Application Form 2 for Superannuation Funds/Trusts

Transcription

1 FORM M2 Trilogy Monthly Income Trust Application Form 2 for Superannuation Funds/Trusts This is an Application Form for Units in the Trilogy Monthly Income Trust ARSN issued by Trilogy Funds Management Limited ACN , AFSL This form is to be used by Superannuation Funds or Trusts for Units in the Trilogy Monthly Income Trust. This Application Form accompanies the Product Disclosure ment (PDS) dated 1 September The PDS contains important information about an investment in the Trust. It is important that you read the PDS in full and the declarations and acknowledgements contained in this Application Form before applying for Units. The PDS is available at or by contacting Investor Relations (see details below). Application process - 4 simple steps STEP 1: COMPLETE AND SIGN FORM Fill in all relevant sections of this form in blue or black pen and using BLOCK letters. Print X in the appropriate boxes to indicate your response. Do not use whiteout on this form. If you need to correct a mistake cross out the section to be corrected accompanied with your full signature. STEP 2: ATTACH DOCUMENTS Attach any required documentation. Please note they must be certified copies. There is a list of those persons able to certify your documents on our website The Anti-Money Laundering and Counter-Terrorism Financing Act 2006 requires us to identify you and verify your identity when you acquire Units in the Trust. As a resullt, you will need to provide certified copies of relevant identification docusment(s) for us to verify your identity. The documentation required is specified in Part 9 of the Application Form. STEP 3: SEND YOUR APPLICATION Select your method of delivery: OPTION 1 Free post your application to: Trilogy Funds Management Limited Reply Paid 1648 Brisbane QLD 4001 STEP 4: TAX RESIDENCY INFORMATION OPTION 2 Scan and your application to: investorrelations@trilogyfunds.com.au OPTION 3 Apply online at: Foreign Account Tax Compliance Act (FATCA) and Common Reporting Standard (CRS) Are any of the entities or individuals mentioned in this form a US citizen or resident of the US for tax purposes, or otherwise a non-resident for tax purposes? Yes No Please complete the Self Certification Declaration Form in addition to this application. The declaration is available at or call (New Zealand ) and request a copy. Complete this Application Form. Please contact us if you have any questions about the application process. Phone Investor Relations on (New Zealand callers phone ) or investorrelations@trilogyfunds.com.au 1

2 PART 1: Entity details How did you hear about the Trilogy Monthly Income Trust? Indicate what type of entity is investing: Superannuation Fund Trust Please specifiy Trust type (e.g. family, unit, charitable, other): 1A: SUPERANNUATION FUND/TRUST DETAILS Full name ABN Tax File Number (TFN) If you are a non-resident of Australia for tax purposes, please provide your country of tax residency and please complete the Self Certification Declaration Form in addition to this application Form. Mailing address Please indicate if your mailing address is the same as your residential address: OR complete this section. / PO Box / PO Box Contact phone number(s) and (Please supply at least one contact phone number and an address) Home ( ) Business ( ) Mobile Fax ( ) 1B: SUPERANNUATION FUND/TRUST BENEFICIARY DETAILS Provide details of the Superannuation Fund/Trust beneficiaries. Please note: If beneficiaries are identified by reference to a class, please provide the details of the class. BENEFICIARY 1 Title Details of class (if any) Date of birth / / 2

3 1B: SUPERANNUATION FUND/TRUST BENEFICIARY DETAILS (CONTINUED) Residential address POLITICALLY EXPOSED PERSON (PEP) Is this beneficiary or any beneficial owner of this beneficiary a PEP? Please refer to if you are unsure. Yes Please provide description of PEP s position: No BENEFICIARY 2 Title Details of class (if any) Date of birth / / Residential address POLITICALLY EXPOSED PERSON (PEP) Is this beneficiary or any beneficial owner of this beneficiary a PEP? Please refer to if you are unsure. Yes Please provide description of PEP s position: No If the Superannuation Fund/Trust has more than two beneficiaries please download an Additional Beneficiary Form at or call Investor Relations on (New Zealand ). 3

4 Indicate the type of trustee for your Superannuation Fund/Trust Individual Trustee(s) Proceed to Part 1C Corporate Trustee Proceed to Part 1D 1C: INDIVIDUAL TRUSTEE(S) TRUSTEE 1 Title Date of birth / / Residential address (The address provided below must be the residence of the Trustee) IF THE TRUST ONLY HAS ONE TRUSTEE, PROCEED TO PART 2 TRUSTEE 2 Title Date of birth / / If your residential address/mailing address and contact details are the same as Trustee 1 indicate here: Residential address (The address provided below must be the residence of the Trustee) If there are more than two individual Trustees, please download an Additional Trustee Form at or call Investor Relations on (New Zealand ). POLITICALLY EXPOSED PERSON (PEP) Is any individual Trustee a PEP? Please refer to if you are unsure. Yes Please provide: Name Description of PEP s position No Proceed to Part 2 4

5 1D: CORPORATE TRUSTEE Company details Full name (as registered with ASIC for Australian Trustees) Australian Company Number (ACN) Australian Business Number (ABN) Registered office details (The address supplied below must not be a PO Box) Principal place of business (The address supplied below must not be a PO Box) Please indicate if the principal place of business is the same as the registered office address: OR complete this section. DIRECTOR 1 (Please note Directors names are only required for proprietary companies) Title Date of birth / / Residential address 5

6 1D: CORPORATE TRUSTEE (CONTINUED) DIRECTOR 2 (Please note Directors names are only required for proprietary companies) Title Date of birth / / Residential address If there are more than two Directors, please download an Additional Director Form at or call Investor Relations on (New Zealand ). Provide details of all individuals who are beneficial owners of the proprietary company through one or more shareholdings of more than 25% of the company s issued capital. See if you are unsure what beneficial owner means. BENEFICIAL OWNER 1 Title Date of birth / / Residential address BENEFICIAL OWNER 2 Title 6

7 Date of birth / / 1D: CORPORATE TRUSTEE (CONTINUED) Residential address If there are more than two Beneficial Owners, please download an Additional Beneficial Owner Form at or call Investor Relations on (New Zealand ). POLITICALLY EXPOSED PERSON (PEP) Is any beneficial owner a PEP? Please refer to if you are unsure. Yes Please provide: Name Description of PEP s position No PART 2: Investment details Investment amount: $ How will this payment be made? (Minimum investment amount is $10,000 and in multiples of $1,000 thereafter.) Cheque Make cheque payable to: The Trust Company Limited ACF TMIT Please note: Your cheque must be in Australian currency drawn on an Australian bank and marked Not Negotiable. Sufficient cleared funds should be held in your account, as cheques returned unpaid may result in your application being rejected. Direct deposit BSB: Account number: Account name: Trilogy Monthly Income Trust Reference: For identification purposes, please use your Investor ID or Superannuation Fund/ Trust name as the payment description of your transaction. Biller Code: Reference: Please call us on (New Zealand ) to obtain your unique 7

8 PART 3: Bank account details reference number or Nominate a bank account into which your distributions are to be paid. If you are an overseas Investor please download an Overseas Bank Details form at or call Investor Relations on Bank account details Financial institution name Account name BSB Account number Distribution preferences Pay my distribution to the account noted above OR Reinvest my distribution. PART 4: Operating authority Companies must give instructions and sign in accordance with the Corporations Act 2001 (i.e., two directors, a director and a secretary or a sole director/secretary). For all other applicants, when giving instructions to us about your investment, please indicate who has the authority to operate your account. If no box is ticked we will assume all signatories must sign. Either signatory to sign OR Both signatories must sign OR Other, please specify: PART 5: Communication preferences Please provide your communication preferences below: I/we agree to receive correspondence in accordance with the standard delivery schedule set out below (which may be updated at Note: Please contact Investor Relations if you have a special request, for example, a hard copy delivered to you in the post. Communication Timing Delivery Distribution ments Monthly Other Communications When a material change occurs Website and Transaction Confirmations After each transaction Tax ments Annually Periodic ments Annually Annual Report Annually Website I/we do not have an address and therefore would like all communication to be mailed to the mailing address specified in Part 1A of this form. 8

9 PART 6: Financial Adviser details and certifications ONLY COMPLETE PART 6 IF YOU HAVE A FINANCIAL ADVISER. OTHERWISE PROCEED TO PART 7. 6A Financial Adviser details (Adviser to complete) If you are an overseas Financial Adviser please investorrelations@trilogyfunds.com.au to confirm what details you will need to supply. Licensee name Business name Adviser s full name ABN AFSL or AR number / PO Box Business phone ( ) Is there a specific fee payable on this investment? Yes Please provide your bank account details below and ensure that your client completes Part 6B No Financial Adviser bank account details Financial institution name Account name BSB Account number 9

10 Financial Adviser AML/CTF Certification Where an investment is made via a Financial Adviser, Trilogy Funds will, in accordance with AML/CTF legislation, rely upon the Financial Adviser to verify the identity of the Investor. In verifying the identity of the Investor(s) and any beneficial owners(s). I confirm that I have complied with the requirements of the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 and associated rules (AML/CTF legislation). I understand that I am legally required to have verified the identity of the Investor prior to providing the designated service (that is, arranging for the Investor to invest in the Trust). I understand that as permitted by the AML/CTF legislation, Trilogy Funds will rely on the Investor identification that I conduct. Unless requested, Trilogy Funds does not require certified copies or originals of the documents verifying the Investor s identity. I acknowledge that Trilogy Funds, as permitted under the AML/CTF legislation, will rely on me to verify the Investor s and any beneficial owner s identification. Trilogy Funds may (as required) seek additional information from me or the Investor to verify the Investor s identity. I acknowledge that Trilogy Funds may not accept an application until it is satisfied that the Investor and any beneficial owners is verified. I confirm that in accordance with the requirements of the AML/CTF legislation, I will retain all documentation used by me to verify the identity of the Investor and any beneficial owner. Yes, I confirm that I have verified the identity of the Investor(s) and any beneficial owner(s). Must be signed by the Financial Adviser or an authorised person. Adviser stamp (if available) Signature Date / / 6B Payment instruction (Investor to complete) Please note the fee nominated will be collected from your application monies and paid by Trilogy Funds Management Limited as agent of the Financial Adviser. I/We, hereby direct Trilogy Funds Management Limited to pay the amount of $ out of my Trilogy Monthly Income Trust application money to my Financial Adviser. Payment is to be made to my Financial Adviser s bank account nominated in Part 6A. Trustee / Director 1 Signature Date / / Trustee / Director 2 If this is a joint application, the second applicant must also sign below. Signature Date / / 10

11 PART 7: Declarations and acknowledgements An investment in the Trust is offered by Trilogy Funds Management Limited ACN Australian Financial Services Licence Number Before signing this Application Form it is important that you have read and understood the PDS dated 1 September By signing this Application Form in Part 8: I/We declare that: All details in this Application Form and any other information provided in support of the application are complete and accurate. I/We have read the PDS to which this application applies and agree to the offer contained in it and to be bound by the provisions of the Trust s Constitution (as amended) which governs the Trust. If I/We have received the PDS from the internet or other electronic means, I/we declare that I/we have received it personally, or a printout of it, accompanied by or attached to the Application Form before making an application for Units in the Trust. I/We acknowledge that all information relating to this application or any subsequent information I/we give you relating to my/our investment may be disclosed to any service provider to the Trust and to my/our adviser. I/We understand that this authority will continue unless rescinded in writing by me/us. In the case of joint applications, the joint Investors agree that unless otherwise expressly indicated on this Application Form, the Units will be held as joint tenants. If this Application Form is signed under Power of Attorney, the Attorney declares that he/she has not received notice of revocation of that power (a certified copy of the Power of Attorney must be submitted with this application). I/We have all requisite power and authority to execute and perform the obligations under the PDS and this Application Form. Other than as disclosed in this Application Form, no person or entity controlling, owning or otherwise holding a Unit is a tax resident of any country other than Australia, including a United s citizen or resident of the United s for taxation purposes (US Person). I/We will promptly notify Trilogy Funds of any change to the information I/we have previously provided to Trilogy Funds, including any changes which result in a person or entity controlling, owning or otherwise holding a Unit who is a US Person or a tax resident of any country other than Australia. I/We consent to Trilogy Funds disclosing any information it has in compliance with its obligations under intergovernmental agreement between the Government of Australia and the Government of other countries in respect of the exchange of tax and financial account information and any related Australian law and guidance implementing the same (together, the IGA). This may include disclosing information to the Australian Taxation Office, who may in turn report that information to the relevant foreign equivalent. I/We acknowledge that the collection of my/our personal information may be required by the OECD s Common Reporting Standard in Australia, Financial Transaction Reports Act 1988, the Corporations Act 2001, the Income Tax Assessment Act 1936, the Income Tax Assessment Act 1997, the Taxation Administration Act 1953, and the Anti-Money Laundering and Counter-Terrorism Financing Act Otherwise, the collection of information is not required by law, but I/we acknowledge that if I/we do not provide personal information, Trilogy Funds may not allow me/us to invest in the Trust. I/We are not aware and have no reason to suspect that the monies used to fund my/our investment in the Trust have been or will be derived from or related to any money laundering, terrorism financing or similar or other activities illegal under any applicable law or regulations or otherwise prohibited under any international convention or agreement. I/We will provide Trilogy Funds with all additional information and assistance that Trilogy Funds may request in order for Trilogy Funds to comply with any AML/CTF Law, or to comply with the intergovernmental agreements to exchange financial account information. I/We acknowledge that Trilogy Funds may decide to delay or refuse any request or transaction, including by suspending the issue or redemption of any investment in the Trust, if Trilogy Funds is concerned that the request or transaction may breach any obligation of or cause Trilogy Funds to commit or participate in an offence, including under any AML/CTF Law or any intergovernmental agreement to exchange financial account information. I/We acknowledge that: If this application is made through a financial adviser and we have made an instruction to Trilogy Funds in Section 6 of this form, then we may have agreed with our financial adviser to pay service fees for advice provided to us by our financial adviser and I/we declare that I/we have received this advice to which the service fee releates. Investments in the Trust are subject to investment and other risks, including possible delays in repayment and the loss of income and principal invested. Trilogy Funds does not guarantee the repayment of capital or the performance of the Trust or any particular rate of return from the Trust. I/We agree to the collection, use and disclosure of my/our personal information as set out in Trilogy Funds privacy policy when I/we make an investment in the Trust. I/We acknowledge that Trilogy Funds may deliver and make reports, statements and other communications available in electronic form, such as or by posting on its website. 11

12 PART 8: Applicant signatures I/We hold all necessary approvals I/we require to sign this Application Form to make the investment and hold Units in the Trust. Trustee/Director 1 Signature Date / / Trustee/Director 2 Signature Date / / PART 9: AML/CTF and ID requirements The information below is required under the Anti-Money Laundering and Counter-Terrorism Financing Act Source of investment funds Please identify the source of your investment assets or wealth: Inheritance/gift Superannuation savings Financial investments Business activity Other Please specify: What is the purpose of this investment? Savings Growth Retirement Business Account Income For unregulated Trust (i.e. other than Superannuation Funds or registered managed investment schemes) please provide the following information: The material assets contribution to the Trust by the settlor at the time the Trust was established was less than $10,000 The settlor of the Trust is deceased Neither of the above is correct Please provide the full name of the settlor of the Trust: 12

13 Please complete the relevant sections below to finalise your application. Any required documents must be certified copies, not original documents. To ensure your documents are correctly certified, please refer to Any document not in English must be accompanied by an English translation prepared by an accredited translator. SUPERANNUATION FUNDS Indicate which document you will supply: Option 1 Option 2 ABN provided in Part 1A OR Trust Deed or extract showing the name of the trust attached to this application. TRUSTS Indicate which document you will supply: Option 1 Option 2 Trust Deed or extract showing the name of the Trust OR A letter from a solicitor or qualified accountant that confirms the name of the Trust OR Option 3 A notice issued by the Australia Taxation Office within the last 12 months (e.g. Notice of Assessment). IF YOU HAVE INDICATED THE DOCUMENTS YOU WILL PROVIDE FOR EACH TRUSTEE ABOVE: INDIVIDUAL TRUSTEES PROCEED TO PART 9A CORPORATE TRUSTEES PROCEED TO PART 9B 9A: INDIVIDUAL TRUSTEE(S) There are two methods (complete wither Option 1 or Option 2) that may be used to verify your identity for AML/CTF purposes. Please note that it is a legal requirement that Trilogy Funds verifies your identity in order to provide financial services to you. OPTION 1: PROVIDE DRIVER S LICENSE OR PASSPORT DETAILS Trilogy Funds will use a third party provider to confirm your identity for AML/CTF purposes. Please see Trilogy funds privacy policy on the website in relation to our use of your personal information. Provide details of either your driver s license or Australian passport below for an electronic verification. Trustee 1 Driver s license no. Expiry date / / Card no. (NSW only) of issue OR Australian passport no. Expiry date / / Complete name at birth including middle name Place of birth (as shown on passport) of birth Family name at citizenship 13

14 Trustee 2 ONLY COMPLETE THIS SECTION IF THIS IS A JOINT APPLICATION. Driver s license no. Expiry date / / Card no. (NSW only) of issue OR Australian passport no. Expiry date / / Complete name at birth including middle name Place of birth (as shown on passport) of birth Family name at citizenship IF YOU HAVE PROVIDED DETAILS IN OPTION 1 ABOVE PLEASE PROCEED TO PART 9C OPTION 2: PROVIDE CERTIFIED DOCUMENTS Please indicate the certified documents you are providing by printing an X in the relevant box as you attach the document to your application. For each individual named in Part 1 of this Application Form, you need to provide only one document. Documents must be certified copies, not original documents. To ensure your documents are correctly certified, please refer to Any document not in English must be accompanied by an English translation prepared by an accredited translator. Please ensure that the certified document contains both your full name and photograph. Certified document Trustee 1 Trustee 2 Australian driver s licence (both front and back) OR Australian passport (current or expired less than 2 years ago) OR Proof of age card issued under a state or territory law OR Foreign passport (current or expired less than 2 years ago). IF YOU HAVE PROVIDED ONE CERTIFIED DOCUMENT FOR EACH BENEFICIARY ABOVE PLEASE PROCEED TO PART 9C If you cannot supply any of the documents listed on the previous page you must provide one certified document from each category below. Indicate what you are attaching by printing an X in the relevant boxes. Category A Trustee 1 Trustee 2 Australian Birth Certificate OR Australian Citizenship Certificate OR Pension Card issued by Department of Human Services AND Category B Trustee 1 Trustee 2 Notice from the Australian Taxation Office that shows your name and residential address (issued within the preceding 12 months) OR Notice from Commonwealth or or Territory Government outlining financial benefits that shows your name and residential address (issued within the preceding 12 months) OR Document from local government body or utilities provider that shows your name and residential address (issued within the preceding 3 months). IF YOU HAVE PROVIDED ONE CERTIFIED DOCUMENT FROM EACH CATEGORY ABOVE 14

15 IF YOU HAVE PROVIDED ONE CERTIFIED DOCUMENT FOR EACH TRUSTEE ABOVE PLEASE PROCEED TO PART 9C 9B: CORPORATE TRUSTEE(S) Please indicate which requirement you will satisfy: ACN and/or ABN provided in Part 1D OR Certificate of registration issued by ASIC supplied. 9C: INDIVIDUAL BENEFICIARY(S) There are two methods (complete either Option 1 or Option 2) that may be used to verify your identity for AML/CTF purposes. Please note that it is legal requirement that Trilogy Funds verifies your identity in order to provide financial services to you. Trilogy Funds will use a third party provider to confirm the identity of the beneficiary(s) for AML/CTF purposes. Please see Trilogy Funds privacy policy on the website in relation to our use of personal information. OPTION 1: PROVIDE DRIVER S LICENSE OR PASSPORT DETAILS Provide details of either your driver s license or Australian passport below for an electronic verification. Beneficiary 1 Driver s license no. Expiry date / / Card no. (NSW only) of issue OR Australian passport no. Expiry date / / Complete name at birth including middle name Place of birth (as shown on passport) of birth Family name at citizenship Beneficiary 2 Driver s license no. Expiry date / / Card no. (NSW only) of issue OR Australian passport no. Expiry date / / Complete name at birth including middle name Place of birth (as shown on passport) of birth Family name at citizenship IF YOU HAVE PROVIDED DETAILS IN OPTION 1 ABOVE YOUR APPLICATION IS NOW COMPLETE 15

16 OPTION 2: PROVIDE CERTIFIED DOCUMENTS Please indicate the certified documents you are providing by printing an X in the relevant box as you attach the document to your application. For each individual named in Part 1 of this Application Form, you need to provide only one document. Documents must be certified copies, not original documents. To ensure your documents are correctly certified, please refer to Any document not in English must be accompanied by an English translation prepared by an accredited translator. Please ensure that the certified document contains both your full name and photograph. Certified document Trustee 1 Trustee 2 Australian driver s license (both front and back) OR Australian passport (current or expired less than 2 years ago) OR Proof of age card issued under a state or territory law OR Foreign passport (current or expired less than 2 years ago). IF YOU HAVE PROVIDED ONE CERTIFIED DOCUMENT FOR EACH BENEFICIARY ABOVE YOUR APPLICATION IS NOW COMPLETE. If you cannot supply any of the documents listed on the previous page you must provide one certified document from each category below. Indicate what you are attaching by printing an X in the relevant boxes. Category A Trustee 1 Trustee 2 Australian Birth Certificate OR Australian Citizenship Certificate OR Pension Card issued by Department of Human Services AND Category B Trustee 1 Trustee 2 Notice from the Australian Taxation Office that shows your name and residential address (issued within the preceding 12 months) OR Notice from Commonwealth or or Territory Government outlining financial benefits that shows your name and residential address (issued within the preceding 12 months) OR Document from local government body or utilities provider that shows your name and residential address (issued within the preceding 3 months). YOUR APPLICATION IF YOU HAVE PROVIDED ONE CERTIFIED DOCUMENT FOR EACH CATEGORY ABOVE YOUR APPLIATION IS NOW COMPLETE. END OF APPLICATION 16