Hereford Funds Application Form

Transcription

1 B SHARE APPLICATION FORM Shareholder Name Shareholder ID (11 digits) First time applications: First time applicants must complete all sections of the APPLICATION FORM. The Beneficial Ownership Form and the Declarations & Disclosure Statement are an integral part of the APPLICATION FORM and must be signed and submitted IN ORIGINAL for orders to be accepted. Subsequent applications: For subsequent purchases, only sections 1, 2, 3, 5 & 8 need to be completed and submitted. 1. Investment / Subscription in cash in units (tick as appropriate) 1.1 Compartment or Share class name Class B Shares () 1.2 ISIN 1.3 Currency 1.4 Subscription *) In figures DSM US Large Cap Growth Fund LU LU In words In investing in the DSM US Large Cap Growth Fund Class B Shares (), I/we acknowledge that we are subject to a minimum holding of 10,000,000. If as at the last business day of each quarter, the average holdings during the relevant quarter represents less than 90% of the minimum holding (based on redemptions from the original subscription amount. Variations due to market price variations will not be taken into account.), holdings will automatically be switched into the DSM US Large Cap Growth Fund as of the first net asset value calculation of the following quarter. Class D Shares () LU Class U Shares () Class B Shares () LU DGHM US All-Cap Value Fund LU LU In investing in the DGHM US All-Cap Value Fund Class B Shares (), I/we acknowledge that we are subject to a minimum holding of 10,000,000. If as at the last business day of each quarter, the average holdings during the relevant quarter represents less than 90% of the minimum holding (based on redemptions from the original subscription amount. Variations due to market price variations will not be taken into account.), holdings will automatically be switched into the DGHM US All Cap Value Fund as of the first net asset value calculation of the following quarter. Class D Shares () LU IMVA Opportunity Fund LU *) I/we acknowledge and accept that this/these amount(s) also cover for any subscription and/or cash transfer fees charged in accordance with the Prospectus or by correspondent banks and which will be deducted prior to my/our investment in the Fund

2 2. Investor type Individual Joint Company Trust Bank Insurance Company Other Regulated Financial Sector Professional Other I/we confirm that I am/we are neither US citizen nor US resident for tax purposes (refer to the prospectus, under the caption named US Foreign Account Tax Compliance Act ("FATCA") ) 3. Origin of the funds invested Institutional Investors Institutional Investors: In our capacity as (tick as appropriate):a regulated professional intermediary subject to Financial Action Task Force member country customer identification obligations, we have identified the origin of the funds used for subscription by the ultimate Beneficial Owner(s) of the funds invested in. We further confirm, that if required to do so either by Hereford Funds, BSI, UBSFSL or by any competent Government body having authority in the issue, as a result of concerns arising under Luxembourg Anti-Money Laundering and fight against the financing of terrorism legislation or any amendments hereto, we will disclose the information on the origin of the funds in regard to this subscription to UBSFSL a non-regulated professional intermediary, we declare that the origin of the funds used for subscription by the ultimate Beneficial Owner(s) of the funds invested in are coming from (tick appropriate box) Salary Savings Inheritance Sale of Real Estate Other (please describe) an entity investing its own funds, we declare that the origin of the funds used for subscription is coming from (tick appropriate box): Savings Business proceeds Sale of Real Estate 4. Payment Details Latest audited financial statements and semi-annual report if published thereafter Other (please describe) I/We have arranged for payment of the subscription amount(s) shown in section 1. by (tick and complete as appropriate): SWIFT / telegraphic transfer of (specify total amount of payment) to be received by VP Bank (Luxembourg) S.A. for value on (insert date). To comply with Luxembourg anti-money laundering and fight against the financing of terrorism regulations, we require the bank account information from which you will transfer the invested money. 5. Registration Details In the case of joint holders, account registration address is the address of the first holder. Joint Investors / Legal Guardian Authority We declare each other separately and individually able to represent the minor. We declare each other separately and individually able to sign for transactions. If no preference is expressed, we will assume that Joint Investors or both legal guardians authority is required

3 B SHARE APPLICATION FORM (CONT D) 6. Politically Exposed Person I hereby declare that: I am not and never have been a politically exposed person nor connected to one as defined in EU Directive 2006/70/EC I am or was a politically exposed person please state function: I am or was connected to the following politically exposed person: 7. Signature (Please indicate the capacity of each signatory if signing for a corporate entity, e.g. Director ) Signature (& Company Seal if applicable) 2 nd Signature (& Company Seal if applicable) Name: (please print) Capacity / Title: Date: Name: (please print) Capacity / Title: Date: - 3 -

4 B SHARE APPLICATION FORM (CONT D) 8. Details for Share Registration that will be recorded on the Share Register Registered Shareholder Name Registered Address (place of living / legal domicile) Telephone Number Tax Identification Number Date of Birth / Incorporation Profession / Activity Street: Zip / Postal Code: Country: Business field (e.g. finance, commercial, medical, ) Name of the employer City: Fax Number Country of Taxation Shareholder ID (11 digits) (for existing shareholders) Place of Birth / Incorporation Number of employees 8.11 Passport / ID Document 8.12 Expiry Date 8.13 Issued by (country) Address 9. Address for sending trade confirmations, holding statements and other fund communications (only complete if different from above address) Name Mailing Address Telephone Number Facsimile Number Address Street: Zip / Postal Code: Country: City: 10. Your Bank Details & Standing Instruction for Redemption Proceeds Processing The following details must only be completed by new Applicants or in case the details have changed. To comply with Luxembourg anti-money laundering and fight against the financing of terrorism regulations, we require the bank account information from which you will transfer the invested money. In addition, in the event of redemptions by facsimile, the proceeds will automatically be remitted to this account. Account Number in IBAN format Name of Account Holder Bank Name Bank SWIFT Code Bank Address (The name of the Account Holder must be identical to the applicant s Registered Name under section 4.) Street: Zip / Postal Code: City: Country: - 4 -

5 11. Signature (Please indicate the capacity of each signatory if signing for a corporate entity, e.g. Director ) Signature (& Company Seal if applicable) 2 nd Signature (& Company Seal if applicable) Name: (please print) Capacity / Title: Date: Name: (please print) Capacity / Title: Date: - 5 -

6 GUIDANCE FOR COMPLETING THE APPLICATION FORM This must be used for all first time purchases of shares and is recommended to be used for any subsequent purchases for the following Sub-Funds / classes of shares: Compartment or share class name Currency Security IDs Minimum First Time Investment DSM US Large Cap Growth Fund DSM US Large Cap Growth Fund Class B Shares () DSM US Large Cap Growth Fund ISIN: LU SEDOL: B28TLX2 Common Code: Valor: WKN: A0M58T Bloomberg: DSMUSLA LX ISIN: LU SEDOL: B28TLY3 Common Code: Valor: WKN: A0M58U Bloomberg: DSMUSLB LX. 10,000,000.- Minimum Subsequent Investment Minimum Holding 10,000,000.-* * In investing in the DSM US Large Cap Growth Fund Class B Shares (), I/we acknowledge that we are subject to a minimum holding of 10,000,000. If as at the last business day of each quarter, the average holdings during the relevant quarter represents less than 10% of the minimum holding (due to redemptions and independently to market prices variations), this holdings will automatically by switched in the DSM US Large Cap Growth Fund as of the most practicable net asset value calculation. DSM US Large Cap Growth Fund Class D Shares () DSM US Large Cap Growth Fund Class U Shares () DGHM US All-Cap Value Fund DGHM US All-Cap Value Fund Class B Shares () ISIN: LU SEDOL: B28TM06 Common Code: Valor: WKN: A0M58W Bloomberg: DSMUSLD LX ISIN: LU SEDOL: B3BQFD5 Common Code: Valor: WKN: A0Q4MN Bloomberg: DSMUSLU LX DGHM US All-Cap Value Fund ISIN: LU SEDOL: B5MDN13 Common Code: Valor: WKN: A0RPYP Bloomberg: HERACVA LX ISIN: LU SEDOL: BBP6YG3 Common Code: Valor: WKN: A1W0R2 Bloomberg: HERACVB LX 10,000, , ,000,000.- * * In investing in the DGHM US All-Cap Value Fund Class B Shares (), I/we acknowledge that we are subject to a minimum holding of 10,000,000. If as at the last business day of each quarter, the average holdings during the relevant quarter represents less than 10% of the minimum holding (due to redemptions and independently to market prices variations), this holdings will automatically by switched in the DGHM US All-Cap Value Fund as of the most practicable net asset value calculation. DGHM US All-Cap Value Fund Class D Shares () ISIN: LU SEDOL: B5MDN35 Common Code: Valor: WKN: A0RPYQ Bloomberg: HERACVD LX 1,

7 Compartment or share class name Currency Security IDs Minimum First Time Investment IMVA Opportunity Fund Subscription order cut-off time: Subscription moneys: Redemption order cut-off time: Redemption moneys: Conversion order cut-off time: IMVA Opportunity Fund ISIN: LU SEDOL: BJ625V8 Common Code: Valor: WKN: A1XCJ3 Bloomberg: HFIMVOA LX 4.00 p.m. CET on the business day prior to a valuation day Minimum Subsequent Investment Minimum Holding to be received within 3 (three) Luxembourg bank business days following the rel. valuation day 4.00 p.m. CET on the business day prior to a valuation day to be paid within 5 (five) Luxembourg bank business days following the rel. valuation day 4.00 p.m. CET on the business day prior to a valuation day For FIRST TIME SUBSCRIPTIONS, all of the following forms must be submitted in original to UBSFSL prior to the order being accepted: Declarations & Disclosure Statement, Share and Beneficial Ownership Form. All three forms must be signed by the same person(s). Additional copies shall be used in case of more than 2 applicants/shareholders/beneficial owners. UBSFSL reserves the right to request such information as is necessary to verify the identity of an applicant(s), of the beneficial owner(s) and source of payment. UBSFSL may refuse to accept an application until the applicant provides the requested information. In general, the following information must be submitted to UBSFSL together with the Application Form for the order to be accepted: Physical Person(s) Certified copy of ID card / passport (certification by e.g. notary, commune of residence, police, embassy, consulate) for each of the account holders Signed copy of the latest KIID of the relevant Class(es) of Shares A duly executed self-certification where the investor certifies that he/she is neither a US citizen nor a US resident for tax purposes (document suggested at the end of this application form or form W-8BEN available on the IRS website) Certified copy of ID card / passport of the two directors of the company that signed the application form Certified copy of Articles of Association / Articles of Incorporation List of authorised signatures of the company in original or certified copy thereof For FATCA purposes, please add the appropriate IRS form, duly completed and signed (W-9, W-8BEN, W-8BENE, W- 8IMY, W-8EXP, W-8ECI,, available on the IRS website) Company (other than regulated financial sector professionals) In case the ultimate beneficial owner(s) is (are) different from the applicant(s), the same information must be provided for (each of) the beneficial owner(s) Further documents may be requested, if deemed necessary in order to comply with the laws and regulations in effect in Luxembourg Original extract from the Register of Commerce Certified copy of ID card or passport for all the ultimate beneficial owners Power of attorney form, if any Certified copy of ID card / passport for all the powers of attorney Further documents may be requested, if deemed necessary in order to comply with the laws and regulations in effect in Luxembourg Any other interested investors are requested to contact UBSFSL to clarify the specific requirements applicable to them. s or any other instructions sent by facsimile will only be accepted if sent to the fax number(s) set out below and following receipt of the signed original documents requested for first time subscriptions. Notwithstanding the place where this may be executed or the citizenship, domicile or residency of applicants or shareholders, the rights and obligations of applicants and shareholders of the Fund shall be governed and construed in accordance with the laws of the Grand-Duchy of Luxembourg. If this is not dated in the space provided, it is deemed to bear the date on which it is first received by UBSFSL whose record of such date shall be conclusive. 1. INVESTMENT AND CONVERSIONS Insert the Sub-Fund or share class name(s), as shown above, that you wish to invest in, respecting the minima defined for first time investments, subsequent investments and holdings as indicated above. To subscribe for shares on any Dealing Day, UBSFSL must receive the completed before the cut-off time specified above

8 2. PAYMENT Payments must be made in the currency of the respective Compartment or Share class. For investors' convenience, a SWIFT/Telegraphic Transfer Authority form is included. Please note that BSI may have to confirm receipt of the payment. Bank details for paying the subscription moneys are indicated on the Telegraphic Transfer Authority form. Important: the Compartment s and applicant s names must appear on all payments. 3. REGISTRATION If Shares are registered in the name of a nominee, the nominee must complete the and all other forms. Persons investing in a special capacity (e.g. trustees) should contact UBSFSL. New applicants must complete the address section and include a contact telephone number. Contract notes and correspondence may also be sent to an alternative address if indicated so. 4. AUTHORISED PAYMENT INSTRUCTIONS By completing this section, holders of uncertificated shares may authorise payments to be remitted in accordance with these details prior to the UBSFSL receiving the signed original copy of a redemption instruction. Normally, payment of redemption proceeds will be delayed pending receipt of this documentation. 5. SIGNATURE Corporate subscriptions must be signed by duly authorised officers whose capacity must be stated (e.g. John Smith - Director ). The signatures must be authenticated using a list of authorised signatures or other similar documentation. 6. CASH PAYMENT INSTRUCTIONS We would like to inform you that in order to comply with applicable laws and regulations and especially EC-Directive 1781/2006 of the European Parliament dated 15 November 2006 and entered into force on 1 January 2007 regarding information on the ordering customer (payer) accompanying transfers of funds, BSI EUROPE S.A. is no longer authorised to accept payments which do not conform with the applicable requirements. It is thus mandatory that your payment order mentions the name and account number of the payer, as well as his address when the payer s bank is located outside the EU. Name and account number of the beneficiary must of course also be indicated. In order to comply with these requirements and, in addition, increase the rate of payment instructions processed on a Straight Through basis, we kindly request that you use the format as indicated in the Telegraphic Transfer Authority Form in the SWIFT instructions (MT103 or MT202) to our correspondent banks. Please note that BSI EUROPE S.A. may have to reject incomplete or incorrectly formatted MT103 or MT202 messages and return funds at the cost of the sender. 7. ORDER TRANSMISSION Please forward ORIGINAL APPLICATIONS to or via facsimile (for SUBSEQUENT APPLICATIONS ONLY) UBS Fund Services ( Luxembourg) S.A. UBS Fund Services Attn.: Transfer Agent Attn.: Transfer Agent 33a avenue J.F. Kennedy FAX: L-1855 Luxembourg Tel.: sh-ubsfsl-transferagent@ubs.com For more information visit: