THREADNEEDLE (LUX) SICAV APPLICATION FORM

Transcription

1 THREADNEEDLE (LUX) SICAV APPLICATION FORM Please complete this Application Form in full using BLOCK CAPITALS, sign it and return it to: International Financial Data Services (Luxembourg) S.A. (IFDSL) Attention: IFDSL Registration Team 47, Avenue J.F. Kennedy L-1855 Luxembourg Fax number: IMPORTANT INFORMATION: Luxembourg laws and regulations require that IFDSL obtain the documents indicated under the Terms and Conditions (section B) prior to opening the account. If this form is initially sent by fax, the original must immediately be forwarded by courier and tracking reference provided. Please read the Prospectus of Threadneedle (Lux) before completing this Application Form. The following definitions are used throughout this Application Form: Portfolio: a portfolio of the Company Company: Threadneedle (Lux) SICAV Management Company: Threadneedle Management Luxembourg (S.A.) Investor: The person(s)/company named in section 1 of this Application Form. 1. APPLICANT DETAILS INDIVIDUAL INVESTOR 1st Account Holder Title: 2nd Account Holder Title: Last name/family Name First name(s)/given name(s) Permanent residential address Gender M F Date of Birth: D D / M M / Y Y Y Y Place of birth (city & country) Nationality Professional activity (Please specify position and domain of activityemployer) If you hold or have held any political or public function, or if you are an immediate relative of a person that holds or has held any political or public function, please tick this box Source of funds invested Inheritance Gift Sale of business Savings Pension Investment income Sale of assets (please specify) Other (please specify) Further supporting documentation may be requested if deemed necessary to verify the above information. Tax Reference number Passport/National ID number Country/Countries of Residence for Tax Purposes Address for registration (no PO Box allowed) Address for correspondence Last name/family Name First name(s)/given name(s) Permanent residential address Gender M F Date of Birth: D D / M M / Y Y Y Y Place of birth (city & country) Nationality Professional activity (Please specify position and domain of activity/employer) If you hold or have held any political or public function, or if you are an immediate relative of a person that holds or has held any political or public function, please tick this box Source of funds invested Inheritance Gift Sale of business Savings Pension Investment income Sale of assets (please specify) Other (please specify) Further supporting documentation may be requested if deemed necessary to verify the above information. Tax Reference number Passport/National ID number Country/Countries of Residence for Tax Purposes Address for registration (no PO Box allowed) Address for correspondence Telephone Fax Telephone Fax Telephone Fax Telephone Fax For additional account holder(s), please complete Addendum A.

2 CORPORATE INVESTOR Full Company Name: Registered Address (no PO Box allowed): City, Country, Postal Code: Correspondence Address, if different from Registered Address: City, Country, Postal Code: Tax Identifi cation Number: Country of Taxation: Date of Incorporation, if applicable: Telephone Number: Fax Number: Contact Name: Address: Regulated in a country with requirements of anti-money laundering and counter-terrorism fi nancing (AML-CTF) regulations equivalent to Luxembourg 1 No Yes, by Listed on a recognized Stock Exchange (which country applies AML-CTF regulations equivalent to Luxembourg) No Yes, by By ticking this box, the Investor hereby confi rms that it has received the Key Investor Information Document for the Portfolio it wishes to invest in and it is an institutional investor as defi ned by Luxembourg law and regulation and therefore entitled to purchase institutional Share classes of the Fund. Please indicate in the appropriate box below the type of institutional investor: 1. Institutional investors, such as banks and other professionals of the financial sector, insurance/ reinsurance companies, social security institutions and pension funds, industrial, commercial and financial group companies, subscribing on their own behalf. 2. Credit institutions and other professionals of the financial sector investing in their own name but on behalf of institutional investors. 3. Credit institutions or other professionals of the financial sector established in Luxembourg or abroad which invest in their own name but on behalf of their non institutional clients on the basis of a discretionary management mandate. 4. Collective investment undertakings. 5. Holding companies or similar entities whose shareholders are institutional investors. 6. Territorial administrative bodies (e.g. regions, provinces, cantons, communes, municipalities), in so far as these invest their own funds. 7. Holding companies or similar entities whose shareholders are not institutional investors. 8. A family type holding company or company of similar nature. 1 An equivalent country is a country or jurisdiction having ML/TF Identification Standards deemed appropriate compared to the ones in force in Luxembourg. Countries in the following jurisdictions are considered as equivalent : Countries which are EU/EEA* members Countries which are FATF* members Guernsey, Jersey, Isle of Man All other countries are considered non-equivalent. The Fund and Administrator reserve the right to perform additional due diligence on equivalent countries in which deficiencies have been identified in recent examinations reports (FATF,EU); which are judged to have a high level of corruption and/or higher risk ML risk rating. This additional due diligence is applied on a case-by-case basis in order to mitigate the risk of ML/TF/Fraud linked to these countries. *EU: European Union; EEA : European Economic Area; FATF : Financial Action Task Force

3 2. TAX REGULATIONS Tax Regulations 1 require us to collect certain information about each investor s tax residency and tax classifications. In certain circumstances (including if we do not receive a valid self-certification from you) we may be obliged to share information on your account with HMRC. Please complete all sections below as directed. If you have any questions about your organisation s classifications, please see instructions or contact your tax advisor. Please see notes overleaf for key defi nitions. Should any information provided change in the future, please ensure you advise us of the changes promptly. 2.1: Tax residency If your organisation has more than one country of tax residency, please complete one self-certification form for each country Please state the country in which your organisation is resident for tax purposes: Please provide us with your organisation s Tax Reference Number: If the organisation is not a Specified Person 2 in the country stated in above, please tick this box: 2.2: Organisation s classification for FATCA 3 purposes Please tick one box only in this section, with reference to the tax residency stated in box Exempt Benefi cial Owner Participating Foreign Financial Institution Non-Participating Foreign Financial Institution UK Financial Institution or a Partner Jurisdiction Financial Institution Financial Institution resident in the USA or in a US Territory Deemed Compliant Foreign Financial Institution (besides those listed above) Active Non-Financial Foreign Entity Passive Non-Financial Foreign Entity Excepted Non-Financial Foreign Entity US Non-Financial Entity A Passive Non-Financial Foreign Entity will be required to submit individual tax residence self-certifications for each of its Controlling Persons 9 2.3: Organisation s classification under other applicable tax regulations Please tick all boxes that apply, with reference to the tax residency stated in box Please tick the appropriate box below if the organisation is a Non-Financial Foreign Entity: (a) Active Non-Financial Foreign Entity 10 (b) Passive Non-Financial Foreign Entity 11 A Passive Non-Financial Foreign Entity will be required to submit individual tax residence self-certifi cations for each of its Controlling Persons Please tick this box if the organisation is a Non-Profit Organisation 12 : Please tick this box if the organisation is not classified under or 2.3.2: Please tick this box if the organisation is an Investment Entity 13 :

4 Notes 1 Tax Regulations The term tax regulations refers to regulations created to enable automatic exchange of information and include FATCA 3, various Agreements to Improve International Tax Compliance entered into between the UK and its Crown Dependencies and its Overseas Territories and the OECD Common Reporting Standard for Automatic Exchange of Financial Account Information. 2 Specified Person The term Specified Person is defi ned by reference to local laws in the country where an entity is established. In the UK, a Specifi ed United Kingdom Person means a person or entity who is resident in the United Kingdom for tax purposes, other than: (i) a corporation the stock of which is regularly traded on one or more established securities markets; (ii) any corporation that is a Related Entity 14 of a corporation described in clause (i); (iii) a Depository Institution; (iv) a broker or dealer in securities, commodities, or derivative fi nancial instruments (including notional principle contracts, futures, forwards, and options) that is registered as such under the laws of the United Kingdom; (v) a Governmental Entity; (vi) an International Organisation(examples of which include The International Monetary Fund, The World Bank, The International Bank for Reconstruction and Development and The European Community for a full list please see the relevant guidance issued by HMRC, or the IRS); (vii) a Central Bank; or (viii) a pension scheme or other arrangement registered with HMRC under Part 4 of the Finance Act Similar defi nitions apply to entities in the US (defi ned in the FATCA 3 Regulations) and Crown Dependencies and Overseas Territories (as defined in the relevant Agreement to Improve International Tax Compliance with the UK). Entities in other jurisdictions should instead apply the similar definition of Reportable Person under the OECD Common Reporting Standard for Automatic Exchange of Financial Account Information. 3 FATCA The Foreign Account Tax Compliance Act provisions (commonly known as FATCA) contained in the US Hire Act Exempt Beneficial Owner The term Exempt Beneficial Owner means (i) a Governmental Entity; (ii) an International Organisation (examples of which include The International Monetary Fund, The World Bank, The International Bank for Reconstruction and Development and The European Community for a full list please see the relevant guidance issued by HMRC, or the IRS); (iii) a Central Bank; or (iv) a UK registered pension scheme, or non-uk pension scheme falling within the definition of Exempt Benefi cial Owner for the purpose of FATCA 3. 5 Financial Institution The term Financial Institution means a Custodial Institution, a Depository Institution, an Investment Entity 13, or a Specifi ed Insurance Company as defi ned for the purposes of FATCA 3. The same defi nitions apply to the UK s Agreements to Improve International Tax Compliance. Please see the relevant Tax Regulations for the classification defi nitions that apply to Financial Institutions. 6 Active Non-Financial Foreign Entity (NFFE) (US definition) A NFFE is a foreign entity that is not a Financial Institution. For the purpose of section 2 only, an Active NFFE is any NFFE that meets one of the following criteria: (i) Less than 50 per cent of the NFFEs gross income for the preceding calendar year or other appropriate reporting period is passive income (such as dividends, interest, royalties, annuities and rent) and less than 50 per cent of the assets held by the NFFE during the preceding calendar year or other appropriate reporting period are assets that produce or are held for the production of passive income; (ii) The stock of the NFFE is regularly traded on an established securities market or the NFFE is a Related Entity 14 of an entity, the stock of which is traded on an established securities market; (iii) The NFFE is a government, a political subdivision of such government, or a public body performing a function of such government or a political subdivision thereof, or an entity wholly owned by one or more of the foregoing; (iv) Substantially all of the activities of the NFFE consist of holding (in whole or in part) the outstanding stock of, or providing fi nancing and services to, one or more subsidiaries that engage in trades or businesses other than the business of a Financial Institution. However the entity will not qualify as an Active NFFE if it functions (or holds itself out to be) an investment fund, such as a Private Equity Fund, Venture Capital Fund, Leveraged Buyout Fund or any Investment Vehicle whose purpose is to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes. In these circumstances the entity will be a passive NFFE; (v) The NFFE is not yet operating a business and has no prior operating history, but is investing capital into assets with the intent to operate a business other than that of a Financial Institution; provided that the NFFE shall not qualify for this exception after the date that is 24 months after the date of the initial organisation of the NFFE; (vi) The NFFE was not a Financial Institution in the past fi ve years, and is in the process of liquidating its assets, or is reorganising with the intent to continue or recommence operations in a business other than that of a Financial Institution; (vii) The NFFE primarily engages in fi nancing and hedging transactions with, or for Related Entities 14 that are not Financial Institutions, and does not provide financing or hedging services to any entity that is not a Related Entity, provided that the group of any such Related Entities is primarily engaged in a business other than that of a Financial Institution; (viii) The NFFE is organised in a U.S Territory and all the owners of the payee are bona fide residents of that U.S. Territory; or (ix) The entity is a Non-Profit Organisation Passive Non-Financial Foreign Entity (NFFE) (US definition) For the purpose of section 2 only, a Passive NFFE is any NFFE that is not an Active NFFE 6. 8 Excepted Non-Financial Foreign Entity (NFFE) The term Excepted Non-Financial Foreign Entity has the same meaning as Active Non-Financial Foreign Entity 6 and applies to entities in countries that have not signed an intergovernmental agreement with the US to implement FATCA 3. 9 Controlling Persons The term Controlling Persons means the natural persons who exercise control over an Entity. In the case of a trust, such term means the settlor, the trustees, the protector (if any), the beneficiaries or class of benefi ciaries, and any other natural person exercising ultimate effective control over the trust, and in the case of a legal arrangement other than a trust, such term means persons in equivalent or similar positions. The term Controlling Persons must be interpreted in a manner consistent with the Financial Action Task Force Recommendations. 10 Active Non-Financial Foreign Entity (NFFE) (UK and Crown Dependency definitions) An entity will be an Active NFFE (UK and Crown Dependency definitions) for the purpose of section 3 only if they meet one of the criteria in (i) to (vii) in the defi nition of Active NFFE (US defi nition) 6 above. 11 Passive Non-Financial Foreign Entity (NFFE) (UK and Crown Dependency definitions) For the purpose of section 3 only a Passive NFFE (UK and Crown Dependency definitions) is any NFFE that is not an Active NFFE (UK defi nition) Non-Profit Organisation The term Non-Profit Organisation means an entity that meets ALL of the following criteria: (i) It is established and operated in its jurisdiction of residence exclusively for religious, charitable, scientifi c, artistic, cultural, athletic, or educational purposes; or it is established and operated in its jurisdiction of residence and it is a professional organisation, business league, chamber of commerce, labour organisation, agricultural or horticultural organisation, civic league or an organisation operated exclusively for the promotion of social welfare; (ii) It is exempt from income tax in its country of residence; (iii) It has no shareholders or members who have a proprietary or beneficial interest in its income or assets; (iv) The applicable laws of the entity s country of residence or the entity s formation documents do not permit any income or assets of the entity to be distributed to, or applied for the benefit of, a private person or non-charitable entity other than pursuant to the conduct of the entity s charitable activities, or as payment of reasonable compensation for services rendered, or as payment representing the fair market value of property which the entity has purchased; and (v) The applicable laws of the entity s country of residence or the entity s formation documents require that, upon the entity s liquidation or dissolution, all of its assets be distributed to a governmental entity or other non-profit organisation, or escheat to the government of the entity s country of residence or any political subdivision thereof. 13 Investment Entity The term Investment Entity means any entity: (a) that primarily conducts as a business one or more of the following activities or operations for or on behalf of a customer: i. trading in money market instruments (cheques, bills, certifi cates of deposit, derivatives, etc.); foreign exchange; exchange, interest rate and index instruments; transferable securities; or commodity futures trading; ii. individual and collective portfolio management; or iii. otherwise investing, administering, or managing Financial Assets or money on behalf of other persons; or (b) the gross income of which is primarily attributable to investing, reinvesting, or trading in Financial Assets, if the entity is managed by another entity that is a Depository Institution, a Custodial Institution, a Specified Insurance Company, or an Investment Entity described in (a) above. An entity is treated as primarily conducting as a business one or more of the activities described in (a), or an entity s gross income is primarily attributable to investing, reinvesting, or trading in Financial Assets for purposes of (b),if the entity s gross income attributable to the relevant activities equals or exceeds 50 percent of the entity s gross income during the shorter of: (i) the three-year period ending on 31 December of the year preceding the year in which the determination is made; or (ii) the period during which the Entity has been in existence. The term Investment Entity does not include an entity that is an Active NFFE because it meets any of the criteria in (iv) to (vii) in the definition of Active NFFE (US defi nition) 6 above. 14 Related Entity An entity is a Related Entity of another entity if either entity controls the other entity, or two entities are under common control. For this purpose control includes direct or indirect ownership of more than 50 per cent of the vote and value in an entity.

5 THE INVESTMENT IS MADE Please tick one of the following boxes to confirm whether you invest for your own account or on behalf of another person On my/our own behalf On behalf of a Third Party (if investing on behalf of a Third Party, please complete hereinafter the section below with the appropriate details) Ultimate Economic Beneficiary Declaration (If the investor is a regulated financial institution in a country with AML regulations equivalent to Luxembourg or covered by a KYC/AML comfort letter from a parent company that is a financial institution regulated in a country with AML regulations equivalent to Luxembourg, please proceed to the next section). An ultimate economic beneficiary is the fi nal benefi ciary of the investment and who owns, directly or indirectly, more than 25% of the value of the shares/units subscribed. Important: In case of indirect ownership, please describe on a dated and signed chart all the intermediate levels of ownership with names and percentages. I/we declare that the final benefi ciary of my/our investment is: Last name/family name First name(s)/given name(s) Date of birth D D M M Y Y Y Y Please enclose a certified true copy of the ID of the above-referenced individual. If you invest on behalf of more than one ultimate economic beneficiary, please indicate his/her/their full details on a separate sheet and send the related certified ID(s) along with this application form. IF YOU ARE APPLYING VIA A FINANCIAL ADVISOR/DEALER If you invest through a financial advisor or dealer, please have your advisor/dealer complete and sign the below section accordingly. If you are applying directly, please skip this section and go to section 3. a) We certify that the identity of the above named investor(s) has/have been verifi ed by me/us in accordance with the requirements of AML-CTF regulations in place in Luxembourg or in countries with AML-CTF regulations equivalent to Luxembourg b) I/We further declare that the documentary evidence to support the identifi cation is held by me/us and can be produced on demand. Name of fi nancial advisor/dealer Stamp (containing Registered address of fi nancial advisor/dealer) Name of regulatory body (if any) Country of regulatory body Signature of fi nancial advisor/dealer Date IMPORTANT NOTE TO THE ATTENTION OF THE FINANCIAL ADVISOR/DEALER: * In order to act as intermediary for the Company, please contact Threadneedle Management Luxembourg S.A.74,Rue Muhlenweg Luxembourg L-2155 Tel: Fax: luxoversight@threadneedle.com and ensure you sign a dealer/intermediary agreement with the Company accordingly. In addition, please send together with this Application Form and related documentation for the Investor the following documents for your entity/company: an original self-certified authorized signatories list with signature specimen stating who will operate the account, current and dated on company letterhead, not more than one year old a proof of regulation by a competent national supervisory authority * Please note that the Management Company and/or its appointed Transfer Agent (IFDSL) reserve the right to ask for additional identification documents upon receipt of the above documentation

6 3. REDEMPTION/DIVIDEND INSTRUCTIONS Please provide instructions for receiving redemption or dividend proceeds. Payments will be made in the name of the Investor only; no third party payment will be effected. If you wish to provide instructions for multiple currencies, please attach the instructions on a separate sheet of paper. Omission of this information could result in late or non- payment of redemption proceeds and/or dividends. Currency: Bank Name: SWIFT/BIC/ABA: Account Name: Account Number/IBAN: Sub-Account Name: Sub-Account Number: Reference: Dividends, if declared, will be reinvested automatically in additional shares of the same class of the relevant sub- funds unless you indicate otherwise by ticking this box: If dividend payments are requested, they will be credited directly to your bank account. Please ensure you have completed your bank details in section 3. If you wish to receive dividend payments to a different bank account, please indicate your complete dividend banking details on a separate page and sign those accordingly. 4. SUBSCRIPTION INSTRUCTIONS Please complete the attached Subscription Form and make payment by wire transfer to the relevant account listed on such form. The subscription payment MUST come from a bank account in the name of the registered Investor. 5. POWER OF ATTORNEY We, hereby appoint [ATTORNEY NAME] (registered number ) located at [address] (the Attorney ) acting by any employee of the Attorney, to act on our behalf and be our attorney for the following purposes:- 1. Operate our accounts maintained with you and debit/credit cash and securities as the Attorney deems necessary for the purpose of ; and 2. Act upon any and all instructions received or deemed received from us; and 3. We hereby undertake to ratify and confi rm anything that you and the Attorney may do pursuant to this Power of Attorney and we confi rm that the Attorney is entitled to sign documents, forms and contracts on our behalf, which shall be treated for all purposes as if they have been signed by ourselves and in our own name. We further confirm that the Attorney may rely on the information supplied or purportedly supplied to it or to you by us and any other information supplied in relation to the performance of its duties and power hereunder. We hereby undertake to indemnify you, your offi cers, employees and agents, and to hold you and them harmless from any loss, liability, expense, damage or claim of any kind or nature whatsoever suffered or incurred by you or them as a result of any action or inaction in any way relating to or arising out of this Power of Attorney or the acts contemplated hereby (other than as a result of your gross negligence) and confirm that this indemnity shall survive this Power of Attorney which shall be irrevocable. We declare that neither the Attorney, nor you or any third party, shall be liable for acting in a way as if this Power of Attorney were still valid, unless they have received express notice of its termination by us. This Power of Attorney shall be governed by and construed in accordance with laws of Luxembourg. We confi rm that this Power of Attorney may be shown or copy given to any third party and other relevant persons. We further represent and warrant that this Power of Attorney is properly given and is being duly approved by our authorized and empowered officers. Please attach: table/list of authorized signatories of attorney and specimen signatures (original or certifi ed true by two persons from the list) duly signed fax indemnity signed by the POA holder

7 6. SIGNATURE OF AUTHORIZED PERSONS OR APPLICANT(S) By signing below, Applicant agrees to the terms and conditions and representation and warranties set forth in this Application Form. Please attach an original or certificated copy of the authorized signature list. All signatories must be on the list of Authorized Persons. The Undersigned declare(s) that he/she/they is/are duly authorized to sign the present subscription form and that he/she/they has/have received a copy of the Prospectus and Key Investor Information Document for the Portfolio it wishes to invest in (and where relevant a current Annual or Semi-Annual Report) which he/she/ they accept(s) in full. He/she/they further declare(s) that all information contained in this application form is accurate to the best of their knowledge and belief. (Please Type or Print Name) (Signature of Authorized Person) (Date) (Please Type or Print Name) (Signature of Authorized Person) (Date)

8 TERMS AND CONDITIONS A. DATA PROTECTION All personal data contained in this Application Form and all further data collected in the course of the Investor s business relationship with the Company ( Personal Data ) will be collected, stored, recorded, organized, processed, used, disclosed and transferred by the Company, in its capacity of data controller, to its Management Company, or to the Administrative Agent, the Registrar and Transfer Agent and/ or the Distributor, including any successor thereof, as defined in the Prospectus (collectively, the Delegates ). Personal Data will only be used for the purposes of (i) maintaining the register of Investors, (ii) processing subscriptions, redemptions and conversions of shares and payments of dividends to Investors, (iii) performing controls on late trading and market timing practices, and (iv) complying with other legal obligations such as account administration, anti-money laundering identification, tax identification under the EU Tax Savings Directive, servicing of shareholder accounts and (v) for other business purposes for the benefit of shareholders. Personal Data will not be used for marketing other financial products. The Investor may, in its/his/her entire discretion refuse to communicate the Personal Data to the Company, thereby precluding the Company from using such data. In this case, the Company may reject the Investor s subscription application. By signing this Application Form, the Investor expressly agrees with these terms and authorizes the processing of its/her/his Personal Data as described herein and agrees further that the Company may delegate the processing of Personal Data to its Delegates located in the European Union and in countries outside of the European Union which may not offer the same level of protection as in the European Union. IFDSL and/or Custodian may delegate the processing of the Investor s Personal Data to one or several of their agents or delegates which are located in or outside the European Union. The Fund undertakes not to transfer the Investor s Personal Data to any other third parties, except if required by law or if authorized by the Investor. The Company will maintain Personal Data for such periods as may be required by applicable law. B. INVESTOR IDENTIFICATION REQUIREMENTS In the event that the entity named on this Application Form is a legal entity which is not registered within a Luxembourg equivalent jurisdiction and cannot verify through an independent and regulated web site the existence and good standing of the entity, certain additional documents may be required. General requirements include IDENTIFICATION FOR INDIVIDUAL INVESTORS Originals or certified copies of all the following documents in or translated into English, German or French (any other agreed language) must be attached to this Application Form. All translations or copies are to be certified in English, German or French as a true translation or copy by one of the following competent Authorities: Embassy, Consulate, Solicitor, Licensed Lawyer, Notary (Empowered Public Authority) or bank regulated in a jurisdiction which has implemented AML/KYC regulations equivalent to Luxembourg standards. The certification must show the official stamp of the competent Authority, the persons name and signature, date and where possible their position. Original application form completed, dated and signed, and Certified true copy of an official identification card or passport, or Certified true copy of a driver s license, or Certified true copy of any equivalent legal identification document Please note that the identification document must feature a photograph, date of birth, signature and full name of the Applicant and be valid at the time of the application. IDENTIFICATION FOR CORPORATE INVESTORS Originals or certified copies of all the following documents in or translated into English, German or French (any other agreed language) must be attached to this Application Form. All translations or copies are to be certified in English, German or French as a true translation or copy by one of the following competent Authorities: Embassy, Consulate, Solicitor, Licensed Lawyer, Notary (Empowered Public Authority) or bank regulated in a jurisdiction which has implemented AML/CTF regulations equivalent to Luxembourg standards. The certification must show the official stamp of the competent Authority, the persons name and signature, date and where possible their position. 1. You are a regulated and/or listed entity in a jurisdiction which has implemented AML-CTF regulations equivalent to Luxembourg* Original application form completed, dated and signed Original self-certified authorized signatories list with signature specimen stating who will operate the account, current and dated on company letterhead, not more than one year old Proof of regulation by a competent national supervisory authority or proof of listing on a recognized Stock Exchange 2. You are a entity covered by a comfort letter from a regulated mother company in a jurisdiction which has implemented AML-CTF regulations equivalent to Luxembourg* Original application form completed, dated and signed Original or certified true comfort letter completed, dated and signed by your mother company Original self-certified authorized signatories list with signature specimen stating who will operate the account, current and dated on company letterhead, not more than one year old Proof of regulation by a competent national supervisory authority or proof of listing on a recognized Stock Exchange of your mother company 3. You are a non-regulated and non-listed entity* Original application form completed, dated and signed Certified true copy of articles of incorporation or equivalent constitutive documentation of the entity Certified true copy of extract of commercial register or certificate of incorporation Original or certified true copy of latest annual audited report or financial statements describing the nature and purpose of the business of the entity Original self-certified authorized signatories list with signature specimen stating who will operate the account, current and dated on company letterhead, not more than one year old List of Company Representatives/Board of Directors and their certified true copy of IDs (or as a minimum certified true copy of IDs of authorized signatories) List of shareholders and certified true copy of IDs of those owning more than 25% of the shareholders capital * Please note that the Company and/or IFDSL reserve the right to ask for additional identification documents upon receipt of this Application Form. The list above is not exhaustive and can be changed from time to time as required by Luxembourg law and regulations. If the subscription is not for the benefit of the named shareowner of the account, IFDSL needs to be provided with the necessary Know Your Customer documentation for the economic beneficiary of the investment, as described in section 1. Ultimate Economic Beneficiary Declaration C. REPRESENTATIONS AND WARRANTIES Please see the definitions of U.S. Person and U.S. in the Prospectus of the Company. The Investor agrees that the following are continuous representations and that all further purchases will be governed by them. The Investor further agrees to advise the Company promptly of any changes to these representations. In order to induce the Company to accept this subscription and recognizing its reliance thereon, the Investor agrees, represents and warrants to the Company that: 1. The Investor has received and read a copy of the Prospectus outlining, among other things, the organization and investment objectives and policies of, and the risks and expenses of an investment in, the Portfolio. 2. For United States securities law purposes: a. The Investor is not a U.S. Person; b. The Shares are not being acquired for the benefit of, directly or indirectly, any U.S. Person; c. The Investor will not sell or transfer Shares or any interest therein to a U.S. Person or in the U.S.; d. The Investor did not acquire, and will not transfer, any Shares within the U.S.; e. None of the funds used by the Investor to effect the purchase of the Shares have been obtained from a U.S. Person; f. The Investor will notify the Fund immediately if it should become at any time a U.S. Person; g. The Investor was not solicited to purchase Shares while present in the U.S.; and h. The Investor understands that the Portfolio and the Company have not been registered under the U.S. Investment Company Act of 1940, as amended, that the Shares have not been registered and will not be registered under the U.S. Securities Act of 1933, as amended, and that the Shares have not been qualified under the securities laws of any state of the United States or any other jurisdiction and may not be offered or sold in the U.S. or to or for the benefit of, directly or indirectly, any U.S. Person. 3. For Foreign Account and Tax Compliance Act ( FATCA ) purposes, if the Investor falls within the definition of US Persons as defined in the Prospectus during the period of ownership of such investments, the Investor will need to report these investments to the IRS accordingly. Furthermore, the fund is also under an obligation to report such Investors to the relevant tax authority. 4. The Investor agrees to substantiate the foregoing representations and warranties upon request. 5. The Investor hereby agrees that by execution of this Application Form and upon acceptance hereof by the Company, it shall become bound by the terms of the Company s Prospectus. The Investor is aware that the subscriptions should be received by the Company before the cut-off time indicated in the Prospectus. 6. The Investor understands that the Company may reject in its sole discretion and for any reason any application for subscription for Shares in whole or in part. 7. The Investor acknowledges that due to applicable anti-money laundering requirements operating within any jurisdiction, the Company, or any of its duly authorized agents, may require proof of identity (or any other information required by the Company, or any of its duly authorized agents, in their discretion) before this Application or a redemption of Shares can be processed and the Company, and its authorized agents shall be held harmless and indemnified against any loss ensuing due to the failure to process this Application or a redemption of Shares, if such information as has been required has not been provided by the Investor. The Investor consents to the disclosure by the Company of any information about it to regulators and others upon request in connection with money laundering and similar matters both in Luxembourg and in other jurisdictions.

9 Pursuant to the Luxembourg legal framework on countering money laundering and the financing of terrorism, the central administration of the Company and/or its appointed Transfer Agent (International Financial Data Services (Luxembourg) S.A.) may inquire for more details concerning the financial institutions from which the transfer payments are to be made. If such financial institution is not based in a jurisdiction which has implemented AML-CTF regulations equivalent to Luxembourg, the central administration of the Company and its service providers may also ask you for additional documents (duly certified by the local authorities of your country of residence) in order to verify the facts listed in this application form. If you are not able to provide the required details or other necessary documents, the central administration of the Company will refuse the subscription. 8. The Investor hereby indemnifies the Company, the Management Company, the Directors, the Transfer Agent, the Custodian and the Distributor, or any of their authorized agents, and their respective directors, officers, employees and agents against any loss, liability, cost or expense (including without limitation attorneys fees, taxes, and penalties), and agree to keep each of them indemnified against any loss of any nature whatsoever arising to each of them which may result directly or indirectly, from any misrepresentation or breach of any warranty, condition, covenant or agreement set forth herein or in any other document delivered by the Investor to the Company or as a result of any of them acting on this Application. The Company, the Management Company, the Directors, the Transfer Agent, the Custodian, the Distributor, or any of their authorized agents may rely conclusively upon and shall incur no liability in respect of any action taken upon this Application or any notice, request, instructions or other instrument believed, in good faith, to be genuine or to be signed by properly authorized persons. 9. The Investor has consulted with its own professional advisors and is fully informed as to the legal and tax requirements within its own country (or countries) regarding a purchase of the Shares. The Investor understands that the subscription price does not include any amount for stock transfer taxes or any other form of tax and that, as a subscriber, it is required to pay for such taxes, if any, separately. 10. The Investor hereby represents and warrants, on behalf of each beneficial owner of Shares for whose account it is acting, that each of the foregoing representations and warranties are true and correct and that it will notify the Company if it shall come to its knowledge that any such client has become a U.S. Person, that it will not at any time knowingly transfer the Shares or any part thereof or interest therein to a U.S. Person, that it will not make any transfer thereof in the United States and, to the extent required by law or regulation, it will provide additional information to the Company or its authorized agents with respect to the ultimate beneficial ownership of Shares. The Investor understands that the Company is relying on this representation. 11. (For corporations) The Investor hereby certifies that all necessary corporate actions have been taken to authorize the purchase of Shares. 12. The Investor acknowledges that it will not participate in short term trading as described by Commission de Surveillance du Secteur Financier Circular 04/146 (Protection of Undertakings for Collective Investment and of their Investors against Late Trading and Market Timing). The Investor further represents that, if applicable, it will: a. comply promptly with any policies and directives established by the Company or its affiliates relating to the detection and prevention of market timing, excessive trading and late trading in respect of the Company and communicated in writing to the Investor; b. Establish and implement internal policies and procedures to prevent instances of market timing, excessive trading, late trading or other abusive trading activities set forth in the Prospectus; c. Ensure that the its policies and procedures adequately cover investment in the Portfolio by its employees, officers, directors and affiliates; and d. Cooperate fully with any inquiry or investigation by the Company or any regulatory agency concerning possible trading abuses and assist the Company effectively to implement and enforce its policies set forth above. 13. The Investor hereby requests the ability to provide instructions by facsimile. a. The Investor acknowledges that a facsimile transmission is not a secure form of communication and gives rise to higher risks of manipulation or attempted fraud. Facsimiles may also be unclear and of poor quality. b. Until the Investor notifies the Company in writing to the contrary, the Company and its agents are specifically authorized to act upon such instructions received by facsimile without any further authority from the Investor and without further inquiry whatsoever, provided that such instructions are or appear to be given by the Investor or by the Investor s duly authorized representatives who have been identified to the Company for such purpose in writing. c. The Investor agrees to indemnify the Company and its agents from and against all liabilities, losses, costs, actions, proceedings, claims and demands which may be incurred by or brought or made against the Company and its agents, and each of them, arising directly or indirectly from having acted upon such instructions. This indemnity is given for the benefit of the Company and its agents, including the registrar and Transfer Agent, IFDSL. The indemnity is governed by and shall be interpreted in accordance with Luxembourg law. The courts of the Grand Duchy of Luxembourg will have exclusive jurisdiction of all disputes arising from this indemnity. The Undersigned declare(s) that he/she/they is/are aware that: Subscriptions received by the Company on the transaction date no later than the cut-off time stated in the prospectus shall be treated at the issue price calculated on that same day. This contract will be legally binding when it is signed and the sums paid to the Fund are received. Correspondence will be sent to our correspondence address noted above unless otherwise notified by us in writing from time to time. If there is more than one Applicant for investment, all Investors must sign this Application Form. In this case, please select one of the following options: 1) Joint Account Each holder shall individually dispose of the assets in the joint account. In the case of death or incapacity of one of the investors, the surviving investor(s) may continue to freely dispose of the assets in the joint account, unless formal opposition to the contrary from the parties authorised to represent the deceased or incapacitated investor s estate has been received by IFDSL. Or 2) Collective Account The investors shall only have the right to deal collectively in all matters concerning the collective account. Where no box is ticked, option 2 will be the default selection. If the subscription is not for the benefit of the named shareowner of the account, IFDSL needs to be provided with the necessary Know Your Customer documentation for the economic beneficiary of the investment. 14. The Investor declares that the information contained in this Application Form is accurate to the best of its knowledge and agrees to forward any changes in its Personal Data promptly to the Company. D. GOVERNING LAW This Application Form shall be governed by and construed in accordance with the laws of the Grand Duchy of Luxembourg and shall be subject to the non-exclusive jurisdiction of the courts of the Grand Duchy of Luxembourg. E. ANNEX TO APPLICATION FORM FOR RETAIL INVESTORS FOR INVESTMENTS INTHE THREADNEEDLE (LUX) PORTFOLIOS Name: Surname: Address: Occupation: Please confirm if you hold or if you have held any political function: YES NO I declare that I am acting on my own behalf and that I am the beneficial owner of the shares. To the extent that I am acting on behalf of any other party, I will provide the same warranties for the final beneficiaries. I declare that I am not a U.S. Person as defined in the Prospectus and that I am not applying as the nominee or agent of a person who is a U.S. Person. I declare that I have received the Key Investor Information Document for the Portfolio I am investing in.

10 European Directive on the Taxation of Savings The intention of the European Savings Directive (EUSD) Directive 2003/48/EC is to enable savings income in the form of interest payments made in one Member State to benefi cial owners resident for tax purposes in another Member State, to be made subject to effective taxation in accordance with the national laws of the latter Member State. This objective should be achieved via exchange of information between Member States or by application of withholding tax. TAX ID Number: Tax Options: If you are covered by the Directive please select one of the following options: Withholding tax (default option if no option selected) Information Exchange* (if selected, please complete the additional Authorisation for the Exchange of Information form) Withholding Tax Exemption (if selected, please provide the certifi cation of the tax authority, valid for a maximum of 3 years I/we hereby certify that all information provided by me/ us in connection with the EU Savings Tax Directive is true and correct as of the signature date I/we will notify IFDSL and/or its agents immediately in case of any modifi cations with regard to the information data provided herein I/we further recognise that Luxembourg has opted by default for the Withholding Tax Regime. In case I/we would like to opt for another option, such as Exchange of Information or Certifi cate of Disclosure, I/we agree to pre-advise IFDSL and/or its agents and to provide the required documents I/we acknowledge that in the absence of the required documents, IFDSL will apply the withholding tax by default Date: T16882