Corporate Investors Application Form

Transcription

1 Corporate Investors Application Form Fixed Return Bond 12 NOVEMBER 2018 MMPI Limited trading as Broker Solutions is regulated by the Central Bank of Ireland.

2 Corporate Investors Application Form Broker Solutions Fixed Return Bond 12 Please note that by signing this Application Form, you are confirming that you have read and understood the material in the Brochure and the Base Prospectus and that you have received advice from your Financial Broker in relation to the suitability and appropriateness of this investment for you. If you are unclear about any of the information presented in the Brochure or the Base Prospectus or about the suitability of this investment for you, please seek further advice from your Financial Broker before completing this Application Form. In order to effect this investment, unless you are an insured pension investor, you will also need to open an Execution Only Account with Merrion Stockbrokers Limited ( Merrion ). The Merrion Execution Only Stockbroking Account Opening Form (which includes its Terms of Business and Client Asset Key Information Document) is included within this pack of documentation for your completion. Note that Merrion will only provide you with an Execution Only service. It will not provide you with any investment advice or recommendation nor will it carry out any assessment of suitability or of appropriateness relating to your proposed investment. Your Financial Broker will provide you with investment advice or a recommendation and it will carry out an assessment of suitability or appropriateness of this investment for you. Merrion shall rely on the information transmitted to it by Broker Solutions in relation to you, the client, and shall rely on the assessment carried out by your Financial Broker. 1. Investor Information Please complete Section A and Section B in BLOCK CAPITALS and return along with your cheque made payable to Merrion Stockbrokers Limited (or the investing life company where an investment is made on behalf of a Self-Directed or Self-Invested Insured Pension Plan). Prior to any transaction being entered into, a completed Application Form must be received. I/We hereby apply for the Broker Solutions Fixed Return Bond 12 in the name(s) of: A. Corporate Investors Entity Name: Address: Company Phone: Company Number: Revenue Number: Primary Contact Name: Primary Contact Phone: Primary Contact Website Address: Legal Entity Identifier (LEI): 2

3 B. All Investors Foreign Account Tax Compliance Act (FATCA): Are you a citizen of, or resident for tax purposes in the US? Primary Investor: Yes No Secondary Investor: Yes No Common Reporting Standards: Are you resident in any country or territory other than Ireland for tax purposes? Primary Investor: Yes No Secondary Investor: Yes No If Yes, please list below the countries/territories in which you are resident and provide the relevant Tax Identification Number(s) (TIN) in each case: Primary Investor: Country/Territory: TIN: Secondary Investor: Country/Territory: TIN: Source of Wealth & Source of Funds Source of Wealth: Examples: Accumulated Profits, Accumulated Investments, Investment Gain or Income from Sale of Asset(s). Maturing Investment etc. Source of Funds: Payment by: (A) Cheque (drawn on an account in the name of the investor(s) (B) EFT (C) Existing Merrion Account Note: Drafts will not be accepted. Investor Experience/Suitability & Appropriateness I/We would describe myself/ourselves as having the following Investment Knowledge and Experience: Basic (e.g. have never made an investment decision before) Informed (e.g. have made a number of investments in the past) Advanced (e.g. make regular investments on a frequent basis) 3

4 Do you have any other experience or training relevant to making investment decisions? Yes No If yes, please provide any details: Please tick box A, B or C for each of the 9 investment product categories below and indicate the number of investments made and whether you were advised by a Financial Broker in each case: Investment Type (A) Basic (B) Informed (C) Advanced (Number of Advised by a Knowledge Knowledge Knowledge Investments in Financial Broker & Experience & Experience & Experience the last 5 years (Y/N) Equities Bonds Alternatives (commodities, hedge funds, private equity etc.) Real Estate Funds (all collective investments) Tax Based Investments Derivatives Structured Products (Capital Protected) Structured Products (Capital at Risk) Do you understand the risks of the investment, including the potential that you could lose some or all of the amount invested? Do you understand that the Bond is designed to be held for the full 5 year investment term and if you encash it early, the amount you may receive would depend on the value of the Certificates at the date of sale and that this value could be less than the amount you invested? Do you understand that if BNP Paribas is unable to pay the amounts due when the investment matures, or on earlier encashment, you may lose some or all of your initial investment as well as any future fixed returns which you might have otherwise expected? Are your Investment Objectives and Risk Profile consistent with the Target Market described in Section 2.2 in the Brochure? Do you understand that you will not be entitled to compensation under any Deposit Protection Scheme as a result of your investment in this Bond? Do you understand the fees and charges described in the Costs and Charges Section 2.8 of the Brochure? Yes Yes Yes Yes Yes Yes No No No No No No

5 2. Application Amount I/We wish to invest in the Fixed Return Bond 12 ( 25,000 minimum in denominations of 1,000) and if necessary, to open a Merrion Account to do so. 3. Investor Declarations (Please confirm by ticking the boxes) I/We declare that the details above are correct, and that I/We are over 18 and confirm that I/We understand the Key Features and Terms & Conditions of the Bond set out in the Brochure and the Base Prospectus. I/We confirm that the Bond is consistent with my/our Investment Objectives and Risk Profile. I/We understand that the indicative terms outlined in the brochure are subject to change and that the final terms will not be known until 28 December I/We understand that I/We can lose some or all of the amount invested. I/We understand that the investment will not be deemed to have been made until the application has been accepted and that, if and when accepted, the investment will commence on 4 January Where applicable, I/we confirm that I/we have received a copy of the Merrion Stockbrokers Limited Terms of Business and Client Asset Key Information Document ( CAKID ) and that I/We have read and understood this document and its contents. Where applicable, I/we hereby request and authorise you to place my/our Investment Amount in a Client Asset Account in the name of Merrion Stockbrokers Limited. Where applicable, I/we hereby authorise you to transmit to Broker Solutions and for Broker Solutions to transmit to Merrion client information you hold on me/us. Primary Signature: Secondary Signature: Date: Date: Warning: If you invest in this Bond you may lose some or all of the money you invest. Warning: The value of your investment can go down as well as up. 4. The General Data Protection Regulation (GDPR) Consent: I/we authorise Broker Solutions to hold my/our personal data on file and to process it for the purposes intended. Primary Signature: Date: Secondary Signature: Date: 5

6 5. Financial Broker Declarations (Please confirm by ticking the boxes) We have conducted a full review of this investor s financial circumstances. This Bond (in the form of Certificates involving derivatives and therefore a complex product) is suitable and appropriate for the investor. The client understands the Key Features and the risks of the Bond. This Bond is consistent with the investor s Investment Objectives and Risk Profile. We have advised the investor that they can lose some or all of the amount invested. We have complied in full with the Anti Money Laundering (AML) and combating terrorist system that applies to all designated bodies. Where an investor has been identified as potentially vulnerable, we have followed our internal procedures in this regard. We confirm that we are appropriately authorised by the Central Bank of Ireland to recommend this Bond to the investor and have done so in accordance with the requirements of such authorisation and also with due regard to the suitability and appropriateness approaches as laid down by the ESMA Guidance (ESMA(2014/146). Firm Name: Advisor Name: Advisor Signature: Date: Date: 6

7 Application Checklist 1. Completed Application Form Completed by Investor and by the Financial Broker 2. Completed Merrion Stockbrokers Limited Account Opening Application Form Completed by Investor and by the Financial Broker 3. Legal Entity Identifier (LEI) provided on Application Form 4. Payment Cheque, EFT or Existing Merrion Account (Drafts will not be accepted) Cheques made payable to Merrion Stockbrokers Limited Account Details for EFTs below Investments via Pension & Post Retirement Schemes transfer investment monies via Administrator/Trustee 5. Anti Money Laundering Documentation Certified copy of Certificate of Incorporation Certified copy of Memorandum and Articles of Association Authorised Signatory List Proof of Identity: Certified copy of valid passport, driving license for each Authorised Signatory signing the Application Form(s) Proof of Address: Certified copy of valid (within last 6 months) proof of address e.g. utility bills (not mobile phone), bank statements, correspondence from Revenue etc. for each Authorised Signatory signing the Application Forms Bank Account Details Please make EFTs to the following account: Merrion Stockbrokers Limited Client Asset Account Bank of Ireland BIC: BOFIIE2D IBAN: IE 38 BOFI Reference: Investor Name 7

8 4 The Concourse, Beacon Court, Sandyford, D18 X4A4 MMPI Limited trading as Broker Solutions is regulated by the Central Bank of Ireland.

9 Client Application Form Corporate Application Form: Execution Only Service For Clients of Financial Brokers Merrion Stockbrokers Limited, trading as Merrion Private and Merrion Fixed Income, is regulated by the Central Bank of Ireland. Merrion Stockbrokers Limited (registered in Ireland under the number ) is a member of the Irish Stock Exchange and the London Stock Exchange. 1/10

10 Merrion Private Client Application Form SECTION 1: GENERAL INFORMATION WARNING: Please note that Merrion (Merrion Stockbrokers Ltd Trading as Merrion Private) will only provide you with an Execution- Only service. It will not provide you with any investment advice or recommendation nor will it carry out any assessment of suitability or of appropriateness relating to your proposed investment. Your Financial Broker will provide you with investment advice or a recommendation and it will carry out an assessment of suitability or appropriateness of this investment for you. Merrion shall rely on the information transmitted to it by the Product Producer (MMPI t/a Broker Solutions). FEES & CHARGES: Merrion does not apply custody fees directly for client accounts introduced by MMPI t/a Broker Solutions. Merrion receives a fee from MMPI t/a Broker Solutions to cover custody charges applicable to these client accounts. EXECUTION ONLY SERVICE : Merrion Private provides an execution only custody service for investors who require services of a broker to invest in Broker Solutions products.merrion does not provide any investment advice or advise on the merits of any transactions. * Investor Type Corporate Trust Charity Partnership SECTION 1A: GENERAL COMPANY INFORMATION * Company Name: *Registered Office: Correspondence Address (if different): *Telephone Number: * Website: *Country of Incorporation: *Date of Incorporation: / / *Incorporation/Registration/Regulatory Number: *Charity Number *Legal Entity Identifier (LEI): *Please provide a brief description of the company s primary activities: *Please provide anticipated level of trading activity: (number) trades per (timeframe e.g. week, month, quarter, year) 2/10 All questions marked with an asterisk* are mandatory.

11 Client Application Form SECTION 1B: DIRECTOR / TRUSTEE *Please provide details of two directors who will sign this application on behalf of the entity (BLOCK CAPITALS). DIRECTOR /TRUSTEE 1: *Title: Mr/Mrs/Miss/Other *Date of Birth: / / *Home Address: DIRECTOR /TRUSTEE 2 : *Title: Mr/Mrs/Miss/Other *Date of Birth: / / *Home Address: SECTION 1C: SHAREHOLDER DETAILS SHAREHOLDER 1: *Title: Mr/Mrs/Miss/Other *Full Name/Company Name: *Date of Birth/Incorporation: / / *Address: SHAREHOLDER 2: *Title: Mr/Mrs/Miss/Other *Full Name/Company Name: *Date of Birth/Incorporation: / / *Address: All questions marked with an asterisk* are mandatory. 3/10

12 Merrion Private SHAREHOLDER 3: *Title: Mr/Mrs/Miss/Other *Full Name/Company Name: *Date of Birth/Incorporation: / / *Address: SHAREHOLDER 4: *Title: Mr/Mrs/Miss/Other *Full Name/Company Name: *Date of Birth/Incorporation: / / *Address: *SECTION 1D: BOARD RESOLUTION *Below resolution must be signed by the above 2 members of the Board of Directors. As directors of the above named entity, we certify that the following resolutions were duly passed at a Board Meeting held on: *Date: / / We hereby agree to an account(s) being opened with Merrion Stockbrokers Ltd. We have read, understood and accepted the Client Asset Key Information Document ( CAKID ). The Board has appointed the authorised signatory(ies) as per section 1F to act on behalf of the entity in transacting and instructing payments on this account. Please note that this will constitute a legally binding contract. If you have any queries, please contact Merrion for clarification or consult your independent legal adviser. DIRECTOR 1: *Signature: *Date: / / 4/10 All questions marked with an asterisk* are mandatory.

13 Client Application Form DIRECTOR 2: *Signature: *Date: / / *SECTION 1E: BENEFICIAL OWNERSHIP: THE FOURTH EU ANTI-MONEY LAUNDERING DIRECTIVE (EU 2015/849) (AMLD4) Under the AMLD4, any individual owning 25% or more of the client company is defined as a Beneficial Owner. If the client company is owned by another entity, or series of entities, the same rule applies. Please provide the list of all individuals that ultimately own the client company. Please note that if no individual ultimately owns 25% or more of the company, the controlling persons of that corporate entity (CEO and directors) are deemed to be designated as the ultimate beneficial owners of the client company. BENEFICIAL OWNER 1: *Date of Birth: / / *Address: BENEFICIAL OWNER 2: *Date of Birth: / / *Address: BENEFICIAL OWNER 3: *Date of Birth: / / *Address: All questions marked with an asterisk* are mandatory. 5/10

14 Merrion Private BENEFICIAL OWNER 4: *Date of Birth: / / *Address: *SECTION 1F: AUTHORISED SIGNATORIES *Please indicate Authorised Signatory(ies) to act on behalf of the entity (BLOCK CAPITALS). *AUTHORISED SIGNATORY 1: *Position: *Signature: AUTHORISED SIGNATORY 2: *Position: *Signature: Please note that all instructions will be accepted from ANY of the above Authorised Signatories. If you wish to change this set-up e.g. accept only written instructions from both Authorised Signatories, please indicate this by a written instruction on your headed paper and signed by both directors as stated in Part 1C of this application. Please also note that you are responsible for notifing Merrion with immediate effect should one of the Authorised Signatories not be authorised to act on behalf of the entity. SECTION 2: SOURCE OF OVERALL WEALTH Please indicate how the entity s overall wealth was accumulated (You may select more than one option). Retained Profits Equity 6/10 All questions marked with an asterisk* are mandatory.

15 Client Application Form SECTION 3A: SOURCE OF FUNDS Please indicate the source of the entity s initial transfer to Merrion (you may select more than one option). Retained Profits Equity Debt (e.g. loans) *SECTION 3B: BANK DETAILS Please indicate the details of the entity s bank account from which you will transfer the funds to and from Merrion. Please note: this must be a bank account in the name of the entity as no third-party payment requests will be accepted. Bank Name/Branch: Account Name: BIC: IBAN: Currency: *SECTION 4: SECTION 4A: REPORTABLE INFORMATION COMMON REPORTING STANDARDS (CRS) The Standard for Automatic Exchange of Financial Account Information, also known as the Common Reporting Standard (CRS), is a single global standard on Automatic Exchange of Information (AEOI). It was approved by the Organisation for Economic Co-operation and Development (OECD) in February 2014 and draws on earlier work of the OECD and the EU, global anti-money laundering standards and, in particular, the Model FATCA Intergovernmental Agreement. The CRS sets out the financial information to be exchanged, the financial institutions required to report, along with common due diligence standards to be followed by financial institutions. Please note that in certain circumstances, where the entity is identified as a tax resident in country(s) outside of Ireland, we will be obliged to share this information with the relevant tax authority via the Irish Revenue. Self-certification to be completed by the entity. Please provide the full list of countries in which the entity is a tax resident along with the relevant Tax Identification Number (TIN). If the entity is resident for tax purposes in more than 3 countries, please provide details in writing. ENTITY TIN: Country: All questions marked with an asterisk* are mandatory. 7/10

16 Client Application Form TIN: Country: TIN: Country: Please note: If the entity is tax resident outside of Ireland, you will be required to complete our tax compliance self-certification form. SECTION 4B: FOREIGN ACCOUNT TAX COMPLIANCE ACT (FATCA) The Foreign Account Tax Compliance Act (FATCA) is an initiative introduced by the US government aimed at combating tax evasion by US citizens, US tax resident individuals/entities and certain entities with US controlling persons, holding assets or investments through foreign accounts.individual self-certification to be completed by investors, including joint holders. The Irish government signed an Inter-Governmental Agreement (IGA) with the US government, under which the Irish government agreed to apply the provisions of FATCA. The provisions of the IGA have been incorporated into Irish law. Under FATCA, financial institutions in Ireland are obliged to obtain and, when required, report specified information in relation to certain accounts held by US citizens, US tax resident individuals/entities and certain entities with US Controlling Persons to the Irish Revenue for onward transmission to the US Internal Revenue Service (IRS). For more information on FATCA see or Please note that in certain circumstances we may be obliged to share this information with the relevant tax authority(s). Individual self-certification to be completed by investors, including joint holders. ENTITY We confirm that THE ENTITY and its BENEFICIAL OWNER(S) are incorporated or resident in the U.S. for tax purposes. YES NO Please note: If you tick YES, you will be required to complete our tax compliance self certification form. All questions marked with an asterisk* are mandatory. 8/10

17 Client Application Form *SECTION 5: DOCUMENTATION REQUIRED TO ACTIVATE A MERRION ACCOUNT: 1. Duly completed Client Application Form 2. **Certificate of Incorporation 3. **Memorandum & Articles of Association 4. **Latest Audited Financial Statements 5. **List of all directors including dates of birth and addresses (e.g. B1 Form) 6. **Beneficial ownership register or equivalent: list of all beneficial owners with 25% or more, including dates of birth and addresses (e.g. B1 Form) 7. AML* for 2 directors signing the application form 8. AML* for all beneficial owners with 25% or more 9. AML* for all authorised signatories * AML (anti-money laundering) documentation includes the following items: 1. Certified** proof of identification (e.g. passport, driving licence, identity card) 2. Certified** proof of address issued within the last 6 months, (e.g. bank statement, utility bill, government-issued correspondence) Please note: All documentation must be submitted and received by Merrion prior to the commencement of the business relationship. Under General Data Protection Regulation ( GDPR ), your personal information is collected in response to your request for Merrion to provide investment services such as receiving and executing orders (the Services ) to you. In line with the GDPR, Merrion will only collect data for a specific purpose, use it only for that purpose and retain it only for as long as it meets that purpose. Please review our Data Protection Notice at Notice.pdf for the detail on the purposes for which data is processed, the legal basis for processing and disclosure of your personal information and security and safeguarding arrangements concerning your personal information. **All documentation e.g. proofs of identity and address must be certified and stamped to be a true copy of the original. The list of those who can certify documentation includes but is not limited to: Garda (police), practising chartered accountants, certified public accountants, notaries public, practising solicitors, embassy/consular staff, regulated financial/credit institution staff, Peace Commissioners or Commissioner for Oaths. All questions marked with an asterisk* are mandatory. 9/10

18 *SECTION 6: DECLARATIONS Client Application Form Please confirm by ticking the circle. *Please note that this will constitute a legally binding contract. If you have any queries, please contact Merrion for clarification or consult your independent legal advisor. We confirm that the information provided is true and accurate and that Merrion may rely solely on this information. We acknowledge that any false declaration may result in the loss of our right to hold Merrion responsible for any failure to comply with its obligations in relation to assessment of the appropriateness of the service to be provided. We confirm that we will provide all documentation as requested by Merrion, whether as part of the application process or ongoing monitoring. We acknowledge that Merrion may forward such requests at any stage and that any failure to provide additional documentation/information may result in delay of processing of our application as well as future payments. We also confirm that Merrion will be notified as soon as possible in relation to any material changes to my/our circumstances. We acknowledge that Merrion may request additional information and/or documentation to confirm the entity s tax status. We agree to comply at all times with such a request from Merrion within the time specified by Merrion in its request. We have read, understood and accepted the Client Asset Key Information Document ( CAKID ). We have read, understood and accepted the Terms of Business ( uploads/2018/04/merrion_private_terms_of_business.pdf )as amended from time to time and consent to be bound by them. We hereby agree to an account(s) being opened with Merrion Stockbrokers Ltd trading as Merrion Private. I/We confirm to Merrion that we have authorised our Financial Broker to transmit my/our order and information about me/us to the relavant product producer and have authorised the product to, in turn, transmit my/ our order and information about me/us to Merrion and we herby confirm to Merrion that it can rely on such order or information so transmitted to it. DIRECTOR /TRUSTEE 1: Signature: Date: / / DIRECTOR /TRUSTEE 2: Signature: Date: / / 10/10

19 Client Application Form Heritage House 23 St. Stephen s Green Dublin 2 D02 AR55 T F E info@merrion-capital.com Merrion Stockbrokers Limited, trading as Merrion Private and Merrion Fixed Income, is regulated by the Central Bank of Ireland. Merrion Stockbrokers Limited (registered in Ireland under the number ) is a member of the Irish Stock Exchange and the London Stock 11/10