Application Form. for funds managed by Allianz Global Investors GmbH Branch Luxembourg and Allianz Global Investors Ireland Limited.

Transcription

1 IN COOPERATION WITH: Application Form for funds managed by Allianz Global Investors GmbH Branch Luxembourg and Allianz Global Investors Ireland Limited Page 1 of 9

2 Fax Application form to: All Original Account Opening Documents to be sent to: RBC Investor Services Bank S.A. In case of questions please contact RBC IS Customer Support Attn. Register Department Telephone number: , Porte de France allianzgi-clientservice@rbc.com L E sc h - s u r-a lzet te S e r vice h o u r s: M o Fr 0 8 : : 0 0 C E T i n f ive l a n g u a g e s Luxembourg (English, French, German, Italian and Spanish) Page 2 of 9

3 Applicant Information (All fields mandatory) Financial Institution Insurance Company Corporate Pension Fund Investment/ Mutual Fund Fiduciary Government Entity Partnership Foundation Nominee Trust Other (Please specify) Stock exchange listing: Yes No Regulated Entity: Yes No License number: Regulator web-address: Company Name Contact Name Date of Incorporation Country of Incorporation Country of Taxation Activity/Occupation (nature of business) Registered Address Number Post Code Town Country Fax Number Telephone Number Address Address for Correspondence if different from the above Registered Address Number Post Code Town Country Fax Number Telephone Number Address Account Designation, if different from the above Contract Notes to be sent by: Swift (Swift Code) Fax (Fax Number) * ( Address) Monthly Holdings Report to be sent by: Swift (Swift Code) Fax (Fax Number) * ( Address) *In the event of receiving the above documents by , please complete and sign the RBC indemnification letter available on our website Service&Tools, Order methods, or by using this link: This account opening form shall be valid for this application as well as for all in future requested designations Settlement information Please refer to the document Payment instructions to the Funds collection accounts at RBC IS which can be found on our website Service&Tools, Order methods, or by using this link: For SWIFT payments you will find the instructions for MT 103 and MT 202. Please note, that not respecting Cut-off times may result in late payments and therefore in additional costs. Page 3 of 9

4 Bank Account Details* All accounts must be in the name(s) of the account holder(s). Bank account details of Subscription payments ** Bank Name Bank SWIFT / BIC / Sort Code Account owner / Name of the account Account or IBAN Number Country of Bank Bank account details for Redemption payments Bank Name Bank SWIFT / BIC / Sort Code Account owner / Name of the account Account or IBAN Number Country of Bank In case payments must be made through a correspondent bank, please provide the following information: Bank Name Bank SWIFT / BIC / Sort Code Account owner / Name of the account Account or IBAN Number Country of Bank Dividend Instruction In the case of distribution shares being held, please tick off corresponding box of your choice: Dividends will be paid directly to the bank details specified above for redemptions Dividends will be automatically reinvested in the purchase of further shares Please provide us with your standard settlement instruction (SSI) for the various currencies to allow quick transactions in case of redemption or dividends. * Please note that payments to or for the accounts of third parties are not accepted. In case you have changed your Bank Account Details, please send a duly signed written instruction to RBC IS. RBC IS will pay redemption or dividend proceeds to your new Bank Account only if it has received before the original of this written instruction. ** In order to identify source of funds in line with Luxembourg KYC Guidelines. Page 4 of 9

5 Tax information As per the international and local tax laws and regulations applicable to the Fund, Allianz Global Investors GmbH Branch Luxembourg/ Allianz Global Investors Ireland Limited and their investments, the Fund and AllianzGI GmbH Branch Luxembourg/ Allianz Global Investors Ireland Limited have a mandatory duty to collect tax related information about the Account Holder and as the case may be the final beneficiary owner(s). In certain circumstances (including if a valid self-certification is provided), the Fund and AllianzGI GmbH Branch Luxembourg/ Allianz Global Investors Ireland Limited may be obliged to share this information with relevant tax authorities according to applicable tax laws and regulations. If you have any questions about your tax residency, please contact your tax advisor. 1 FATCA 1.1 U.S. Person Please tick either (a) or (b) and complete as appropriate. (a) The Applicant is a specified U.S. Person and the Applicant s U.S. Federal Taxpayer Identifying number (U.S. TIN) is as follows: (b) U.S. TIN The Applicant is a U.S. Person but not specified and the Applicant s U.S. Federal Taxpayer Identifying number (U.S. TIN) is as follows: U.S. TIN 1.2 Declaration of tax residency Please indicate the Applicant s place of tax residency (if residency is more than one country please detail all countries of tax residency and associated Tax ID numbers). Country of Tax residency Tax ID number U.S. TIN 1.3 Financial Institutions Please tick either (a), (b) or (c) and complete as appropriate. (a) If you are not incorporated in a U.S. county/territory for tax purposes, please provide your Global Intermediary Identification number: GIIN: (b) (c) The applicant is an IGA Partner Jurisdiction Financial Institution and has not yet obtained a GIIN. The applicant has not yet obtained a GIIN but is sponsored by another entity which does have a GIIN. Please provide your sponsor s name and sponsor s GIIN: Sponsor s Name: Sponsor s GIIN: Page 5 of 9

6 (d) If you are a Financial Institution, please provide a GIIN, and please tick one of the below FATCA status: 1. Participating Foreign Financial Institution (PFFI) 2. Reporting Foreign Financial Institution under IGA Model 1 3. Reporting Foreign Financial Institution under IGA Model 2 4. Registered deemed-compliant Foreign Financial Institution 5. Direct Reporting Non-Financial Foreign Entity 6. Sponsored Direct Reporting Non-Financial Foreign Entity 7. Certified Deemed Compliant Foreign Financial Institution (including a Foreign Financial deemed compliant under Annex II of an IGA) 8. Restricted distributor 9. Exempt beneficial owner 10. Non-participating Foreign Financial Institution 11. Territory Financial Institution 12. Other, please specify: 1.4 Non-Financial Institutions FATCA Classification If the Applicant is not a Foreign Financial Institution, please confirm the Applicant s FATCA status below: The Applicant is an Active Non-Financial Foreign Entity. OR The Applicant is a Passive Non-Financial Foreign Entity (if the Applicant is a Passive Non-Financial Foreign Entity, please provide details of any Controlling Persons (whose percentage of ownership is 25% or greater) which are U.S. citizens or residents in the U.S. for tax purposes. The term Controlling Persons is to be interpreted in a manner consistent with the recommendations of the Financial Action Task Force. OR I am an Excepted Non-Financial Foreign Entity Full name Date of birth and Place of birth Full residence address % of ownership US Tax ID number Tax residency country The Applicant declares by its signature of this application form that the above information is correct and that he will as soon as practical inform the Fund, the Company and Registrar if the information changes. Page 6 of 9

7 2 CRS Classification 2.1 Declaration of Tax Residency - CRS (Note: Declaration of Tax residency is requested in the context of the OECD Common Reporting Standard ( CRS ), an initiative to implement automatic exchange of financial account information on a global basis.) Please indicate the Entity s place of tax residence (if resident in more than one country please detail all countries of tax residence and associated Tax ID numbers). Country of Tax Residence Tax ID Number (TIN) or equivalent TIN or equivalent not available Reason if TIN or equivalent not available: 2.2 Entity type identification FINANCIAL INSTITUTION (FI) Investment Entity with tax residence in non-participating jurisdiction and managed by an other FI (please fill in Section Controlling Person) Other Investment Entity Financial Institution other than above Investment Entity (Depository Institution, Custodial Institution, Specified Insurance Company) Financial Institution Non Reporting according to your local jurisdiction legislation where you are resident (type to precise below) NON FINANCIAL ENTITY (NFE) Active Non Financial Entity - Corporation that is regularly traded or an affiliate of such corporation Active Non Financial Entity - Governmental Entity or Central Bank Active Non Financial Entity - International Organisation Active Non-Financial Entity other than above Active Non Financial Entity Passive Non-Financial Entity (please fill in section Controlling Person) Page 7 of 9

8 3 Controlling Persons identification This section is mandatory if Entity Type under section Tax information is indicated: as Passive Non-Financial Foreign Entity (FATCA) as Passive Non-Financial Entity (CRS) Full name Date of birth Place of birth Full residence address Tax residence country Tax ID Number (TIN) or equivalent Comments if no TIN or equivalent Role number (please see below table for reference) Controlling Persons Type - allowed Role number entries: CP of legal person ownership 801 CP of legal person other means 802 CP of legal person senior managing official 803 CP of legal arrangement trust settlor 804 CP of legal arrangement trust trustee 805 CP of legal arrangement trust protector 806 CP of legal arrangement trust beneficiary 807 CP of legal arrangement trust other 808 CP of legal arrangement other settlor-equivalent 809 CP of legal arrangement other trustee-equivalent 810 CP of legal arrangement other protector-equivalent 811 CP of legal arrangement other beneficiary-equivalent 812 CP of legal arrangement other other-equivalent 813 Unknown UN We declare (as an authorised signatory of the Entity) that the information provided in this form is, to the best of our knowledge and belief, accurate and complete. We 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 is 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 countires) have entered into agreements to exchange financial account information. We undertake to advise the Registrar and Transfer Agent promptly and provide updated information where any change in circumstance occurs which causes any of the information in this form to be incorrect. Page 8 of 9

9 Declaration of investor type Please select one of the following in what capacity you are investing On own account We declare that we are applying for Units/Shares for our own account and are beneficially entitled to the Units/Shares in respect of which this declaration is made. On behalf of another person or institution * Please indicate your categorisation under the MIFID regulation: Professional Client Eligible Counterparty We declare and confirm the following: We are applying for Units/Shares on behalf of persons who are beneficially entitled to the Units/Shares; such persons or institutions are not named in or subject to Financial Sanctions regimes imposed by either the United Nations, the US Office of Foreign Assets Control (OFAC), or the relevant regulatory authorities in the territory in which we are located; We will verify the identity of the person on whose behalf we are making investments into your funds; We will retain documentary evidence of this verification procedure; and We will make this documentation available to the Registrar and Transfer Agent upon reasonable request. We declare that the origin of the funds used for subscription(s) is coming from: * You may be contacted by the Registrar and Transfer Agent for the appropriate letter of assurance to be completed. The applicant hereby acknowledges that the general terms and conditions have been made available and form part of this agreement and agrees that the general terms and conditions shall apply. ( Service&Tools, Order methods, or by using this link: Authorised signatures: 1 st name 1 st signature Place/Date Title / Position 2 nd name 2 nd signature Place/Date Title / Position Page 9 of 9