APPLICATION FOR UNITS

Transcription

1 KATANA AUSTRALIAN Equity FUND APPLICATION FOR UNITS How to Apply Please complete this form in black ink. For Initial/new investment For Additional investment Mail the completed application form together with a cheque or copy of the payment advice showing the date of payment, to: Link Market Services Limited, c/o Katana, PO Box 3721, Rhodes NSW Completion of this Application form is not required. Please contact our office for an Additional Investment Form. For assistance completing this Application form, please contact us on (08) or admin@katanaasset.com. SECTION 1 - Investor Type Please select which of the following is applicable to this application. Individual or Joint Names Complete Sections 2, 6, 7, 8, 9, 11, 12, 13. Company Complete Sections 3, 6, 7, 8, 9, 11, 12, 13. Trust/Super Fund - Individual Trustee Complete Sections 2, 4, 6, 7, 8, 9, 11, 12, 13. Trust/Super Fund - Corporate Trustee Complete Sections 3, 4, 6, 7, 8, 9, 11, 12, 13. Partnerships - Individuals Complete Sections 2, 5, 6, 7, 8, 9, 11, 12, 13. Partnerships - Corporate Complete Sections 3, 5, 6, 7, 8, 9, 11, 12, 13. US Citizen/Other Please contact Katana Asset Management Ltd to obtain the correct Customer Identification Form which needs to be included with this Application Form. Refer to each Section for Certified Documents required. IF FATCA clauses are activated please complete the FATCA compliance form - available for download at our website, or contact our office. 01

2 SECTION 2 - Individual or Joint Names If you hold the Units jointly with another person, Investor details are required for each applicant. 2.1 Investor 1 Your full name Mr/Miss/Ms/Mrs Given name(s) Surname Your residential address (PO Box is not acceptable) Your date of birth (dd/mm/yyyy) Is the individual a U.S. Citizen for tax purposes? 2.2 Investor 2 NO YES >>> Please complete the FATCA compliance form available for download at our website, or contact our office. Your full name Mr/Miss/Ms/Mrs Given name(s) Surname Your residential address (PO Box is not acceptable) Your date of birth (dd/mm/yyyy) Is the individual a U.S. Citizen for tax purposes? NO YES >>> Please complete the FATCA compliance form available for download at our website, or contact our office. Please provide one of the following documents for each applicant: (refer to Section 14 - Certification Requirements) An original certified copy of your Australian driver s licence Your drivers licence must be current and contain a photograph of you. Please make a copy of both the front and back of the driver s licence. An original certified copy of your passport Your passport must be current or have expired no more than 2 years before the date of this form. The passport must contain a photograph of you. If your passport is written in a language other than English, it must be accompanied by an English translation prepared by an accredited translator. An original certified copy of a card issued under a law of an Australian State or Territory for the purpose of proving your age. Your identification card must be current and contain a photograph of you. Please make a copy of both the front and back of the card. Go to Section 4 if Individual is a trustee of a Trust, otherwise go to Section 6 02

3 SECTION 3 - Company 3.1 Full name of the company as registered with ASIC 3.2 Full address of the company s registered office (PO Box is not acceptable) 3.3 Full address of the company s principal place of business (PO Box is not acceptable) 3.4 ACN (mandatory for company accounts) ARBN or ABN (if applicable) 3.5 Is the company organised or Please complete the FATCA compliance form incorporated in the U.S.? NO YES >>> available for download at our website, or contact our office. 3.6 Regulatory Details - select which of the following is applicable: Is the company registered by ASIC as a proprietary company or public company? Proprietary (Go to 3.7) Public (Go to 3.8) Note: a proprietary company is typically identified by the use of Pty Ltd or Pty Limited at the end of its name. A public company is one that is typically identified by the use of Ltd or Limited. Australian listed company Majority-owned subsidiary of an Australian listed company Financial Institution (Refer to Definitions on page 10) Provide code: Provide the company s Global Intermediary Identification Number (GIIN), if applicable: If the company does not have a GIIN, please provide its FATCA status: 3.7 If you are a Proprietary company list the names of each director of the company Given name(s) Surname Director 1 - Director 2 - Director 3 - Director 4 - Director 5 - Note: If the company has more than 5 directors please provide additional details on a separate piece of paper that is marked with the name of the company and include it with this Identification Form. Tick here if you have included details of additional directors 03

4 SECTION 3 - Company (continued) 3.8 Are there any beneficial owners (who own more than 25% controlling shares) of the company? Beneficial Owner 1 - Beneficial Owner 2 - Beneficial Owner 3 - Beneficial Owner 4 - Given name(s) 3.9 Are any of the directors or beneficial owners (who own more than 25% controlling shares) of the company U.S. citizens or residents of the U.S. for tax purposes? NO YES >>> NO YES >>> Please provide details below and complete Section 2 for each of these owners. Surname Please complete the FATCA compliance form available for download at our website, or contact our office. Please provide: (refer to Section 14 - Certification Requirements) An original certified copy of the Certificate of the Registration of the company as issued by ASIC. Go to Section 4 if Corporation is a trustee of a Trust, otherwise go to Section 6 SECTION 4 - Trusts Complete this section if the investment is in the name of a Trust 4.1 Full name of the trust 4.2 Full business name (if any) of the trustee in respect of the trust (if applicable) Note: A trust does not need to have a trustee which has a business name. 4.3 The country in which the trust was established 4.4 Type of trust, select which of the following is applicable: Australian Regulated Trust (e.g. an SMSF) Provide name of the regulator (e.g. ASIC, APRA, ATO) Provide the trust s ABN or registration / licensing details Family, discretionary, charitable or other trust type Trust description (e.g. Family, unit, charitable, estate) Australian Registered Managed Investment Scheme Provide Australian Registered Scheme Number (ARSN) Australian Government Superannuation Fund Provide name of the legislation establishing the fund Financial Institution or a Trust with a Trustee that is a Financial Institution (Refer to Definitions on page 10) Provide the trust s Global Intermediary Identification Number (GIIN), if applicable: If the trust does not have a GIIN, please provide its FATCA status: United States Trust (a Trust created in the U.S., established under the laws of the U.S. or a U.S. taxpayer) >>> Please complete the FATCA compliance form available for download at our website, or contact our office. 04

5 SECTION 4 - Trusts (continued) 4.5 Trustee details select which of the following is applicable: Individual Trustees >>> Ensure relevant information has been completed in Section 2 Corporate Trustee >>> Ensure relevant information has been completed in Section 3 If the Trust has more than 2 trustees please provide the trustee name(s) and residential address(es) on a separate piece of paper that is marked with the name of the Trust and include it with this Form. Tick here if you have included details of additional trustees. 4.6 Beneficiary details Do the terms of the trust identify the beneficiaries by reference to membership of a class? See Definitions on page 10. Yes, provide details of the class: No, provide full names of each beneficiary of the trust below Given name(s) Surname Entitlement %* Beneficiary 1 - Beneficiary 2 - Beneficiary 3 - Beneficiary 4 - Beneficiary 5 - Note: if the trust has more than 5 beneficiaries please provide additional details on a separate piece of paper that is marked with the name of the trust and include it with this Identification Form. Tick here if you have included details of additional beneficiaries * If entitlement is 25% or above, please complete Section 2 for those beneficiaries 4.7 Are any of the trustees, beneficiaries, appointers or settlers of the trust U.S. citizens or residents of the U.S. for Tax purposes? NO YES >>> Please complete the FATCA compliance form available for download at our website, or contact our office. Please provide: (refer to Section 14 - Certification Requirements) An original certified copy of an extract of the trust deed for the trust that includes the full name of the trust. A full certified copy of the trust deed is not required; and An original certified copy of a notice (such as a notice of assessment) issued by the Australian Taxation Office in the name of the trust within the last 12 months; or An original certified copy of a letter from an accountant or solicitor dated within the last 3 months confirming the name and existence of the trust. Go to Section 6 05

6 SECTION 5 - Partnerships Complete this section if the investment is in the name of a partnership 5.1 Full name of the partnership 5.2 Select which of the following is applicable: Australian Partnership United States Partnership (Partnership for the purposes of US tax legislation) >>> Please complete the FATCA compliance form available for download at our website, or contact our office. Financial Institution (Refer to Definitions on page 10) Provide the partnership s Global Intermediary Identification Number (GIIN), if applicable: If the partnership does not have a GIIN, please provide its FATCA status: Other Partnerships that are not US Partnerships Are any of the partners U.S. citizens or residents of the U.S. for tax purposes? NO YES >>> Please complete the FATCA compliance form available for download at our website, or contact our office. 5.3 Partnership details select which of the following is applicable: Partnership Individuals >>> Ensure relevant information has been completed in Section 2 Partnership Corporate >>> Ensure relevant information has been completed in Section 3 If Partnership has more than 2 partners please provide the partner name(s) and residential address(es) on a separate piece of paper that is marked with the name of the Partnership and include it with this form. Tick here if you have included details of an additional partner. Go to Section 6 SECTION 6 Tax File Number / Exemption Details Please provide Tax File Number, ABN or reason for exemption for this investment - complete for each investor. Name Tax File Number / ABN / Exemption: Individual Corporate Name Tax File Number / ABN / Exemption: Name Name Individual Tax File Number / ABN / Exemption: Individual Tax File Number / ABN / Exemption: Individual Corporate Corporate Corporate NOTE: The collection and use of TFNs is strictly regulated by the tax laws and the Privacy Act 1988 (Cth). You are not required by law to provide your TFN, however, if you do not provide it, tax may be deducted from your distributions at the highest marginal tax rate. If you require further information on the use and collection of TFNs contact the Australian Tax Office Go to Section 7 06

7 SECTION 7 - Contact Details Name of primary contact Mailing address for all correspondence Suburb Postcode Telephone (BH) Mobile Telephone (AH) Facsimile How would you like to receive your statements and transaction advices? Mail Go to Section 8 SECTION 8 - Adviser Details Did a Financial Adviser assist with the preparation of this application? NO YES >>> Please provide details for the Financial Adviser: Name Dealer Group Name AFSL Number Company Phone Postal Address Suburb Postcode Would you like the adviser to also receive copies of any correspondence in relation to this investment? Go to Section 9 NO YES >>> If yes, please select the method of contact: Mail SECTION 9 - Investment Details Please specify the amount you wish to invest: (minimum investment is $25,000) $ Investment payment options: By Cheque: Please make your cheque payable to Katana Australian Equity Fund By Direct Deposit: Please deposit the Investment amount (net of all bank charges) to the bank account details below Bank Name JPMorgan Chase Bank N.A. Sydney Level 18, 85 Castlereagh Street Sydney NSW 2000 Account Name Katana Asset Management Ltd ATF Katana Australian Equity Fund - Applications Account BSB Account Number Note: only the net amount received will be invested in the Fund Please provide a copy of the payment advice showing the value date of payment (refer How to Apply section on page 01 for instructions). Go to Section 10 07

8 SECTION 10 Bank Account Details NOTE: Distributions and Redemption proceeds can only be paid to an Australian financial institution. This Account must be in the name of the Investor. Distribution method: How would you like us to pay your distributions? Reinvestment Paid to bank (provide distribution bank details) Bank Name Account Name BSB Account Number Redemption Proceeds: Account where you would like us to pay redemptions (if different from above) Account Name BSB Account Number Go to Section 11 SECTION 11 - Reporting Requirements (optional) Do you require a copy of your correspondence to be sent to a 3rd party? No Yes >>> Full name: Choose one option Post Address: Details: Go to Section 12 SECTION 12 Account Operating Instructions Any 1 to sign Any 2 to sign All to Sign Other (please specify) If no selection is made, All to Sign will be assumed Go to Section 13 08

9 SECTION 13 Application Declaration I/We declare that: all details in this application are true and correct; I/we have read and understood the Product Disclosure Statement accompanying this application and agree to the terms and conditions contained in it and to be bound by the Product Disclosure Statement and the Trust Deed of the Fund; and l/we have legal power to invest in accordance with this application. If this is a joint application, each of us agrees that our investment is as joint tenants. Each of us is able to operate the account and bind the other to any transaction including investments or withdrawals by any available method. If investing as a trustee on behalf of a super fund or trust I/we confirm that I am/we are acting in accordance with my/our designated powers and authority under the trust deed. In the case of a super fund, I/we also confirm that it is a complying fund under the Superannuation Industry (Supervision) Act I/We acknowledge that the Manager: is under no obligation to accept this application in part or in full; and does not guarantee the performance of the Fund, the return of capital invested or whether any income will be generated by the investments of the Fund. Signature Signature Full Name Full Name Please indicate title (Individual, Director, Secretary, Trustee, Other) Please indicate title (Individual, Director, Secretary, Trustee, Other) Date Date 09

10 SECTION 14 Certification Requirements Each document provided with this form must be certified by an acceptable certifier. We will not accept photocopies or faxes of a certification. Please ask the certifier to include the following certification on the front page of the document: First name Last name Details of certifier: Phone number Category of Certifier (refer to list below) I certify that this is a true and correct copy of the original document provided to me. OR Statement by certifier: I certify that this page and the following pages are true and correct copies of the original document provided to me. Signature of the Certifier Date (dd/mm/yyyy) a member of the Institute of Chartered Accountants in Australia, CPA Australia, or the National Institute of Accountants with 2 or more years continuous membership an officer with, or authorised representative of, a holder of an Australian financial services licence, having 2 or more years continuous service with one or more licensees a legal practitioner enrolled in a Supreme Court of a State, or Territory or the High Court of Australia a judge of a court a magistrate a chief executive officer of a Commonwealth court Acceptable certifiers a registrar or deputy registrar of a court a Justice of the Peace a notary public a police officer an agent of the Australian Postal Corporation who is in charge of an office supplying postal services a permanent employee of the Australian Postal Corporation who supplies postal services an Australian consular officer or Australian diplomatic officer an officer with 2 or more continuous years service with one or more financial institutions a finance company officer with 2 or more continuous years service with one or more finance companies. How to certify SAMPLE Definitions Beneficiaries FATCA Financial Institution Beneficiaries under a trust may be specifically named e.g. Bill Jones, or be part of a class e.g. members of the Jones family. Where members are specifically named, their individual details should be provided. Where they are classified, provide details of the class or grouping e.g. prescribed charities, Jones family, etc. From 1 July 2014, the Foreign Account Tax Compliance Act (FATCA) requires Australian financial institutions to review customer accounts to determine whether they are held by US citizens, US tax residents or US entities (or in some cases non-us entities controlled by US persons). As defined by FATCA, a Financial Institution may be any of the following: Custodial Institution that conducts a substantial business of holding financial assets for others; Depository Institution a bank or similar business that accepts deposits in the ordinary course of business; Investment Entity that conducts (or is managed by an entity that conducts) a. money market trading, b. portfolio management, or c. investing, administering or managing funds or money, as a business on behalf of a customer. Examples include responsible entities for managed funds, professional fund managers; Specified Insurance Company Issues a cash value insurance contract or annuity; but excludes small passive investment vehicles, such as family trust and personal investment companies, that are not managed by professional trustees or fund managers. AMP Building, Level St Georges Terrace Perth, Western Australia 6000 GPO Box Z5364 Perth St Georges Tce WA 6831 TEL FAX admin@katanaasset.com 10