UNIT TRUST INVESTMENT APPLICATION FORM. Global Funds - Individual

Transcription

1 UNIT TRUST INVESTMENT APPLICATION FORM Global Funds - Individual

2 HOW TO INVEST Before investing, please read the Terms and Conditions of this investment (attached hereto), as well as the Prospectus of Prescient Global Funds plc ( the Company ), carefully. Please complete all relevant sections of this form, and send the original completed Application Form together with the required supporting documents to: Methodical Investment Management (Pty) Ltd, 58 Main Street, Newlands, 7700, Cape Town, Tel: , newapplications@methodical.co.za or Prescient Global Funds plc, c/o Prescient Fund Services (Ireland) Limited, 49 Upper Mount Street, Dublin 2, Ireland, Tel: , Fax: The Application Form with the required documents must be received together with cleared funds before a.m. (Irish time) on the Relevant Dealing Day. Investment amounts must be received by the Company in the account of the Custodian as cleared funds for value. Any applications and/or cleared funds therefore received after a.m. Irish time on the Relevant Dealing Day will be held over until the next Dealing Day. The following supporting documentation must be submitted with this application: FICA Documentation Proof of Deposit Proof of Banking Details Self-Certification for Tax Purposes DETAILS Existing Investor New Investor Client Number INVESTOR - INDIVIDUAL INVESTORS (for more than one Investor please make a copy of this page) Title Male ID / Passport Number (if no RSA ID) Female Surname Name Income Tax Number Date of Birth D D M M Y Y Y Y Country of Residence for Tax Purposes Occupation Nationality Physical Address Postal Code Postal Address Same as registered address? Postal Code Telephone Cell Tel (W) Fax Address Please specify your preferred method of receiving correspondence * Postal Address Send copy to Financial Advisor * Where no selection is made correspondence will be sent to the address supplied above. If no address is supplied, correspondence will be sent via post. 1 OF 13

3 Source of Funds Invested Please specify the source of funds (e.g. investment proceeds; sale of assets; etc.) Prescient reserves the right to request documentary proof e.g. income statement, bank statement. Banking Details of Investor Name of Account Holder Name of Bank Branch Name Branch Code Bank Address Postal Code Account Number Account Type IBAN* Swift Code Account Type Corresponding Bank (if necessary) Swift Code Signature of Account Holder Date D D M M Y Y Y Y A cancelled cheque or bank statement must be attached as proof of banking details. The onus is on the investor to inform Prescient of any changes to the bank account details. No payments will be made into third party bank accounts or credit cards. (i.e. payments will only be made to the bank account in the name of the registered investor). 2 OF 13

4 Method of Payment Lump Sum Please deposit your lump sum investment directly into the following bank account, by means of EFT. Currency Beneficiary Bank SWIFT Code Account Name Account Number IBAN Correspondent Bank SWIFT Code USD Citibank NA, Dublin CITIIE2X Prescient Global Funds plc IE42CITI Citibank N.A. New York CITIUS33 * Electronic internet transfers may take up to 2 days to appear in the bank account. Units may only be purchased upon receipt of documentation and funds into the account. Please insert investors name and surname as reference. Please attach proof of transfer. Investment Option Details Unit Trust Portfolio Base Currency Annual Fees (ex. VAT) (Paid to the Company) Fee Class Annual Advisor Fees Capped at 1% (ex. VAT) Lump Sum Investment (Minimum $3 000) ACP Global Equity Fund USD 1% + 20% of out-performance of benchmark A % $ ACP Global Flexible Fund USD 1% + 20% of out-performance of benchmark A % $ * Should a distribution be paid by any of the Portfolios, such dividend will be reinvested in additional shares. Financial Advisor / Intermediary (IFA) Details and Declaration (if applicable) Name of Financial Advisor Name of Financial Service Provider (FSP) FSP License Number Contact Tel No. Address Prescient s FSP code (to be obtained from Prescient) License Category : Category I Category II Category IIA VAT Vendor Status Registered Not Registered VAT Number I, the appointed Financial Advisor for this investment application declare that : 1. I am licensed to render services in respect of this product. 2. I have made the disclosures required in terms of the Financial Advisory and Intermediary Services Act 37 of 2002 (FAIS) and subordinate legislation thereto, to the investor/s. 3. I have fully explained the meaning and implications of replacement (if applicable) to the investor/s and that I am fully aware of the possible detrimental consequences of replacement. 4. I have established and verified the identity of the investor/s (and persons acting on behalf of the investor) in accordance with the Financial Intelligence Centre Act 38 of 2001 (FICA) and the regulations thereto, and I will keep records of such identification and verification according to the provisions of FICA. 5. I have explained all fees that relate to this investment to the investor/s and I understand and accept that the investor/s may withdraw his / her authority for payment to me in writing and inform Prescient. 6. My personal information may be used by Prescient in the normal course of business to provide the products and services and Prescient may retain any information for purposes of investment transactions, processing and administration and to communicate directly with me. Personal information will not be given or sold to any third parties. Prescient will disclose or report personal information if and when required to do so by law or any regulatory authority, and to our employees, or agents who require such information to carry out their duties. Signature of Account Holder Date D D M M Y Y Y Y 3 OF 13

5 Anti-Money Laundering (AML) and Counter Terrorist Financing Requirements Measures aimed towards the prevention of money laundering and terrorist financing require a detailed verification of the investor s identity. All investors are therefore required to submit the minimum documentation as set out in the Compulsory anti-money laundering documentation section of this document, with the initial subscription in the Company. The Company, Investment Manager or the Administrator may require further identification and make any further enquiries they deem necessary to comply with anti-money laundering/counter terrorist financing laws, before the Application can be processed and the Company shall be held harmless and indemnified against any loss arising due to the failure to process this Application if such information as has been required by the parties hereto has not been provided. In such case or delay or failure to provide satisfactory information, the Company may take such action as they see fit. Prescribed Countries include the following: European Union Member States; Argentina; Australia; Brazil; Canada; Channel Islands; Hong Kong; Iceland; Isle of Man; Japan; Liechtenstein; Mexico; New Zealand; Norway; Russian Federation; Singapore; South Africa; Switzerland; United States of America; The Dutch overseas territories of Netherlands Antilles and Aruba, The French Overseas Territories of Mayotte, New Caledonia, French Polynesia, Saint Pierre and Miquelon and Wallis and Futuna Designated Bodies includes entities such as banks, building societies, investment companies and other financial institutions. Certified Copy The certification of all documents must be carried out by any of the following; a police officer, practising chartered and certified public accountant, notaries public, practising solicitor embassy and consular staff and your Bank if authorised and regulated in the EU, Argentina, Australia, Brazil, Canada, the Channel Islands, Hong Kong, Iceland, the Isle of Man, Japan, Liechtenstein, Mexico, New Zealand, Norway, Singapore, South Africa, Switzerland, The Dutch overseas territories of Netherlands Antilles and Aruba, The French Overseas Territories of Mayotte, New Caledonia, French Polynesia, Saint Pierre and Miquelon and Wallis and Futuna or the USA. Please indicate if the Investor is : A B C Designated Body in a Prescribed Country (Proof of registration of Investor with corresponding regulator in Prescribed Country e.g. license.) Is not a Designated Body and that subscription monies originate from an account in the name of the Investor with a bank in a Prescribed Country. Is not a Designated Body and that the subscription monies do NOT originate from an account in the name of the Investor with a bank in a Prescribed Country. Authorisation and Declaration The singular shall include a reference to the plural and vice versa and the term Company shall include the Investment Manager (Prescient Investment Management (Pty Ltd) and the Administrator (Prescient Fund Services (Ireland) Limited) and their directors, employees and agents as well as affiliated and associated companies. References to I shall include we where applicable. By signing this application form below : General 1. I acknowledge that this Application is subject to, and shall be governed by, the laws of Ireland. 2. I declare that each Investor is over the age of 18, and that I agree to accept the number of shares allotted in respect of this Application. 3. I hereby irrevocably apply for such number of shares (including fractions) at a price determined in accordance with the Prospectus. 4. I warrant that I am duly authorised to sign this Application Form and to subscribe for or redeem shares in the Company and that by subscribing for, holding or redeeming shares in the Company I am not in breach of any laws or regulations of any competent jurisdiction. 5. I acknowledge that the Company reserves the right to reject any application in whole or in part. 6. I agree to notify the Company immediately if I become aware that any of the representations are no longer accurate and complete in all respects and agree immediately to sell or to tender to the Company for redemption a sufficient number of shares to allow the representation to be made. 7. I acknowledge that any delay by me in providing documentation may result in delayed processing of my application and/or delayed payment of any future redemption payments to me or processing of share transfer requests on my behalf. 8. I warrant and declare that the monies being invested pursuant to this application do not represent directly or indirectly the proceeds of any criminal activity and the investment is not designed to conceal such proceeds so as to avoid prosecution for offence or otherwise. 9. I confirm I have read, understood and retained a copy of the Key Investor Information Document (KIID). 10. I confirm I have received and considered a copy of the Prospectus, and hereby confirm that I have understood the Prospectus and that this Application is based solely on the Prospectus and material contracts referred to therein together (where applicable) with the most recent annual report and accounts of the Company and the Memorandum and Articles of Association. 11. I hereby undertake to observe and be bound by the provisions of the Memorandum and Articles of Association (as amended from time to time) of the Company and apply to be entered in the Register of Shareholders as the holder/holders of the shares issued in relation to this Application. 12. I agree to provide to the Company, at such times as it may request, such declarations, certificates or documents as it may reasonably require in connection with this investment. Should any information furnished to it become inaccurate or incomplete in any way, I agree to notify the Company immediately of any such change and further agree to request the redemption of shares in respect of which such confirmations have become incomplete or inaccurate where requested to do so by the Company. 13. I acknowledge that I will indemnify and hold the Company harmless against any loss, liability, cost or expense (including without limitation attorneys fees, taxes and penalties) 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 me to the Company and shall notify the Company if any of the representations herein made are no longer accurate and complete in all respects. 4 OF 13

6 14. I confirm that the Company is authorised and instructed to accept and execute any instructions in respect of the shares to which this Application relates given by me in written form or by facsimile and I indemnify the Company and agree to keep it indemnified, against any loss of any nature whatsoever arising to it as a result of it acting on facsimile instructions. The Company may rely conclusively upon and shall incur no liability in respect of any action taken upon any notice, consent, request, instruction or other instrument believed, in good faith, to be genuine or to be signed by properly authorised persons. I acknowledge the onus is on me to ensure that such instructions are received in legible form. 15. I understand that the tax disclosures set forth in the Prospectus are of a general nature and may not cover the jurisdiction in which I am subject to taxation and that the tax consequences of my purchase of shares depend on my individual circumstances. 16. I declare that I am aware of the requirement to complete and submit the Self-certification regarding tax residency document. 17. I declare that I am aware that the Self-certification form and the information contained therein, forms part of this Application. 18. I hereby authorise investigation of my identity, and agree to an enhanced ongoing monitoring should I be deemed to be politically exposed. Politically exposed persons are defined as natural persons who are or have been entrusted with prominent public functions within the past year, as well as immediate family members, or persons known to be close associates, of such persons. 19. The Company may rely inclusively upon and shall incur no liability in respect of any action taken upon any notice, consent, request, instruction or any other instrument believed in good faith to be genuine or to be signed by properly authorised persons. 20. I understand that the confirmations, representations, declarations, indemnities and warranties made or given herein are continuous and apply to all subsequent purchases of shares by me in the Company. 21. I acknowledge that any notice or document may be served by the Company on me in the manner specified from time to time in the Prospectus and, for the purposes of the Electronic Commerce Act 2000, if I have provided an address or fax number to the Company or its delegate, consent to any such notice or document being sent to me by fax or electronically to the fax number or address previously identified to the Company or its delegate which I acknowledge constitutes effective receipt by me of the relevant notice or document. I acknowledge that I am not obliged to accept electronic communication and may at any time choose to revoke my agreement to receive communications by fax or electronically by notifying the Company in writing at the above address provided that my agreement to receive communications by fax or electronically shall remain in full force and effect pending receipt by the Company of written notice of such revocation. 22. I have evaluated the risks of investing in the Company and to make an informed decision with respect thereto and I am aware of the risks inherent in investing in the shares and the method by which the assets of the Company are held and/or traded; and I can bear the risk of loss of my entire investment. 23. I understand and agree that the Company prohibits the investment of funds by any persons or entities that are acting, directly or indirectly, (i) in contravention of any applicable laws and regulations, including anti-money laundering regulations or conventions, (ii) on behalf of terrorists or terrorist organizations, including those persons or entities that are included on the List of Specially Designated Nationals and Blocked Persons maintained by the U.S. Treasury Department s Office of Foreign Assets Control (OFAC ), as such list may be amended from time to time, (iii) for a senior foreign political figure, any member of a senior foreign political figure s immediate family or any close associate of a senior foreign political figure, unless the Fund, after being specifically notified by me in writing that it is such a person, conducts further due diligence, and determines that such investment shall be permitted, or (iv) for a foreign shell bank (such persons or entities in (i) - (iv) are collectively referred to as Prohibited Persons ). 24. I represent, warrant and covenant that I am not, nor is any person or entity controlling, controlled by or under common control with me, a Prohibited Person. 25. I confirm that the intermediary/ifa whose details appear in this document is my appointed advisor and that I am aware and have agreed to any remuneration payable. Data Protection General 26. The Company and its delegates holding, using, disclosing and processing my personal information/data in accordance with the Data Protection Acts 1988 to 2003 in order to manage and administer my investment in the Company and any related investments on an ongoing basis. 27. The use of my personal information/ data being processed by the Company for the purposes of carrying out the services of administrative agent, registrar and transfer agent of the Company and to comply with legal obligations under company law and AML legislation. 28. The Company disclosing my personal information/data to third parties where necessary or for legitimate business interests including to auditors and the Central Bank of Ireland or agents of the Company who possess the data for AML and counter terrorist financing purposes or for compliance with foreign regulatory requirements. 29. The processing of my personal information/data and the disclosure of my personal information/data and where necessary in respect of any of the Company s legitimate interests in any of the group of companies or their agents or delegates including companies situated in countries outside of the European Economic Area (including without limitation the United States of America) which may not have the same data protection laws as Ireland. 30. The processing of my personal information/data and the disclosure of my personal information/data in order to carry out statistical analysis and market research as well as for any other specific purposes where I have given specific consent to do so. 31. The processing of my personal information/data and the disclosure of my personal information/data to any tax authority and/or as may be required to comply with FATCA and the Common Reporting Standard (CRS) as explained in paragraphs 35 to 39 hereunder. 32. I hereby acknowledge my right of access to and the right to amend and rectify my personal data, as provided herein. I understand that the Company is a data controller and will hold any personal information provided by me in confidence and in accordance with the Data Protection Act 1988 as amended by the Data Protection (Amendment) Act The recording of telephone calls made to and received from me by the Company for record keeping, security and/or training purposes. 34. The recording of telephone calls that I make to and receive from the Administrator, the Company, the Custodian, the Investment Manager or the Sub-Investment Manager and their delegates or duly appointed agents and any of their respective related, associated or affiliated companies for record keeping, security and/or training purposes. I consent to the Company sending information about other investment services to me by letter, telephone or other reasonable means of communication. I understand that I have a right not to receive such information. If you do not wish to receive marketing material please indicate this by ticking this box. 5 OF 13

7 FATCA and the Common Reporting Standard ( CRS ) 35. I/We acknowledge that the Company intends to take such steps as may be required to satisfy any obligations imposed by (i) the Foreign Account Tax Compliance Act ( FATCA ) or (ii) any provisions imposed under Irish law arising from the inter-governmental agreement between the Government of the United States of America and the Government of Ireland ( IGA ) so as to ensure compliance or deemed compliance (as the case may be) with FATCA or the IGA from 1 July Furthermore, I/We hereby acknowledge that the Company intends to also take such steps as may be required to satisfy any obligations imposed by (i) the Standard for Automatic Exchange of Financial Account Information in Tax Matters ( the Standard ) and, specifically, the Common Reporting Standard ( CRS ) therein or (ii) any provisions imposed under Irish law arising from the Standard or any international law implementing the Standard (to include the Multilateral Competent Authority Agreement on Automatic Exchange of Financial Account Information or the EU Council Directive 2011/16/EU (as amended by Council Directive 2014/107/EU)) so as to ensure compliance or deemed compliance (as the case may be) with the Standard and the CRS therein from 1 January In order for the Company to comply with the above FATCA and CRS obligations, I/We agree to provide to the Company or its agents the necessary declarations, confirmations and/or classifications at such times as each of them may request and furthermore provide any supporting certificates or documents as each of them may reasonably require in connection with this investment by reason of FATCA or CRS, as described above, or otherwise. Should any information furnished to any of them become inaccurate or incomplete in any way, I/we hereby agree to notify the Company immediately of any such change and further agree to immediately take such action as the Company may direct, including where appropriate, redemption of our Shares in respect of which such confirmations have become incomplete or inaccurate where requested to do so by the Company or its agents. If relevant, I/we agree to notify the Company or its agents of any change to my/our tax residency status. I/we hereby also agree to indemnify and keep indemnified the Company and its agents against any loss, liability, cost or expense (including without limitation legal fees, taxes and penalties) which may result directly or indirectly as a result of a failure to meet our obligations pursuant to this section or failure to provide such information which has been requested by the Company and has not been provided by me/us, and from any misrepresentation or breach of any warranty, condition, covenant or agreement set forth herein or in any document delivered by me/us to the Company. I/We further acknowledge that a failure to comply with the foregoing obligations or failure to provide the necessary information required may result in the compulsory redemption of our entire holding in the Company, and that the Company and its agents are authorized to hold back from redemption proceeds or other distributions to me/us such amount as is sufficient after the deduction of any redemption charges to discharge any such liability and I/we shall indemnify and keep indemnified the Company and its agents against any loss suffered by them or other Shareholders in the Company in connection with any obligation or liability to so deduct, withhold or account. 38. I/We confirm that we have accurately and correctly completed the relevant self-certification form included at Appendix IA or IB (as applicable). I/ We further confirm that if any information included in the self-certification form subsequently becomes inaccurate or incorrect we will notify the Company immediately of any such change and agree to immediately take such action as the Company may direct, including where appropriate, redemption of our Shares. 39. I/We confirm that we have read, understood and consent to the Customer Information Notice Common Reporting Standard which appears in the Terms and Conditions section at the end of this Application Operation of Umbrella Cash Accounts 40. I/we acknowledge that the [Company] operates umbrella cash accounts, which may designated in different currencies in its name into which (i) subscription monies received from investors who have subscribed for shares are deposited and held until shares are issued as of the relevant Dealing Day; and (ii) redemption monies due to investors who have redeemed Shares are deposited and held until paid to the relevant investors; and (iii) dividend payments owing to Shareholders are deposited and held until paid to such Shareholders (hereinafter referred to as Umbrella Cash Account ). We acknowledge that all subscriptions, redemptions and dividends payable to or from the Fund are channelled and managed through the relevant Umbrella Cash Account. 41. I/we acknowledge that my / our subscription monies/ redemption monies / dividend monies will be paid into the relevant Umbrella Cash Account, that such monies will be treated as an asset of the Fund and I/we will not benefit from the application of any investor money protection rules (i.e. the monies will not be held on trust as investor monies for me/us) and that I/we will be an unsecured creditor of the Company (i) with respect to the amount subscribed for Shares and held in the relevant Umbrella Cash Account until such Shares are issued to me/us as of the relevant Dealing Day or (ii) with respect to the redemption/dividend amount to be paid and held in the relevant Umbrella Cash Account until such amount is paid to me/us (whichever is applicable). 42. I/we acknowledge that in accordance with applicable anti money-laundering and terrorist financing requirements (the AML Requirements ), redemption / dividend monies shall not be paid on un-verified accounts. In the event that I/we fail to submit the necessary documentation requested by the [Company, the Manager or their delegates] as required under the AML Requirements, redemption / dividend monies will be held in the relevant Umbrella Cash Account and shall remain an asset of the Fund and I/we will not benefit from the application of any investor money protection rules (i.e. the redemption /dividend monies will not be held on trust for me/us). In such circumstances, I/we acknowledge that I/we will be unsecured creditor of the Company in respect of the Fund in respect of such redemption / dividend monies until such time as the relevant documentation required by the Company, the Manager or their delegates has been received to its/their satisfaction and the redemption /dividend monies have been paid to me/us. 43. I/we acknowledge that the following risks arise in relation to the operation of the Umbrella Cash Account:- (i) in the event that subscription monies received and held in the Umbrella Cash Account are lost prior to the issue of Shares to the relevant investor as of the relevant Dealing Day, the Company on behalf of the Fund may be obliged to make good any losses suffered by the investor (in its capacity as a general creditor of the Fund), in which case such loss will need to be discharged out of the assets of the Fund and, therefore, will represent a diminution in the Net Asset Value per Share for existing Shareholders of the Fund; (ii) in the event that redemption or dividend monies held in the Umbrella Cash Account are lost prior to payment to the relevant investor/ Shareholder, the Company on behalf of the Fund may be obliged to make good any losses suffered by the investor/ Shareholder (in its capacity as a general creditor of the Fund), in which case such loss will need to be discharged out of the assets of the Fund and, therefore, will represent a diminution in the Net Asset Value per Share for existing Shareholders of the Fund; and (iii) in the event of an insolvency of the Fund, (a) there is no guarantee that the Fund will have sufficient funds to pay unsecured creditors in full; (b) investors who have forwarded subscription monies in advance of a Dealing Day and which are held in the Umbrella Cash Account and investors / Shareholders due redemption / dividend monies which are held in the Umbrella Cash Account will rank equally with all other unsecured creditors of the Fund and will be entitled to a pro-rata share of monies which are made available to all unsecured creditors by the insolvency practitioner; and (c) in such circumstances, the investor subscribing for Shares may not recover all monies originally paid into the Umbrella Cash Account in relation to the application for Shares and the redeeming investor entitled to redemption monies and the Shareholder entitled to a dividend payment may not recover all monies originally paid into the Umbrella Cash Account for onward transmission to that investor/shareholder. 44. In the event that Shares are allotted / issued notwithstanding that cleared funds have not been received within the usual time limits as set out in the Prospectus, I/we acknowledge that the Company may cancel the allotment and/or charge me/us interest to cover the expenses incurred by the Fund as a result, which will be paid into the assets of the Fund. In addition, the Fund has the right to sell all or part of my/our holding of Shares in the Fund in order to meet such charges. 6 OF 13

8 Investor Resident Outside of Ireland An Investor resident outside Ireland is required by the Irish Revenue Commissioners to make the following Declaration, which is in a format authorised by them, in order to receive payment without deduction of tax. It is important to note that this Declaration, if it is then still correct, shall apply in respect of any subsequent acquisitions of Shares. Terms used in this Declaration are defined in the Prospectus (see heading, Irish Taxation ). Please tick the relevant option applicable to you and delete as appropriate where marked with an * : 1. Declaration on own behalf I/we* declare that I am/we are* applying for the Shares on my own/our own behalf/on behalf of a company* and that I am/we are/the company is* entitled to the Shares in respect of which this declaration is made and that : I am/we are/the company is* not currently Resident or Ordinarily Resident in Ireland, and Should I/we/the company* become Resident in Ireland I will/we will* so inform you, in writing, accordingly. Or 2. Declaration on own behalf I/we* declare that I am/we are* applying for Shares on behalf of persons : Who will be beneficially entitled to the Shares; and, Who, to the best of my/our* knowledge and belief, are neither Resident nor Ordinarily Resident in Ireland. I/we* also declare that : Unless I/we* specifically notify you to the contrary at the time of Application, all Applications for Shares made by me/us* from the date of this Application will be made on behalf of such persons; and, I/we* will inform you in writing if I/we* become aware that any person, on whose behalf I/we* holds Shares, becomes Resident in Ireland. IMPORTANT NOTES Non-resident declarations are subject to inspection by the Irish Revenue Commissioners and it is a criminal offence to make a false declaration. To be valid, the application form (incorporating the declaration required by the Irish Revenue Commissioners) must be signed by the Investor. Where there is more than one Investor, each person must sign. If the Investor is a company, it must be signed by the company secretary or another authorised officer. If the application form (incorporating the declaration required by the Irish Revenue Commissioners) is signed under power of attorney, a copy of the power of attorney must be furnished in support of the signature. Please note: If the Applicant is an Exempted Irish Investor, they should contact the Administrator who will provide them with the appropriate declaration which must be made to confirm their status. Signed at Date D D M M Y Y Y Y Full Name Capacity Signature of Investor Full Name Capacity Signature of Investor * If signing on behalf of the investor please provide proof of authority and supporting verifying documentation. 7 OF 13

9 [ Please complete Appendix 1A or 1B ] Appendix 1A Individual (Controlling Person s) Self-Certification for FATCA and CRS (compulsory information) Instructions for completion : We are obliged under Section 891E, Section 891F and Section 891G of the Taxes Consolidation Act 1997 (as amended) and regulations made pursuant to those sections to collect certain information about each investor s tax arrangements. Please complete the sections below as directed and provide any additional information that is requested. Please note that in certain circumstances we may be legally obliged to share this information, and other financial information with respect to an investor s interests in the Fund with relevant tax authorities. This form is intended to request information only where such request is not prohibited by Irish law. If you have any questions about this form or defining the investor s tax residency status, please refer to the OECD CRS Portal or speak to a tax adviser For further information on FATCA or CRS please refer to Irish Revenue website at : or the following link to the OECD CRS Information Portal at: in the case of CRS only. If any of the information below about the investor s tax residence or FATCA/CRS classification changes in the future, please advise of these changes promptly. Please note that where there are joint or multiple account holders each investor is required to complete a separate Self-Certification form. Sections 1, 2, 3 and 5 must be completed by all investors. Section 4 should only be completed by any individual who is a Controlling Person of an entity investor which is a Passive Non- Financial Entity. For further guidance see : (Mandatory fields are marked with an *) Section 1: Investor Identification Investor Name (the entity) Country of Incorporation or Organisation Current Registered Address Number Street City, Town, State, Province or County Postal / ZIP Code County Postal Address Postal Code Number Street City, Town, State, Province or County Postal / ZIP Code County 8 OF 13

10 Section 2: FATCA Declaration of U.S. Citizenship or U.S. Residence for Tax purposes* Please tick either (a) or (b) and complete as appropriate. (a) or (b) I confirm that [I am] / [the investor is] a U.S. citizen and/or resident in the U.S. for tax purposes and [my] / [its] U.S. federal taxpayer identifying number (U.S. TIN) is as follows: I confirm that [I am not] / [the investor is not] a U.S. citizen or resident in the U.S. for tax purposes. Section 3: CRS Declaration of Tax Residency (please note you may chose more than one country) * Please indicate your/ the investor s country of tax residence (if resident in more than one country please detail all countries of tax residence and associated taxpayer identification numbers ( TIN ). Please see the CRS Portal for more information on Tax Residency. Country of Tax Residency Tax ID Number NOTE : Provision of a Tax ID number (TIN) is required unless you are tax resident in a Jurisdiction that does not issue a TIN. Section 4 Type of Controlling Person (ONLY to be completed by any individual who is a Controlling Person of an entity investor which is a Passive Non-Financial Entity or an Investment Entity located in a Non-Participating Jurisdiction and managed by another Financial Institution) For joint or multiple Controlling Persons please complete a separate Self-Certification form for each Controlling Person Country of Tax Residency Please Tick Entity Name Controlling Person of a legal person - control by ownership Controlling Person of a legal person - control by other means Controlling Person of a legal person - senior managing official Controlling Person of a trust - settlor Controlling Person of a trust - trustee Controlling Person of a trust - protector Controlling Person of a trust - beneficiary Controlling Person of a trust - other Controlling Person of a legal arrangement (non-trust) - settlor-equivalent Controlling Person of a legal arrangement (non-trust) - trustee-equivalent Controlling Person of a legal arrangement (non-trust) - protector-equivalent Controlling Person of a legal arrangement (non-trust) - beneficiary-equivalent Controlling Person of a legal arrangement (non-trust) other-equivalent 9 OF 13

11 Section 5: Declaration and Undertakings I declare that the information provided in this form is, to the best of my knowledge and belief, accurate and complete. I acknowledge that the information contained in this form and information regarding the Account Holder may be reported to the tax authorities of the country in which this account(s) is/are maintained and exchanged with tax authorities of another country or countries in which the Account Holder may be tax resident where those countries (or tax authorities in those countries) have entered into Agreements to exchange financial account information. I undertake to advise the recipient promptly and provide an updated Self-Certification form where any change in circumstances occurs which causes any of the information contained in this form to be incorrect. Full Name Capacity Signature of Investor Full Name Capacity Signature of Investor 10 OF 13

12 Terms and Conditions (To be retained by Investor) General 1. To be valid, the Application Form (incorporating the Declaration required by the Irish Revenue Commissioners) must be completed by the investor. 2. Where there is more than one Investor, each person must sign. If this Application Form is signed by any Investor under power of attorney, such power of attorney or a duly certified copy thereof must accompany this Application Form. 3. If the Investor is a company, the Declaration must be signed by the Company s Secretary or an authorised officer and a list of authorised signatories must accompany this Application Form. 4. This Application Form and required documentation must be received together with cleared funds before a.m. (Irish time) on the Relevant Dealing Day. 5. Subscription amounts must be received by the Company in the subscription account of the Custodian as cleared funds for value. Any applications and/or cleared funds therefore received after a.m. Irish time on the Relevant Dealing Day will be held over until the next Dealing Day. 6. The dealing deadline for redemption requests shall be a.m. Irish time on the Relevant Dealing Day. 7. Redemptions will not be processed on non-cleared/verified accounts. 8. No redemption payment may be made until the original subscription application form has been received from the Investor and all documentation required by the scheme and anti-money laundering and counter terrorist financing procedures have been completed. The signed originals of the initial Application Forms should be sent to arrive within ten Business Days after the time for receipt of such application. Applicable if appointing a Financial Advisor / IFA 1. The Company will only accept applications, submitted on behalf of investors, from IFA s who have been granted a licence by the regulating authority of the country in which the service is being rendered to the investor. 2. The Company cannot be held responsible or liable for loss or damage suffered by the investor as a result of the IFA acting outside his / her licence parameters or because of delays in the processing or rejection of this application form, caused by the fact that the investor s IFA is not authorised as per 1 above. 3. The IFA is responsible for ensuring that the investor receives and understands all appropriate advice, product and fee information including changes in the working practices and procedures of the Company. Fees 1. The fees that apply to this investment are set out in the latest Investment Option Details in the Application. 2. The annual fee is the fee you pay to the Company for managing the portfolios. 3. You may negotiate an annual advisor fee to be paid to your IFA. Shares will need to be sold to pay your IFA this fee. 4. All fees may be amended by the Company from time to time, and in such event, a notification will be sent to the investor. Risk Warning Collective Investment Schemes in Securities (CIS) should be considered as medium to long-term investments. The value may go up as well as down and past performance is not necessarily a guide to future performance. CIS s are traded at the ruling price and can engage in scrip lending and borrowing. A schedule of fees, charges and maximum commissions is available on request from the Manager. There is no guarantee in respect of capital or returns in a portfolio. A CIS may be closed to new investors in order for it to be managed more efficiently in accordance with its mandate. CIS prices are calculated on a net asset basis, which is the total value of all the assets in the portfolio including any income accruals and less any permissible deductions (brokerage, STT, VAT, auditor s fees, bank charges, trustee and custodian fees and the annual management fee) from the portfolio divided by the number of participatory interests (units) in issue. Forward pricing is used. Where foreign securities are included in a portfolio there may be potential constraints on liquidity and the repatriation of funds, macroeconomic risks, political risks, foreign exchange risks, tax risks, settlement risks; and potential limitations on the availability of market information. The investor acknowledges the inherent risk associated with the selected investments and that there are no guarantees. Contact Details Prescient Global Funds plc c/o Prescient Investment Management (Pty) Ltd Prescient House Westlake Business Park Otto Close, Westlake Cape Town, 7945, Tel: , Fax: or c/o Prescient Funds Services (Ireland) Limited 49 Upper Mount Street Dublin 2 Ireland Tel: , Fax: Compulsory Anti-Money Laundering Documentation to be submitted 1. Individual Applicants (In the case of Joint Holders please supply the documentation in respect of ALL the holders) Certified copy of a document verifying name and date of birth (e.g., current valid full passport); and Original or certified copy verifying the Investor s residential address (e.g.: recent utility bill, bank statement, tax statement). 11 OF 13

13 2. Corporate Applicants If you are a regulated financial institution or a company quoted on a regulated market in a Prescribed Country then proof of authorisation or proof of listing on a regulated market is required. Private Companies/Companies quoted on a regulated market in a Non Prescribed Country Certified copy of the Certificate of Incorporation or Certificate to Trade; and Certified copy of Memorandum and Articles of Association; and Certified list of directors names, occupations, residential and business addresses and dates of birth; and Certified copy of a properly authorised mandate of the directors to open/operate an account; and Certified copy of Investor authorised signatory list with specimen signatures on company letterhead; and A copy of a company bank statement Individual documentation as per 1 above must be supplied by at least two directors of such company and all persons authorised to operate the account; and In the case of shareholders holding more than 25% of the share capital then the documentation as per 1 above. Partnerships Certified list of names, date of birth, occupation and addresses of all partners. Certified copies of the identification of all the beneficiaries who hold more than 25% of the partnership as per 1 above for an individual and as per 2 above for a company. Certified copies of two partners identification as per 1 above for an individual and as per 2 above for a company. Evidence of the above partners authority to make investments on behalf of the partnership and an appropriate certified authorised signatory list. Certified copy of partnership agreement (All documents must be dated) Institutional Investor e.g. Pension Fund, Local Authority, Charity List of names, dates of birth, occupation and permanent addresses of all governors/board members/partners Certified copies of the above governors/board members/partners identification cards/passports and certified copies of proof of address as per part I above. Certified authorised signatory list. Properly authorised mandate of persons completing the form to act on behalf of the applicant. Documentary evidence of the regulatory status of the applicant, please contact the administrator for further details. Certified copies of the identification of any beneficial owners holding more than 25% of the charity, a non EEA pension fund or a local authority which is not from a prescribed country. Trust Full name of trust and certified copy of trust deed. Nature and purpose of the trust. Country of establishment. Name of all the trustees, with certified copies of identification documentation to be supplied for two of the trustees as per 1 above for an individual or as per 2 above for a company. Evidence of the trustee s authority to make investments on behalf of the trust and an appropriate certified authorised signatory list. Customer Information Notice Common Reporting Standard The Company intends to take such steps as may be required to satisfy any obligations imposed by (i) the Standard for Automatic Exchange of Financial Account Information in Tax Matters ( the Standard ) and, specifically, the Common Reporting Standard ( CRS ) therein or (ii) any provisions imposed under Irish law arising from the Standard or any international law implementing the Standard (to include the Multilateral Competent Authority Agreement on Automatic Exchange of Financial Account Information or the EU Council Directive 2011/16/EU (as amended by Council Directive 2014/107/EU)) so as to ensure compliance or deemed compliance (as the case may be) with the Standard and the CRS therein from 1 January The Company is obliged under Section 891F of the Taxes Consolidation Act 1997 (as amended) and regulations made pursuant to that section to collect certain information about each Investor s tax arrangements. Please note that in certain circumstances the Company may be legally obliged to share this information and other financial information with respect to an Investor s interests in the Company with the Irish Revenue Commissioners. In turn, and to the extent the account has been identified as a Reportable Account, the Irish Revenue Commissioners will exchange this information with the country of residence of the Reportable Person(s) in respect of that Reportable Account. In particular, the following information will be reported by the Company to the Irish Revenue Commissioners in respect of each Reportable Account maintained by the Company: The name, address, jurisdiction of residence, tax identification number and date and place of birth, in the case of an individual, of each Reportable Person that is an Account Holder of the account and, in the case of any Entity that is an Account Holder and that, after application of the due diligence procedures consistent with CRS is identified as having one or more Controlling Persons that is a Reportable Person, the name, address, jurisdiction of residence and tax identification number of the Entity and the name, address, jurisdiction of residence, TIN and date and place of birth of each such Reportable Person. The account number (or functional equivalent in the absence of an account number); The account balance or value as of the end of the relevant calendar year or other appropriate reporting period or, if the account was closed during such year or period, the closure of the account; The total gross amount paid or credited to the Account Holder with respect to the account during the calendar year or other appropriate reporting period with respect to which the Reporting Financial Institution is the obligor or debtor, including the aggregate amount of any redemption payments made to the Account Holder during the calendar year or other appropriate reporting period. Please note that in certain limited circumstances it may not be necessary to report the tax identification number and date of birth of a Reportable Person. 12 OF 13

14 In addition to the above, the Irish Revenue Commissioners and Irish Data Protection Commissioner have confirmed that Irish Financial Institutions (such as the Company) may adopt the wider approach for CRS. This allows the Company to collect data relating to the country of residence and the tax identification number from all non-irish resident Investors. The Company can send this data to the Irish Revenue Commissioners who will determine whether the country of origin is a Participating Jurisdiction for CRS purposes and, if so, exchange data with them. Revenue will delete any data for non-participating Jurisdictions. The Irish Revenue Commissioners and the Irish Data Protection Commissioner have confirmed that this wider approach can be undertaken for a set 2-3 year period pending the resolution of the final CRS list of Participating Jurisdictions. Applicants and Investors can obtain more information on the Company s tax reporting obligations on the website of the Irish Revenue Commissioners (which is available at or the following link in the case of CRS only: (All capitalised terms above, unless otherwise defined above, shall have the same meaning as they have in the Standard.) Complaints Please do not hesitate to contact us if you are not satisfied with this investment or the services received from Prescient. A complaint must be submitted to the Compliance Officer. Prescient will acknowledge the complaint in writing and will inform the investor of the contact details of the persons involved in the resolution thereof. If an investor is not satisfied with the response from Prescient or if an investor has a complaint about the advice given by the Financial Advisor, he/ she has the right to address his/her complaint in writing to the Ombud for Financial Services Providers at the address below. The Ombud is legally empowered to investigate and adjudicate complaints in a procedurally fair, economical and expeditious manner. P O Box Tel: Lynnwood Ridge Fax: info@faisombud.co.za 13 OF 13