bank accunt details fr redemptins & dividends cmpleted in sectin 5. OR please cmplete the details belw Remitting Bank Name Remitting Bank Address AML CONFIRMATION FOR NOMINEES / INTERMEDIARIES This cnfirmatin can nly be cmpleted by designated bdies regulated fr anti-mney laundering purpses by the apprpriate regulatr in ne f the fllwing cuntries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Guernsey, Hng Kng, Iceland, Ireland, Italy, Jersey, Luxemburg, Isle f Man, Netherlands, Nrway, Prtugal, Singapre, Spain, Sweden, Switzerland, United Kingdm, United States (please nte this list is subject t change). DESCRIPTION OF INVESTOR DESIGNATED BODY INVESTING AS AN INTERMEDIARY NOMINEE COMPANY RELATIONSHIP OF CONFIRMATION PROVIDER (REGULATED ENTITY) TO INVESTOR INVESTOR PARENT OF INVESTOR UNLESS THE FOLLOWING BOX IS TICKED THE ADMINISTRATOR WILL APPLY THE BELOW CONFIRMATION TO ANY SUBSEQUENT DESIGNATED ACCOUNTS IN THE NAME OF THIS INVESTOR. DO NOT APPLY THE BELOW CONFIRMATION TO SUBSEQUENT DESIGNATIONS 3 February 2018

4 AML CONFIRMATION FOR NOMINEES / INTERMEDIARIES (cntinued) Name f Regulated Entity Name f Regulatr Address f Regulated Entity We cnfirm that we are a designated bdy regulated fr anti-mney laundering purpses by the belw regulatr and hereby cnfirm the fllwing in cnnectin t the investr. * delete as applicable 1. We / the investr* has perfrmed the anti-mney laundering and cunter-terrrist financing identificatin fr any parties n whse behalf the investr is purchasing shares ( underlying investrs ). 2. The evidence we / the investr* has btained t verify the identity f the underlying investrs, and where apprpriate, their beneficial sharehlders, meets the requirements f ur natinal anti-mney laundering and cunter-terrrist financing legislatin and regulatins. 3. We cnfirm that all dcuments and infrmatin, which we / the investr* may have n ur / the investr s* files relating t the identity f each underlying investr will be sent t a cmpetent authrity as sn as practicable upn the cmpetent authrity s request. 4. We cnfirm that all dcuments and infrmatin, which we / the investr* may have n ur / the investr s files relating t the identity f each underlying investr will be sent t the Administratr f the Fund as sn as practicable upn its request, subject t applicable rules and regulatins. 5. We / the investr* will retain these dcuments and infrmatin fr a perid f at least 5 years after the relatinship with an underlying investr has ended. 6. We / the investr* will take measures t ensure that the underlying investrs are neither individuals nr institutins against whm sanctins have been impsed by the EU r United Natins r persns r entities that are included n the List f Specially Designated Natinals and Blcked Persns maintained by the U.S. Treasury s Department s Office f Freign Asset Cntrl ( OFAC ). Yurs faithfully Name Authrised Signatry f Regulated Entity. Title This shuld be signed by an authrised member f the Cmpliance Department r Legal Department (please state psitin). 4 February 2018

5 3. FAX INSTRUCTIONS The undersigned (the Applicant ) hereby authrises the Administratr and any ther agents f the ICAV t act upn instructins by fax withut a signature guarantee. T enable prmpt investment, an initial subscriptin may be prcessed upn receipt f a faxed instructin and Shares may be issued. Hwever, the riginal Applicatin must be received prmptly. In the case f faxed redemptins, the redemptin will be traded but n redemptin prceeds will be paid until the riginal Applicatin has been received and all f the necessary anti-mney laundering checks have been cmpleted. Original bank details must be n file. The Applicant understands and agrees that any amendments t the infrmatin n the Applicatin, including the sectin entitled Repayment Accunt Details (1) must be made in writing t the Administratr; (2) must cntain the apprpriate number f signatures and all such signatures must be signature guaranteed; and (3) can nly be effected upn receipt f riginal dcuments. Absent their negligence, the Administratr, the ICAV and its agents shall nt be liable fr such redemptins r fr the payments made t any unauthrised accunt. The Applicant agrees t indemnify and keep indemnified the Administratr, the Investment Manager and any ther agents against any lss f any nature whatsever arising t each f them as a result f any f them acting r nt n fax instructins. 4. REPRESENTATIONS OF THE APPLICANT a. The Applicant represents and warrants that it (and each investr fr which it is acting as nminee, if applicable ( Underlying Investr(s) ): (i) has reviewed the terms f the Prspectus and has cncluded that its purchase f Shares is legal and prper under applicable tax, accunting and ther relevant laws and regulatins; (ii) has the knwledge and experience in financial and business matters as t be capable f evaluating the merits and risks f an investment in the Shares and has determined that such an investment is suitable under its applicable investment criteria and that it is capable f and willing t assume related investment risks (financially r therwise); (iii) if applicable, is fully authrised by its crprate charter, by-laws and/r ther cnstituent dcuments t purchase Shares and has duly empwered and authrised its advisr, trustee, brker r such ther entity as is purchasing Shares n its behalf t d s, and the individual(s) executing and delivering this Applicatin are duly empwered and authrised t d s; (iv) understands that subscriptins and redemptins f Shares in nn-base currencies will be subject t freign-exchange risk, and that the freign-exchange rate btained by the Administratr may nt be the best market rate; (v) understands that (A) the ICAV and the Funds are nt registered under the US Investment ICAV Act f 1940, as amended, (B) the Shares are nt registered under the US Securities Act f 1933, as amended (the 1933 Act ), r under the securities laws f any State r ther jurisdictin within the US, (C) the Shares may be resld nly in transactins that are nt subject t r are exempt frm the registratin requirements f the 1933 Act, and (D) the Shares may nt be ffered, sld r delivered, directly r indirectly, in the US, r t r fr the accunt f any US Persns, as such term is defined in the Prspectus; (vi) (A) is nt, and the accunt frm which its subscriptin mnies will be remitted is nt, a US Persn, (B) will nt transfer r deliver, directly r indirectly, any Shares t a US Persn, (C) was nt slicited t purchase and did nt acquire any Shares while present in the US, (D) it will ntify the ICAV in the event it becmes a US Persn at any time that it hlds any Shares, (E) will nt transfer r redeem any Shares while present in the US, its territries r pssessins, r areas subject t its jurisdictin, and (F) agrees that if it is a bank, brker, dealer r nminee, and it is acquiring Shares n behalf f clients fr investment purpses, that such clients are nt US Persns, that it will ntify the ICAV if it learns that any such client has becme a US Persn, that it will nt at any time knwingly transfer r deliver Shares r any part theref r interest therein t r fr the accunt r benefit f a US Persn and that it will nt make any transfer r delivery theref directly r indirectly int the US; (vii) is a nn-united States Persn as defined in the Prspectus r, if it is acting as nminee, that each f its Underlying Investrs is a nn- United States Persn as defined in the Prspectus; (viii) understands that its Shares will be registered in the ICAV s Sharehlder registry in its registratin name set ut in this Applicatin. In the case f jint Applicants, the ICAV may accept any instructins regarding such Shares (including fr redemptins) given by any ne Applicant; and (ix) has received the latest versin f the KIID fr the Fund(s) and Share Class(es) theref t which this Applicatin relates. b. The Applicant agrees that neither the ICAV, the Funds nr their agents, including the Funds investment managers, distributrs, custdian and Administratr (the Agents ), shall be liable fr any lss r damage whatsever fr A) unauthrised use f the fax r B) frging f any authrised signature which is reasnably believed t be genuine r C) any material misrepresentatin made by the Applicant in the Applicatin. The Applicant shall indemnify the ICAV, the Funds and their Agents frm r against any and all liabilities, bligatins, lsses, damages, claims, penalties, actins, judgements, suits, csts, expenses r disbursements f any accunt r nature whatsever which may be impsed and/r incurred by r asserted against them in reliance f any misrepresentatin made by applicant herein r the acceptance f r acting in accrding with fax r telephne instructins prperly received and apparently authrised by the Applicant. The aggregate liability f the Applicant fr Lsses, t the Funds and the Agents, shall be limited t the aggregate amunt subscribed fr in the Funds by the Applicant. c. The Applicant acknwledges and agrees that all f the representatins, warranties, agreements, infrmatin and acknwledgments in this Applicatin are deemed t be made r given as f the date the Applicant executes this Applicatin and as f the date n which this Applicatin is accepted by the ICAV. The Applicant agrees t immediately infrm the ICAV in writing if any f the freging representatins, warranties, agreements, r infrmatin shuld becme untrue r incrrect r n lnger accurate and cmplete in all respects. d. The Applicant acknwledges and agrees that it (r its Underlying Investr, if applicable) will nt sell, exchange, transfer, assign, pledge, hypthecate r therwise dispse f all r any part f the Applicant s Shares withut the prir written apprval f the ICAV and subject t the terms and cnditins set ut in the Prspectus and the Articles f the ICAV. 5 February 2018

6 4. REPRESENTATIONS OF THE APPLICANT (cntinued) e. The Applicant acknwledges and agrees that this Applicatin (A) may be signed in any number f cunterparts, all f which taken tgether shall cnstitute ne Applicatin, (B) is nt transferable r assignable in whle r in part by the Applicant r the principal n whse behalf the Applicant is investing, and (C) is gverned by and cnstrued in accrdance with the laws f the Republic f Ireland. Shuld any part f this Applicatin fr any reasn be declared invalid, such decisin shall nt affect the validity f any remaining prtin, which remaining prtin shall remain in full frce and effect as if the Applicatin had been signed with the invalid prtin eliminated. 5. REPAYMENT ACCOUNT DETAILS Please indicate the fllwing details abut the bank accunt t which any payment t yu frm the ICAV, including redemptin payments and cash dividend payments, shuld be made by the Administratr. Payment will be made by electrnic transfer. The accunt must be in the name(s) f the registered sharehlder(s). N thirdparty payments will be made. Redemptins will nt be prcessed n nn-cleared/verified accunts. Bth the IBAN and SWIFT Cde must be included fr banks within the EU/EEA. Bank Name Bank Address ABA N. / Srt Cde Reference Currency Accunt Number Accunt Name SWIFT IBAN Intermediary Bank Details: Bank Name SWIFT IBAN The ICAV will be required t withhld Irish tax n redemptin prceeds, at the applicable rate, unless it has received frm the registered sharehlder the Declaratin Frm fr nn-irish Residents r Declaratin Frm fr Exempt Irish Residents, as apprpriate. T be deemed valid, each registered sharehlder must fully cmplete and sign the relevant declaratin and include the relevant capacity f the authrised signatry (if applicable). 6. ACKNOWLEDGMENT OF DATA USAGE I/We hereby acknwledge that my/ur persnal infrmatin will be handled by the Administratr (as data prcessr n behalf f the ICAV) in accrdance with the Irish Data Prtectin Acts 1988 t 2003, as amended frm time t time. I/We als acknwledge that this infrmatin will be prcessed by the Administratr fr the purpses f carrying ut the services f administratr, registrar and transfer agent f the ICAV and t cmply with legal bligatins including legal bligatins under cmpany law and anti-mney laundering legislatin. I/We acknwledge that the Administratr r ICAV will disclse my/ur infrmatin t third parties where necessary r fr legitimate business interests. This may include disclsure t third parties such as the auditrs, the Irish Revenue Authrities pursuant t the EU Savings Directive and the Irish Financial Regulatr r agents f the Administratr wh prcess the data fr anti-mney laundering purpses r fr cmpliance with freign regulatry requirements. I/We hereby cnsent t the prcessing f my/ur infrmatin, which may include (1) the recrding f telephne calls with the Administratr fr the purpse f cnfirming data, (2) the disclsure f my/ur infrmatin as utlined abve t the Manager, the Investment Manager r Legg Masn (3) the disclsure f my/ur infrmatin where necessary, r in the ICAV s r the Administratr s legitimate interests, t the MLRO and/r any cmpany in the Administratr s and/r Legg Masn and/r the Investment Manager s and/r the Legg Masn grup f cmpanies, r (4) the disclsure f my/ur infrmatin t agents f the Administratr, including cmpanies situated in cuntries utside f the Eurpean Ecnmic Area which may nt have the same data prtectin laws as in Ireland. I/we acknwledge my/ur right f access t and the right t amend and rectify my/ur persnal data, as prvided herein. Fr the avidance f dubt the ICAV shall be cnsidered a data cntrller in accrdance with the Irish Data Prtectin Acts and the Administratr shall be cnsidered a Data Prcessr. 6 February 2018

7 7. PAYMENT INSTRUCTIONS Shares will be held in the name f the registered sharehlder(s) directly with the Administratr. Payment by wire transfer in the full amunt f the purchase request is due in immediately available funds. Payment shuld be made in the respective currency t: USD Beneficiary Bank: Bank f America, N.A. A/C Number: Beneficiary Bank Swift Cde: BOFAUS3N ABA Cde: A/C Name: Legg Masn Alternative Funds ICAV EUR Beneficiary Bank: Bank f America, N.A. A/C Number: Beneficiary Bank Swift Cde: BOFAGB22 IBAN: A/C Name: Legg Masn Alternative Funds ICAV GB67 BOFA GBP Beneficiary Bank: Bank f America, N.A. A/C Number: CHF Beneficiary Bank Swift Cde: BOFAGB22 IBAN: A/C Name: Beneficiary Bank: Legg Masn Alternative Funds ICAV Bank f America, N.A. Lndn re: Switzerland Branch GB45 BOFA A/C Number: Beneficiary Bank Swift Cde: BOFACH2X IBAN: CH A/C Name: Legg Masn Alternative Funds ICAV SGD Beneficiary Bank: Bank f America, N.A. A/C Number: Beneficiary Bank Swift Cde: A/C Name: BOFASG2X Legg Masn Alternative Funds ICAV AUD Beneficiary Bank: Bank f America, N.A. A/C Number: Beneficiary Bank Swift Cde: A/C Name: BOFAAUSX Legg Masn Alternative Funds ICAV JPY Beneficiary Bank: Bank f America, N.A., Tky Branch A/C Number: Beneficiary Bank Swift Cde: A/C Name: BOFAJPJX Legg Masn Alternative Funds ICAV 8. TAX INFORMATION The ICAV is bliged under Sectin 891E, Sectin 891F and Sectin 891G f the Irish Taxes Cnslidatin Act 1997 (as amended) and regulatins made pursuant t thse sectins t cllect certain infrmatin abut each investr s tax arrangements. Please cmplete the relevant Schedule(s) as directed and prvide any additinal infrmatin that is requested. Please nte that in certain circumstances we may be legally bliged t share this infrmatin and ther financial infrmatin with respect t an investr s interests in the Fund with relevant tax authrities. All Applicants wh are entities (and nt individuals) shuld cmplete the attached Schedule A (Entity Self-Certificatin fr FATCA and CRS) as directed. All Applicants wh are individuals (and nt entities) shuld cmplete the attached Schedule B (Individual (Cntrlling Persn s) Self- Certificatin fr FATCA and CRS) as directed. Any individual wh is a Cntrlling Persn f an Applicant that is an entity shuld cmplete sectin 4 f Schedule B as directed. 7 February 2018

8 9. REQUIRED CUSTOMER DUE DILIGENCE ( CDD ) DOCUMENTATION The fllwing CDD dcumentatin requirements are fr the specified entity types in an EU Member State r equivalent jurisdictin. Applicants frm certain jurisdictins may be required t prvide further dcumentatin n request. Fr mre infrmatin regarding CDD, please cntact the Administratr at LeggMasnTA@statestreet.cm Any cpies f nn-electrnic dcuments must be certified by a suitable persn. The certifying persn shuld sign and date the dcument and include their name, address and prfessinal registratin number (if applicable). Suitable persns include: designated persns, as defined under the relevant anti-mney laundering legislatin ( AML ) in an EU Member State, r equivalent jurisdictin (excluding Tier 1 jurisdictins) practicing slicitr r slicitr firm embassy r cnsular fficial legal advisr plice fficer accuntant r accuntancy firm ntary public cmpany secretary medical prfessinal Any dcuments nt in English must be accmpanied by a full and accurate English translatin. The translatr must prvide their name and cntact details and certify the translatin as accurate. Entity Type Individual Custmer Due Diligence ( CDD ) Requirements a) Name Verificatin A certified cpy f a passprt, driver's licence r ther gvernment issued pht identificatin card (valid, in date, clearly legible and signature matches that n the riginal applicatin frm) b) Address Verificatin One riginal r certified cpy address verificatin received. This must be n mre than 6 mnths ld frm accunt pening date. The address must match the registered address prvided n the riginal applicatin frm. A street address must be prvided fr the purpse f a registered address. A PO bx r C/O address cannt be accepted as a registered address but can be used fr mailing purpses Listed Cmpany (Simplified) Regulated Creditr Financial Institutin A listed cmpany whse securities are admitted t trading n a regulated market based in an EU Member State r equivalent jurisdictin. Please prvide the name f the Stck Exchange: Regulated in an EU Member State r equivalent jurisdictin Please prvide URL t relevant website evidencing the entry in the regulatry authrity s web-site: Designated Persn Regulated in an EU Member State r equivalent jurisdictin Please prvide URL t relevant website evidencing the entry in the regulatry authrity s web-site: Regulated Cllective Investment Scheme Cllective Investment Scheme ( CIS ) (Lw Risk) Public Bdy (Simplified) Regulated in an EU Member State r equivalent jurisdictin Please prvide URL t relevant website evidencing the entry in the regulatry authrity s web-site: Nt regulated in an EU Member State r equivalent jurisdictin Prspectus r ffering memrandum which will cnfirm full name f CIS, registered address f CIS, name and address f scheme prmter, name and address f scheme administratr, name and address f entity carrying ut anti-mney laundering checks upn the scheme investrs and cnfirmatin that entity is regulated fr AML purpses Names f beneficial wners f the CIS (hlding greater than 25%) A Public Bdy in an EU Member State r equivalent jurisdictin Please prvide URL t relevant website detailing status as a Public Bdy: Examples f institutins falling int this categry include Cunty Cuncils, Lcal Authrities, the Eurpean Central Bank, The Eurpean Investment Bank, the Eurpean Envirnment Agency, the public bdy is either accuntable t an institutin f the Eurpean Cmmunities r t a public authrity f a Member State Public Bdy (Lw Risk) A Public Bdy nt in an EU Member State r equivalent jurisdictin Original r certified cpy f the cnstitutinal dcumentatin Names f main public bdy fficials 8 February 2018

9 9. REQUIRED CUSTOMER DUE DILIGENCE ( CDD ) DOCUMENTATION (cntinued) Entity Type Custmer Due Diligence ( CDD ) Requirements Pensin Scheme A Pensin Scheme prviding Retirement Benefits t Emplyees in an EU Member State r equivalent jurisdictin Original r certified cpy Revenue Cmmissiners r Tax apprval dcument Pensin Scheme (Lw Risk) A Pensin Scheme prviding Retirement Benefits t Emplyees nt in an EU Member State r equivalent jurisdictin Original r certified cpy f the cnstitutin / frmatin dcument Names f trustees/directrs/gvernrs r equivalent Original r certified cpy f apprval dcument frm the tax authrity Private Trust Original r certified cpy f the trust deed Verify the identity f tw trustees, r ne trustee and ne authrised signatry in line with the prcedures fr identifying an individual investr List f the all beneficiaries f the trust (may be lcated in the trust deed) Where the beneficiary is a crprate entity, btain details f the ultimate beneficial wner (if applicable) (may be lcated in the trust deed) Private Cmpany (Unlisted Crprate Entity) Where the entity is NOT a whlly wned subsidiary f a public listed cmpany n a regulated market in a lw risk cuntry, a SITE cmpany r FSC regulated entity in Taiwan: Original r certified cpy f the certificate f incrpratin r certificate f trade r printut frm the relevant cmpany's registratin ffice cnfirming entity is "live" n the registry Original r certified cpy f the memrandum and articles f assciatin r equivalent cnstitutinal dcumentatin Original r certified cpy f register f directrs The identity f at least tw directrs must be established (r ne directr and ne authrised signatry) in line with the prcedures fr identifying an individual investr r if the directr r authrised signatry is FCA (r equivalent) regulated, ID dcuments are nt required but prf f regulatry status will suffice Original r certified cpy f register f members r sharehlders Identify the ultimate beneficial wner - this infrmatin can be prvided by the custmer, n the custmer's behalf by a duly authrised representative r btained frm a reliable independent surce (e.g. financial statements). Where the entity IS a whlly wned subsidiary f a public listed cmpany n a regulated market in a lw risk cuntry, a SITE cmpany r FSC regulated entity in Taiwan: All f the requirements abve, hwever, the fllwing alternative methds f verifying the identity f a directr fr a lw risk cmpany can be used: - btaining a cpy f the annual audited accunts listing directrs (where the necessary infrmatin is publicly accessible and cnsidered by t be current and reliable); r - btaining a relevant and up-t-date legal pinin frm a reliable surce dcumenting due diligence cnducted, including in relatin t infrmatin n directrs; r - btaining infrmatin frm the relevant cmpany r ther registry such as the Cmpanies Huse r knwn freign equivalent; r - verify ne r mre directrs in line with requirements fr identifying an individual investr Partnership Original r certified cpy f the partnership agreement r apprpriate excerpts Verify the identity f tw partners, r ne partner and ne authrised signatry, t the frmal arrangement in accrdance with the requirement listed elsewhere within this dcument (based n their entity type and lcatin List all the beneficiaries f the partnership - this infrmatin may be lcated in the partnership agreement. Where the beneficiary is a crprate entity, btain details f the ultimate beneficial wner f that entity (if applicable) Registered Charity / Fundatin Unregistered Charity / Fundatin Original r certified cpy apprval frm the tax authrity Prf f registratin status frm the relevant charity cmmissin r equivalent. Original r certified cpy f the Cnstitutin/Frmatin dcument r riginal r certified cpy f the audited accunts Names f trustees/directrs/bard members r equivalent Verify the identity f tw trustees/directrs/bard members r equivalent, r ne trustee/directr/bard member r equivalent and ne authrised signatry in line with the prcedures fr identifying an individual investr. Names f beneficiaries (if applicable) 9 February 2018

10 9. REQUIRED CUSTOMER DUE DILIGENCE ( CDD ) DOCUMENTATION (cntinued) Entity Type Custmer Due Diligence ( CDD ) Requirements Clubs and Scieties The fllwing must be prvided in riginal r certified cpy frm, n cmpany headed paper and signed by an authrised signatry r cmpany secretariat: Full name and registered ffice address f the club/sciety Legal status f the club/sciety Purpse f the club/sciety Names f all fficers Verify the identity f tw f the fficers f the club and sciety, r ne fficer and ne authrised signatry in line with the prcedures fr identifying an individual investr. Depending n its risk assessment f the Applicant, the Administratr may request additinal dcuments frm time t time. Initially, the Applicant may prvide cmpliant CDD dcuments in cpy frmat acceptable t the Administratr; hwever, the Applicant must prvide riginal r certified cpy dcuments within 28 days after its initial investment. If the Applicant fails t d s, the Applicant will be unable t buy mre Shares until it des s. N redemptin prceeds will be paid until riginal r certified cpy dcumentatin is received by the Administratr. PAYMENT INFORMATION Please prvide the fllwing details fr the bank frm which yur payment t the Fund is being wired: Bank Name Bank Address ABA N. / Srt Cde Reference Accunt Number Accunt Name SWIFT IBAN Intermediary Bank Details: Bank Name SWIFT IBAN Yu must wire the payment frm an accunt in the name(s) f the registered sharehlder(s). SIGNING AUTHORITY All nn-individual investrs must prvide an riginal r certified cpy f the entity s authrised signatry list ( ASL ), which must clearly reference wh is authrised t sign and fr what purpses. The ASL must be prvided n headed paper that clearly identifies the entity s name and shuld include specimen signatures fr the authrised signatries. If a party ther than the registered sharehlder(s) is signing the applicatin r has trading authrity n the accunt, an riginal r certified cpy f the apprpriate empwering dcument must als be prvided t demnstrate the authrity f the third party (and any f its representatives) t sign n behalf f the registered sharehlder(s). Such dcuments may include an investment management agreement, custdian agreement, pwer f attrney, bard mandate, trust deed, etc. 10 February 2018

11 10. IRISH RESIDENTS ONLY Pursuant t the Return f Values (Investment Undertakings) Regulatins 2013 (S.I. 245 f 2013) (the Regulatins ), the Cmpany is required t cllect certain infrmatin frm nn-excepted Share Hlders. All Applicants, whether individuals, bdies crprate r unincrprated bdies f persns, which are Irish resident r rdinarily resident shuld review the list f Excepted Share Hlders set ut belw. If the Applicant is Irish resident r nn-irish resident and is nt an Excepted Share Hlder, please prvide the fllwing infrmatin and dcumentatins: Irish Tax Reference Number (TRN) / PPS Number (if applicable): Any ne f the fllwing additinal dcuments is required t verify the TRN r PPS Number (either a cpy r the riginal is sufficient): P60, P45, P21 Balancing Statement, payslip (where emplyer is identified by name r tax number), Drug Payment Scheme Card, Tax Assessment, Tax Return Frm, PAYE Ntice f Tax Credits, Child Benefit Award Letter/Bk, Pensin Bk, Scial Services Card r Public Services Card. In additin, any printed dcumentatin issued by the Irish Revenue Cmmissiners r by the Department f Scial Prtectin which cntains the Applicant s name, address and tax reference number will als be acceptable. In the case f jint accunt hlders, the additinal dcumentatin is required fr each Applicant. The dcumentatin shuld be submitted with this Applicatin. Yur persnal infrmatin will be handled by the Administratr, the Cmpany r its duly appinted delegates as Data Prcessr fr the Cmpany in accrdance with the Data Prtectin Acts 1988 t Infrmatin prvided herein will be prcessed fr the purpses f cmplying with the Regulatins and this may include disclsure t the Irish Revenue Cmmissiners. Excepted Share Hlders. The fllwing entities will cnstitute Excepted Share Hlders prvided the Fund has btained a duly cmpleted apprpriate declaratin: - TCA 1997 reference, An investment undertaking 739D(6)(c), An investment limited partnership 739D(6)(cc), etc, (the table in the return f values dcument can be listed) 11 February 2018

12 11. SUBSCRIPTION DETAILS It is intended that issues f Shares will nrmally be made fr each Dealing Day in respect f applicatins received n r prir t the relevant Dealing Deadline. Applicatins received after the Dealing Deadline fr the relevant Dealing Day shall, unless the ICAV and/r the Administratr therwise agree, be deemed t have been received by the fllwing Dealing Deadline. See Prspectus fr details f Dealing Deadline. Investment in a fund is nly suitable fr investrs wh can affrd the risks invlved. The Funds are subject t investment risks, including the pssible lss f the principal amunt invested. Please read the Prspectus fr additinal details n the specials risks and cnsideratins f investing in a Fund. Fr each share class f each sub-fund fr which yu are subscribing indicate in the apprpriate rw belw: (i) the currency (e.g. US$ & Eur) in which yur subscriptin mnies will be denminated and; (ii) either the amunt f yur subscriptin r the number f shares fr which yu are subscribing. Sub-Fund Name Share Class Name ISIN Cde Subscriptin Currency Subscriptin Amunt * Number f Shares ** Sub-Fund Name Share Class Name ISIN Cde Subscriptin Currency Subscriptin Amunt * Number f Shares ** Sub-Fund Name Share Class Name ISIN Cde Subscriptin Currency Subscriptin Amunt * Number f Shares ** Sub-Fund Name Share Class Name ISIN Cde Subscriptin Currency Subscriptin Amunt * Number f Shares ** Sub-Fund Name Share Class Name ISIN Cde Subscriptin Currency Subscriptin Amunt * Number f Shares ** Sub-Fund Name Share Class Name ISIN Cde Subscriptin Currency Subscriptin Amunt * Number f Shares ** * PLEASE USE: ',' TO DESIGNATE '000'S AND A '.' TO DESIGNATE DECIMALS ** Yu can nly chse this ptin if yu are dealing in the fund's base currency. 12 February 2018

13 12. SIGNATURES By signing and submitting this Applicatin, the undersigned, subject t the terms and cnditins f this Applicatin and the ICAV s Memrandum and Articles f Assciatin and current Prspectus, irrevcably ffers n its behalf r n behalf f each investr in which it is acting as nminee t subscribe fr and purchase Shares in each Fund as indicated in Sectin 10 f this Applicatin. The acceptance f this ffer, as evidenced by the issuance f Shares f the Funds subscribed fr t the Applicant, will cnstitute an irrevcable agreement between the Applicant and the ICAV fr the Applicant t purchase such Shares and fr the ICAV t issue and sell the Shares t the Applicant. FIRST AUTHORISED SIGNATORY NAME AND TITLE (if signing in a Crprate capacity) SECOND AUTHORISED SIGNATORY (if applicable) NAME AND TITLE (if signing in a Crprate capacity) THIRD AUTHORISED SIGNATORY (if applicable) NAME AND TITLE (if signing in a Crprate capacity) FOURTH AUTHORISED SIGNATORY (if applicable) NAME AND TITLE (if signing in a Crprate capacity) DATE (dd/mm/yyyy) Nte: (i) Where there is mre than ne named hlder n an accunt, all hlders must sign. (ii) A crpratin must sign under the hand f a duly authrised persn. At least tw authrised persns must sign and shuld state their crprate psitins. (iii) The right is reserved t reject any applicatins. (iv) If signed under a Pwer f Attrney, such Pwer r a duly certified cpy must accmpany the Applicatin. 13 February 2018

14 SCHEDULE A: INDIVIDUAL (CONTROLLING PERSON S) SELF-CERTIFICATION FOR FATCA AND CRS INSTRUCTIONS FOR COMPLETION We are bliged under Sectin 891E, Sectin 891F and Sectin 891G f the Taxes Cnslidatin Act 1997 (as amended) and regulatins made pursuant t thse sectins t cllect certain infrmatin abut each investr s tax arrangements. Please cmplete the sectins belw as directed and prvide any additinal infrmatin that is requested. Please nte that in certain circumstances we may be legally bliged t share this infrmatin, and ther financial infrmatin with respect t an investr s interests in the Fund with relevant tax authrities.this frm is intended t request infrmatin nly where such request is nt prhibited by Irish law. If yu have any questins abut this frm r defining the investr s tax residency status, please refer t the OECD CRS Prtal r speak t a tax adviser. Fr further infrmatin n FATCA r CRS please refer t Irish Revenue website at r the fllwing link t the OECD CRS Infrmatin Prtal at: in the case f CRS nly. If any f the infrmatin belw abut the investr s tax residence r FATCA/CRS classificatin changes in the future, please advise f these changes prmptly. Please nte that where there are jint r multiple accunt hlders each investr is required t cmplete a separate Self-Certificatin frm. Sectins 1, 2, 3 and 5 must be cmpleted by all investrs. Sectin 4 shuld nly be cmpleted by any individual wh is a Cntrlling Persn f an entity investr which is a Passive Nn-Financial Entity. Fr further guidance see. (Mandatry fields are marked with an *) 1. INVESTOR IDENTIFICATION Investr Name * Accunt Designatin (if applicable) Current Residential Address * (we are unable t accept a PO Bx address) Cuntry * Pstcde * Mailing Address (if different than the Current Residential Address supplied abve) Cuntry Pstcde Date f Birth (dd/mm/yyyy) * Twn r City f Birth * Cuntry f Birth * 2. FATCA DECLARATION OF U.S. CITIZENSHIP OR U.S. RESIDENCE FOR TAX PURPOSES * Please tick ( ) ne f the belw and cmplete as apprpriate. I cnfirm that [I am] / [the investr is] a U.S. citizen and/r resident in the U.S. fr tax purpses and [my]/[its] U.S. federal taxpayer identifying number (U.S. TIN) is as fllws: U.S. TIN: I cnfirm that [I am nt] / [the investr is nt] a U.S. citizen r resident in the U.S. fr tax purpses. 14 February 2018

15 SCHEDULE A: INDIVIDUAL (CONTROLLING PERSON S) SELF-CERTIFICATION FOR FATCA AND CRS (cntinued) 3. CRS DECLARATION OF TAX RESIDENCY (please nte yu may chse mre than ne cuntry) * Please indicate yur / the investr s cuntry f tax residence (if resident in mre than ne cuntry please detail all cuntries f tax residence and assciated taxpayer identificatin numbers ( TIN ). Please see the CRS Prtal fr mre infrmatin n Tax Residency. Cuntry f Tax Residency Tax ID Number NOTE: Prvisin f a Tax ID number (TIN) is required unless yu are tax resident in a Jurisdictin that des nt issue a TIN. 4. TYPE OF CONTROLLING PERSON (ONLY t be cmpleted by any individual wh is a Cntrlling Persn f an entity investr which is a Passive Nn-Financial Entity r an Investment Entity lcated in a Nn-Participating Jurisdictin and managed by anther Financial Institutin) Fr jint r multiple Cntrlling Persns please cmplete a separate Self-Certificatin frm fr each Cntrlling Persn. Please cnfirm what type f Cntrlling Persn applicable under CRS that applies t yu / the investr by ticking the apprpriate bx. Cntrlling Persn f a legal persn cntrl by wnership Cntrlling Persn f a legal persn cntrl by ther means Cntrlling Persn f a legal persn senir management fficial Cntrlling Persn f a trust settlr Cntrlling Persn f a trust trustee Cntrlling Persn f a trust prtectr Cntrlling Persn f a trust beneficiary Cntrlling Persn f a trust ther Cntrlling Persn f a legal arrangement (nn-trust) settlr-equivalent Cntrlling Persn f a legal arrangement (nn-trust) trustee-equivalent Cntrlling Persn f a legal arrangement (nn-trust) prtectr-equivalent Cntrlling Persn f a legal arrangement (nn-trust) beneficiary-equivalent Cntrlling Persn f a legal arrangement (nn-trust) ther-equivalent Please Tick Entity Name 15 February 2018

16 SCHEDULE A: INDIVIDUAL (CONTROLLING PERSON S) SELF-CERTIFICATION FOR FATCA AND CRS (cntinued) 5. DECLARATION AND UNDERTAKINGS I declare that the infrmatin prvided in this frm is, t the best f my knwledge and belief, accurate and cmplete. I acknwledge that the infrmatin cntained in this frm and infrmatin regarding the Accunt Hlder may be reprted t the tax authrities f the cuntry in which this accunt(s) is / are maintained and exchanged with tax authrities f anther cuntry r cuntries in which the Accunt Hlder may be tax resident where thse cuntries (r tax authrities in thse cuntries) have entered int Agreements t exchange financial accunt infrmatin. I undertake t advise the recipient prmptly and prvide an updated Self-Certificatin frm where any change in circumstances ccurs which causes any f the infrmatin cntained in this frm t be incrrect. AUTHORISED SIGNATURE * PRINT NAME * CAPACITY IN WHICH DECLARATION IS MADE * DATE (dd/mm/yyyy) 16 February 2018

17 SCHEDULE B: ENTITY SELF-CERTIFICATION FOR FATCA AND CRS INSTRUCTIONS FOR COMPLETION Investrs that are individuals shuld nt cmplete this frm and shuld cmplete the frm entitled Individual (Cntrlling Persn s Self- Certificatin fr FATCA and CRS. We are bliged under Sectin 891E, Sectin 891F and Sectin 891G f the Taxes Cnslidatin Act 1997 (as amended) and regulatins made pursuant t thse sectins t cllect certain infrmatin abut each investr s tax arrangements. Please cmplete the sectins belw as directed and prvide any additinal infrmatin that is requested. Please nte that in certain circumstances we may be legally bliged t share this infrmatin, and ther financial infrmatin with respect t an investr s interests in the Fund, with relevant tax authrities. This frm is intended t request infrmatin nly where such request is nt prhibited by Irish law. If yu have any questins abut this frm r defining the investr s tax residency status, please refer t the OECD CRS Prtal r speak t a tax adviser. Fr further infrmatin n FATCA r CRS please refer t Irish Revenue website at r the fllwing link: in the case f CRS nly. If any f the infrmatin belw abut the investr s tax residence r FATCA/CRS classificatin changes in the future, please ensure that we are advised f these changes prmptly. (Mandatry fields are marked with an *) 1. INVESTOR IDENTIFICATION Please fill in the whle frm in BLOCK CAPITALS using black r blue ink Investr Name * (the Entity ) Cuntry f Incrpratin r Organisatin Current Registered Address * (we are unable t accept a PO Bx address) Cuntry Pstcde Mailing Address (if different than the Current Registered Address supplied abve) Cuntry Pstcde 2. FATCA DECLARATION SPECIFIED U.S. PERSON * Please tick ( ) ne f the belw and cmplete as apprpriate. The Entity is a Specified U.S. Persn and the Entity s U.S. Federal Taxpayer Identifying number (U.S. TIN) is as fllws: U.S. TIN: The Entity is nt a Specified U.S. Persn. (please als cmplete Sectins 3, 4 and 5) The Entity is a US persn but nt a Specified U.S. Persn. (please als cmplete Sectins 4 and 5) 17 February 2018

18 SCHEDULE B: ENTITY SELF-CERTIFICATION FOR FATCA AND CRS (cntinued) 3. ENTITY S FATCA CLASSIFICATION * The infrmatin prvided in this sectin is fr FATCA, please nte yur classificatin may differ frm yur CRS classificatin in Sectin 5: 3.1 Financial Institutins under FATCA If the Entity is a Financial Institutin, please tick ne f the belw categries and prvide the Entity s GIIN at 3.2. I. Irish Financial Institutin r a Partner Jurisdictin Financial Institutin. II. III. Registered Deemed Cmpliant Freign Financial Institutin. Participating Freign Financial Institutin. 3.2 Please prvide the Entity s Glbal Intermediary Identificatin number. GIIN 3.3 If the Entity is a Financial Institutin but unable t prvide a GIIN, please tick ne f the belw reasns: I. The Entity has nt yet btained a GIIN but is spnsred by anther entity which des have a GIIN. Please prvide the spnsr s name and spnsr s GIIN : Spnsr s Name: Spnsr s GIIN: II. III. IV. Exempt Beneficial Owner. Certified Deemed Cmpliant Freign Financial Institutin. (including a deemed cmpliant Financial Institutin under Annex II f the Agreement) Nn-Participating Freign Financial Institutin. V. Excepted Freign Financial Institutin. 3.4 Nn-Financial Institutins under FATCA If the Entity is nt a Financial Institutin, please tick ne f the belw categries. I. Active Nn-Financial Freign Entity. II. III. Passive Nn-Financial Freign Entity. (if this bx is ticked, please include self-certificatin frms fr each f yur Cntrlling Persns) Excepted Nn-Financial Freign Entity. 4. CRS DECLARATION OF TAX RESIDENCY (please nte yu may chse mre than ne cuntry) * Please indicate the Entity s cuntry f tax residence fr CRS purpses, (if resident in mre than ne cuntry please detail all cuntries f tax residence and assciated tax identificatin numbers ( TIN )). NOTE: Prvisin f a Tax ID number (TIN) is required unless yu are tax resident in a Jurisdictin that des nt issue a TIN. If the Entity is nt tax resident in any jurisdictin (e.g., because it is fiscally transparent), please indicate that belw and prvide its place f effective management r cuntry in which its principal ffice is lcated. Cuntry f Tax Residency Tax ID Number 18 February 2018

19 SCHEDULE B: ENTITY SELF-CERTIFICATION FOR FATCA AND CRS (cntinued) 5. ENTITY S CRS CLASSIFICATION * The infrmatin prvided in this sectin is fr CRS, please nte an Entity s CRS classificatin may differ frm its FATCA classificatin in sectin 3: Fr mre infrmatin please see the CRS Standard and assciated cmmentary Financial Institutins under CRS If the Entity is a Financial Institutin, please tick ne f the belw categries and prvide the Entity s GIIN at 3.2. I. Financial Institutin under CRS. (ther than (II) belw) II. An Investment Entity lcated in a Nn-Participating Jurisdictin and managed by anther Financial Institutin. (If this bx is ticked, please indicate the name f any Cntrlling Persn(s) f the Entity and cmplete a separate individual self-certificatin frms fr each f yur Cntrlling Persns **) 5.2 Nn-Financial Institutins under CRS If the Entity is Nn-Financial Institutin, please tick ne f the belw categries. I. II. III. IV. V. Active Nn-Financial Entity a crpratin the stck f which is regularly traded n an established securities market r a crpratin which is a related entity f such a crpratin. Active Nn-Financial Entity a Gvernment Entity r Central Bank. Active Nn-Financial Entity an Internatinal Organisatin. Active Nn-Financial Entity ther than (I)-(III). (fr example a start-up NFE r a nn-prfit NFE) Passive Nn-Financial Entity. (If this bx is ticked, please cmplete a separate Individual Self-Certificatin Frm fr each f yur Cntrlling Persn(s)) ** Cntrlling Persns: NB: Please nte that each Cntrlling Persn must cmplete a Separate Individual Self-Certificatin frm. If there are n natural persn(s) wh exercise cntrl f the Entity then the Cntrlling Persn will be the natural persn(s) wh hld the psitin f senir managing fficial f the Entity. Fr further infrmatin n Identificatin requirements under CRS fr Cntrlling Persns, see the Cmmentary t Sectin VIII f the CRS Standard February 2018

20 SCHEDULE B: ENTITY SELF-CERTIFICATION FOR FATCA AND CRS (cntinued) 6. DECLARATION AND UNDERTAKINGS I / We declare (as an authrised signatry f the Entity) that the infrmatin prvided in this frm is, t the best f my/ur knwledge and belief, accurate and cmplete. I / We acknwledge that the infrmatin cntained in this frm and infrmatin regarding the Accunt Hlder may be reprted t the tax authrities f the cuntry in which this accunt(s) is / are maintained and exchanged with tax authrities f anther cuntry r cuntries in which the Accunt Hlder may be tax resident where thse cuntries (r tax authrities in thse cuntries) have entered int Agreements t exchange financial accunt infrmatin. I / We undertake t advise the recipient prmptly and prvide an updated Self-Certificatin where any change in circumstance ccurs which causes any f the infrmatin cntained in this frm t be incrrect.. FIRST AUTHORISED SIGNATORY * PRINT NAME * CAPACITY IN WHICH DECLARATION IS MADE * SECOND AUTHORISED SIGNATORY * PRINT NAME * CAPACITY IN WHICH DECLARATION IS MADE * THIRD AUTHORISED SIGNATORY * PRINT NAME * CAPACITY IN WHICH DECLARATION IS MADE * FOURTH AUTHORISED SIGNATORY * PRINT NAME * CAPACITY IN WHICH DECLARATION IS MADE * DATE (dd/mm/yyyy) 20 February 2018