APPLICATION FORM. BMO INVESTMENTS (IRELAND) PLC (an umbrella fund with segregated liability between sub-funds) (the Company )

Transcription

1 APPLICATION FORM BMO INVESTMENTS (IRELAND) PLC (an umbrella fund with segregated liability between sub-funds) (the Company ) Please complete this form in blue or black ink using BLOCK CAPITALS. TRADE DATE: day of 20 This application form should be sent without delay to the Administrator at the fax number stated below, with the original application form to follow to the address stated below. Redemption proceeds will not be processed until the Administrator is in receipt of the original application form and appropriate anti-money laundering documentation. All personal information submitted with this application form will be treated in accordance with the Company s privacy statement which is available at: BMO Investments (Ireland) plc C/O State Street Fund Services (Ireland) Limited (the Administrator ) Transfer Agency Department 78, Sir John Rogerson s Quay Dublin 2 Ireland Fax: The Applicant acknowledges that unless otherwise defined in this application form, all capitalised terms used herein shall have the same meaning as defined terms in the Company s prospectus dated 2nd July 2018, as may be amended, supplemented or replaced from time to time (the Prospectus ). The Applicant, having received and read a copy of the Prospectus and the Key Investor Information Document (the KIID ) for the Fund(s) and Share Class(es) to which its investment relates hereby applies to invest in the Company, as indicated in the table below: Fund Name Share Class Currency* Amount / Number of Shares (Please delete one) Pyrford Global Total Return (Sterling) Class A Stg Accumulating GBP Fund Class A Stg Distributing GBP Class B Stg Accumulating GBP Class B Stg Distributing GBP Class C Stg Accumulating GBP Class C Stg Distributing GBP *Subscription monies for the Share Classes of each Fund should be remitted in the designated currency of the relevant Share Class. The Administrator may, at its discretion, accept payment in other currencies, but such payments will be converted into the currency of the relevant Share Class at the then prevailing exchange rate and any conversion expenses shall be borne by the Shareholder. This may result in a delay in processing the application. SETTLEMENT DETAILS Currency: Account Name: Account Number: ABA: SWIFT: USD BMO Investments (Ireland) plc BOFAUS3N Currency: 1

2 Account Name: BMO Investments (Ireland) plc IBAN: Sort Code: SWIFT: BOFAGB22 * GBP payments should be made via CHAPS Currency: Account Name: IBAN: Sort Code: SWIFT: Currency: Account Name: IBAN: Sort Code: SWIFT: EUR BMO Investments (Ireland) plc GB35BOFA BOFAGB22 CHF BMO Investments (Ireland) plc GB66BOFA BOFAGB22 The Applicant acknowledges that due to anti-money laundering requirements operating within its jurisdiction, the Company, the Directors, the Administrator, the Investment Manager and any Sub-Investment Managers (each acting on behalf of the Company), may require directly or via a distributor, further identification of the Applicant before the Shares can be registered in the Applicant s name and the Company, the Directors, the Administrator, the Investment Manager and any Sub-Investment Managers shall be held harmless and indemnified against any loss arising as a result of a failure to process the application if such information has been required and has not been provided by the Applicant. The Applicant hereby applies for the Shares in the Fund indicated earlier in this application form on the terms and conditions set out in the Memorandum and Articles of Association of the Company, this application form and the Prospectus. The Applicant agrees to be bound by the terms of the Prospectus and the Memorandum and Articles of Association of the Company. Where the Applicant is a natural person, he/she confirms that he/she has reached the age of majority under the laws of his/her country of nationality or domicile. Where the Applicant is a corporate entity, it confirms that it has the full right and power to make this application and invest in Shares and all necessary corporate action has been taken to authorise this application and such investment. The Applicant acknowledges that it has received and read the Prospectus and the KIID(s) for the Fund(s) and Share Class(es) to which its investment relates and that this application is made on the terms of the Prospectus and is subject to the Memorandum and Articles of Association of the Company. The Administrator is hereby authorised and instructed to accept and execute any instruction (including, but not limited to, any instructions regarding subscriptions, switches or redemptions of Shares or any payment in relation to same or otherwise) in respect of Shares, given by the Applicant in written form, by facsimile or TradingPyrford@statestreet.com. Please note the address is for trade instructions only. The Applicant hereby agrees to indemnify each of the Administrator and the Company and to keep each of them indemnified against any loss of any nature whatsoever arising to any of them as a result of any of them acting upon instructions given in written form by the Applicant, i.e., by facsimile, confirmed by the Applicant in writing. The Administrator and 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. Amendments to investors registration details and payment instructions will only be effected on receipt of an original instruction which has been duly authorised. The Applicant is fully empowered and has authority to make this investment whether the investment is on its own behalf or on the behalf of another person or institution. The Applicant hereby represents and warrants that the Shares are not being acquired and will not be held in violation of any applicable laws. The Applicant confirms that it has the right and the authority to request a redemption of Shares and confirms that the Applicant will comply with the redemption procedures set out in the Prospectus. All redemption instructions must be given in writing, quoting the relevant account number and be accompanied by the relevant redemption documentation. The Applicant agrees to immediately sell or to tender to the Company for redemption or transfer Shares held by it in the Company if the continuing holding of the Shares by it would result in regulatory, pecuniary, legal, taxation or material 2

3 administrative disadvantage for the Company or the Shareholders as a whole or be otherwise contrary to the provisions of the Prospectus. The Applicant hereby agrees to indemnify and keep indemnified the Company, the Administrator and the Depositary, their affiliates, and the officers, directors, employees and professional advisers of any of the foregoing, from and against any loss arising to any of them as a result of any breach of any representation, warranty, covenant, undertaking, agreement, declaration, acknowledgement, instruction or confirmation by the Applicant in this application form or from the Applicant s failure to disclose any relevant details or provide it with all the information requested by the Company, the Administrator or the Depositary. In the case of delay or failure to provide satisfactory information, each of the Company and the Administrator may take such action (including declining to accept an application) as they think fit. (In respect of joint Applicants only). The Applicants direct that on the death of one of them the Shares for which they hereby apply be held in the name of and to the order of the survivor or survivors of the Applicants or the executor or manager of such survivor or survivors. The Applicant undertakes to observe and be bound by the provisions of the Memorandum and Articles of Association of the Company (as amended from time to time) and applies for the Shares issued in relation to this application to be entered in the register of Shareholders in the name of the Applicant (or in the name of a nominee or agent). The Applicant agrees to accept such lesser number of Shares, if any, than may be specified above in respect of which this application may be accepted. The Applicant acknowledges that Shares are subject to investment risks, including possible loss of principal amount invested. The Applicant confirms its agreement with the distribution policy as outlined in the Prospectus. The Applicant understands that the representations and warranties made herein are continuous and all subsequent subscriptions of Shares by the Applicant shall be governed by them, and the Applicant agrees to notify the Company or the Administrator promptly if any representation or warranty should cease to be true at any time. The Applicant acknowledges that, once submitted, this application form shall, subject to applicable law and regulation, be irrevocable by, and binding on, the Applicant. The Applicant consents to any notice or other document to be sent by the Company or the Administrator to the Applicant as a Shareholder, including, without limitation, the annual and other periodic reports and the KIID(s), being sent by electronic means including but not limited to , swift or posting such notice or other document on a website notified to the Applicant by post or by . The Applicant confirms that it has been notified electronically of the Company s website address and the place on the Company s website where the KIID(s) may be accessed. The Applicant acknowledges that it will be entitled to look solely to the assets of the relevant Fund in respect of all payments in respect of its Shares. If the realised net assets of the Fund are insufficient to pay any amounts payable in respect of the relevant Shares, the Applicant will have no further right of payment in respect of such Shares nor any claim against or recourse to any of the assets of any other Fund or any other asset of the Company or of the Administrator or of the Depositary. The Applicant acknowledges that subscription monies received by a Fund in advance of the issue of Shares will be held in a single umbrella cash account opened in the name of the Company (the Umbrella Cash Account ) and will be treated as an asset of the relevant Fund. For the avoidance of doubt, such monies will not be held in an account that is subject to the Central Bank (Supervision and Enforcement) Act 2013 (Section 48(1)) Investor Money Regulations 2015 for Fund Service Providers. Accordingly, subscribing investors will be unsecured creditors of the relevant Fund with respect to the subscription amount until the corresponding Shares are issued on the relevant Dealing Day. Such investors will not benefit from any appreciation in the Net Asset Value of the Fund or any other Shareholder rights in respect of the subscription amounts (including dividend entitlements) until such time as the Shares are issued. The Applicant acknowledges that monies held in an Umbrella Cash Account will be commingled with the assets and liabilities of the other Funds and will be exposed to counterparty risk, the risk of market conditions generally, the Fund s creditors and any other risks affecting the relevant Fund. In the event of an insolvency of a Fund, there is no guarantee that the Fund will have sufficient funds to pay unsecured creditors (including investors entitled to subscription, redemption and dividend payments) (see above) in full. The Applicant acknowledges that no interest will be paid on the amounts held in the Umbrella Cash Account prior to the payment of any redemption or dividend proceeds. Any interest earned on the monies in the Umbrella Cash Account will 3

4 be for the benefit of the relevant Fund and will be allocated to the Fund on a periodic basis for the benefit of the Shareholders at the time of the allocation. CONFIRMATION OF OWNERSHIP If you wish confirmation of ownership to be sent to you on a monthly basis please tick and ensure that your contact details are inserted below. Yes No Name: Name: Name: Name: DATA PROTECTION The Applicant agrees that the personal data contained in this application form together with any other personal data furnished in connection with the investment in the Company (the Data ) will be held and processed by and on behalf of the Company in accordance with the requirements of Regulation (EU) 2016/679, the General Data Protection Regulation, as described in further detail in the Company s data privacy statement, a copy of which is available on the website at The Applicant acknowledges that they have received and read the privacy statement. To the extent that the Data contained in this application form or any other information that is furnished in connection with the investment in the Company constitutes personal data in respect of another individual, the Applicant warrants that they have provided the privacy statement to such individual and have been authorised by that individual to acknowledge on that individual s behalf that such Data shall be held and processed on behalf of the Company in the manner outlined above. The Applicant acknowledges that all telephone calls may be recorded for record keeping and verification, security and quality assurance and training purposes. The Company and the Administrator may carry out electronic searches of publicly available or paid information with regard to anti-money laundering and client identification requirements and may retain records on file from such electronic searches. We would like to provide you with details of financial services and products that we offer which we think you might find interesting. If you would NOT like to receive such information, please tick this box [ ]. If at any time you change your mind, please let us know by ing us at preferences@bmogam.com. 4

5 ELECTRONIC DELIVERY OF ACCOUNT INFORMATION The Applicant hereby agrees and consents to have the Company, the Investment Manager, any Sub-Investment Manager and/or the Administrator electronically deliver Account Communications (as defined below) to it. Account Communications means all current and future account statements, constitutional documents of the Company (including the Prospectus, the Memorandum and Articles of Association and any supplements and/or amendments thereto), the KIID(s), letters to investors, annual audited financial statements, regulatory communications and other information, documents, data and records regarding the Shareholder s investment in a Fund. Electronic communication by the Company, the Investment Manager, any Sub-Investment Manager and/or the Administrator includes delivery as well as electronically making available Account Communications to Shareholders on the Company s, the Investment Manager s or any Sub-Investment Manager s internet site, if applicable. The Applicant hereby represents that it has regular access to the internet. The Applicant acknowledges that it has been offered the choice of receiving the KIID(s) on paper and in electronic form by means of a website or by and hereby specifically consents to receiving the KIID(s) in electronic form by way of or by accessing the latest version of the document online at (or such other website address as may be notified to the Applicant from time to time) through the Documents tab. The Applicant hereby acknowledges that it has received or accessed by electronic means the KIID(s) in respect of the relevant Share Class(es) or representative Share Class(es). The Applicant also consents to accessing the KIID(s) by electronic means before making any subsequent and/or future subscriptions for Shares in any Share Class and/or Fund. Where the Applicant is acquiring the Shares for or on behalf of any person in its capacity as a sub-distributor of the Company, the Applicant certifies that prior to accepting any order for the acquisition of Shares, the Applicant will ensure that the investor will be provided with the current KIID(s) for the relevant Share Class(es). Where permitted by applicable law, provided shall include informing the investor of the applicable website where the KIID(s) may be obtained, which is (or such other website address as may be notified to the Applicant from time to time). The Applicant s address is set forth below under the heading Details of Applicant(s). The Applicant hereby agrees to notify the Company in writing if its address details change. If an address is not provided, all communications will be delivered via post to the registered address of the Applicant set forth below under the heading Details of Applicant(s). The Applicant hereby acknowledges that it may at any time request a paper copy of the Prospectus or the KIID from the Company and that it may revoke or restrict its consent to electronic delivery of Account Communications at any time by notifying the Company, in writing, of its intention to do so. The Applicant hereby agrees that the Company, the Investment Manager, each Sub-Investment Manager and the Administrator will not be liable for any interception of Account Communications. Shareholders should note that no additional charge for electronic delivery will be assessed, but Shareholders may incur charges from internet service or access providers. In addition, there are risks, such as systems outages, that are associated with electronic delivery. 5

6 US PERSONS I/We confirm that I am/we are not a US Person (as defined in the Prospectus), am/are not applying for Shares as a nominee of a U.S. Person, and am/are not acting on behalf of, nor do I/we intend to transfer any Shares which I/we may purchase to, any US Person Return of Values (Investment Undertakings) Regulations, 2013 Pursuant to the Return of Values (Investment Undertakings) Regulations, 2013, any Applicant who is an individual, company or any unincorporated body of persons which are an Irish resident or ordinarily Irish resident must provide the following additional information and documentation: Tax Identification Number (TIN) / PPS Number (if applicable) Any one of the following additional documents is required to verify the TIN or PPS Number (either a copy or the original is sufficient): P60, P45, P21 Balancing Statement, payslip (where employer is identified by name or tax number), Drug Payment Scheme Card, European Health Insurance Card, Tax Assessment, Tax Return Form, PAYE Notice of Tax Credits, Child Benefit Award Letter/Book, Pension Book, Social Services Card or Public Services Card. In addition, any printed documentation issued by the Irish Revenue Commissioners or by the Department of Social Protection which contains the Applicant s name, address and tax reference number will also be acceptable. In the case of joint account holders, the additional documentation is required for each Applicant. 6

7 POLITICALLY-EXPOSED PERSONS Please complete EITHER Section A or B below, with reference to the definitions below A Politically-Exposed Person ( PEP ) is an individual who has at any time in the preceding 12 months been entrusted with a prominent public function. This includes the following individuals (but excluding any middle ranking or more junior official): a. a specified official ; and b. a member of the administrative, management or supervisory body of a state-owned enterprise. A specified official is (including any such officials in an institution of the European Communities or an international body): a. a head of state, head of government, government minister or deputy or assistant government minister; b. a member of a parliament; c. a member of a supreme court, constitutional court or other high level judicial body whose decisions, other than in exceptional circumstances, are not subject to further appeal; d. a member of a court of auditors or of the board of a central bank; and e. an ambassador, chargé d affairs or high-ranking officer in the armed forces. An immediate family member of a PEP includes any of the following persons: a. any spouse of the PEP; b. any person who is considered to be equivalent to a spouse of the PEP under the national or other law of the place where the person or PEP resides; c. any child of the PEP; d. any spouse of a child of the PEP; e. any person considered to be equivalent to a spouse of a child of the PEP under the national or other law of the place where the person or child resides; f. any parent of the PEP; and g. any other family member of the PEP who is of a class prescribed by the Minister for Justice under section 37(11) of the Criminal Justice (Money Laundering and Terrorist Financing) Acts, 2010 and A close associate of a PEP includes any of the following persons a. any individual who has joint beneficial ownership of a legal entity or legal arrangement, or any other close business relations, with the PEP; and b. any individual who has sole beneficial ownership of a legal entity or legal arrangement set up for the actual benefit of the PEP. As an example, a beneficial owner of a body corporate is any individual who (other than a company having securities listed on a regulated market): a. ultimately owns or controls, whether through direct or indirect ownership or control (including through bearer shareholdings) more than 25% of the shares or voting rights of the body; or b. otherwise exercises control over the management of the body. SECTION B: PLEASE CHECK BOX BELOW IF THE PEP RULES DO NOT APPLY WITH REFERENCE TO THE ABOVE DEFINITIONS: I/we confirm that the application is NOT being made by a PEP / immediate family member of a PEP / close associate of a PEP; AND the application is NOT being made for the benefit of a PEP / immediate family member of a PEP / close associate of a PEP; AND the Applicant does not have a beneficial owner who is a PEP / immediate family member of a PEP / close associate of a PEP; AND 10

8 it is NOT intended to transfer the Shares to a PEP / immediate family member of a PEP / close associate of a PEP. 11

9 This section is for all Applicants DETAILS OF APPLICANT(S) First Applicant: Registered Name: Account Designation (if any): Nature and Purpose of Entity: Registered Address (PO or C/O will not be accepted): Mailing Address (if different): Address: Contact Name: Tel No.: Fax No.: Additional Information for Individuals: Source of wealth (e.g., inheritance, income from employment, income from business activities) (if individual): Occupation (If individual or joint account): Joint Applicant(s): Details of up to three additional holders may be added to the application by completing Schedule A attached hereto. 12

10 This section is for Applicants which are bodies corporate only BENEFICIAL OWNER(S) If the Applicant is a body corporate and is beneficially owned by one or more persons, the following information must be provided. A beneficial owner is considered to be an individual or corporate entity: (a) which ultimately owns or controls, whether through direct or indirect ownership or control (including through bearer shareholdings) more than 25% of the share or voting rights of the Applicant, or (b) otherwise exercises control over the management of the Applicant. Beneficial Owner 1 (where applicable): Registered Name: Registered Address (PO or C/O will not be accepted): Entity Type: Date of Birth (if individual): Beneficial Owner 2 (where applicable): Registered Name: Registered Address (PO or C/O will not be accepted): Entity Type: Date of Birth (if individual): Beneficial Owner 3 (where applicable): Registered Name: Registered Address (PO or C/O will not be accepted): Entity Type: Date of Birth (if individual): Beneficial Owner 4 (where applicable): Registered Name: Registered Address (PO or C/O will not be accepted): Entity Type: 13

11 Date of Birth (if individual): 14

12 APPLICANT BANK ACCOUNT DETAILS FOR REDEMPTION AND DISTRIBUTION PAYMENTS Please list the details of the account to which redemption proceeds and/or dividend distributions should be paid. Payments will only be made to a bank account held in the name of the registered Shareholder. No third party payments will be made. Redemptions will not be processed on non-cleared/verified accounts. Both IBAN and SWIFT (BIC) Codes should be quoted for all banks within the EU/EEA. Amendments to the Applicant s payments instructions will only be effected upon receipt of an original instruction which has been duly authorised. In the case of joint accounts, instructions will only be made upon receipt of instructions duly signed by all Applicants. Correspondent Bank Name : Correspondent Bank Address: Correspondent Bank Sort Code/SWIFT (BIC)/ABA/Fedwire: Beneficiary Bank Name: Beneficiary Bank Address: Beneficiary Bank Sort Code/SWIFT (BIC)/ABA/Fedwire: Beneficiary Account Name: Beneficiary Account Number: Reference: DIVIDEND OPTION DISTRIBUTING SHARE CLASSES ONLY (please select) Shareholders will be assumed to have elected to invest distributions in additional Shares of the relevant Class unless a Shareholder designates otherwise in this application form. Reinvest Option: Automatic purchase of additional Shares of the same Distributing Share Class equivalent to annual dividends for such other intervals as the Directors may determine and notify in advance to Shareholders. Cash Option: Pay all dividends from a Distributing Share Class to the redemption bank account listed above. Should this section not be completed, dividends will be reinvested automatically annually or such other intervals as the Directors may determine and notify in advance to Shareholders. Changes to account details such as amending redemption bank accounts can be instructed by: One authorised signatory for the account: Two authorised signatories for the account: Other (please provide alternative authorisation procedures): 15

13 DECLARATION OF RESIDENCE OUTSIDE IRELAND (This section must be completed and signed) Applicants resident outside Ireland are 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 that this declaration, if it is then still correct, shall apply in respect of any subsequent acquisitions of Shares. Terms used in the declaration are defined in the Prospectus. Declaration on own behalf (*Please delete as appropriate) 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 Irish Resident or ordinarily resident in Ireland, and should I/we/the company* become Irish Resident or ordinarily resident in Ireland I/we will so inform you, in writing, accordingly. OR Declaration as Intermediary (*Please delete as appropriate) I/we* declare that I am/ we are* applying for Shares on behalf of persons: who are beneficially entitled to the Shares; and who, to the best of my/our* knowledge and belief, are neither Irish Resident nor ordinarily resident Ireland. I/we* also declare that: Unless I/we* specifically notify you to the contrary at the time of the application, all applications for Shares made by me/us* from the date of the 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 Irish Resident or ordinarily resident in Ireland. NOTES: Non-resident declarations are subject to inspection by the Irish Revenue Commissioners and it is a criminal offence to make a false declaration. In the case of a firm (not a limited company) applications should be in the name(s) of and signed by the proprietor(s). To be valid, the application form (incorporating the declaration required by the Irish Revenue Commissioners) must be signed by the Applicant. Where there is more than one Applicant, each person must sign. If the application 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. If this form is not fully completed to the satisfaction of the Administrator, the application/transfer may not be accepted. The Administrator acting on behalf of the Company reserves the right to reject an application for Shares in whole or in part. Persons who are resident or ordinarily resident in Ireland and who are seeking to apply for Shares should contact the Administrator for an application form, which does not include the above declaration. Irish residents who are entitled to payment without deduction of tax (i.e., exempt Irish Investor) should also request the appropriate alternative declaration form from the Administrator. Applicants who are resident in Ireland but not a taxable Irish person should contact the Administrator for the alternative declaration available for such Applicants. 16

14 AUTHORISATION The Applicant(s) agree(s) to be bound by the declarations, representations, consents and indemnities set out in this application form. Principal Applicant Signature / Authorised Signatory: (Declarant) Capacity of authorised signatory (if applicable): Name (block capitals): Date: day of, 20. Joint Applicants: Name: Signature: Name: Signature: Name: Signature: Name: Signature: 17

15 ANTI-MONEY LAUNDERING REQUIREMENTS Under Irish legislation and supplemental Guidance covering anti-money laundering, economic sanctions and the taxation of savings the Company and the Administrator are required to obtain the following documentation to verify the identity of all new applicants. This documentation should be provided with the application form. The documentation listed below may not cover all applications and the Company and the Administrator reserve the right to request additional documentation if required. Should documents be provided in a language other than English, an English translation may be required. Please note that the application may not be accepted until the Administrator is in receipt of all required anti-money laundering documentation, the original Application Form and the original banking details for the settlement of the redemption proceeds. In any event, redemption and dividend payments will not be processed until full anti-money laundering documentation has been received on the account and the Company and the Administrator reserve the right to take further action where full anti-money laundering documentation has not been received. Documentation which may be required for all Retail Applicants 1. Personal Verification 1 - ONE official photographic document (Certified 2 ) 2. Address Verification 3 - TWO different address verification documents (Original or Certified) Documentation which may be required for Designated Bodies in certain Countries 1. Confirmation of Name and Address 2. Confirmation of Regulatory Body 3. Original Authorised Signatory List 4. Original Letter of Assurance (where investing as an intermediary*) 5. Original letter of assurance (where investing as an intermediary) Documentation which may be required for non-designated bodies 1. Confirmation of name, office address, principal business address and registered number 2. Confirmation of regulatory body (if applicable) 3. Certificate of incorporation or certificate to trade (certified) 4. Memorandum and articles of association (certified) 5. Latest audited financial statements (certified) 6. Nature and purpose of the entity 7. List of directors to include full name, dates of birth, occupations, residential and business addresses 8. Authorised mandate or board resolution to establish the business relationship 9. Original authorised signatory list 10. ONE personal verification and TWO address verification documents for at least TWO directors OR ONE director and ONE authorised signatory (original or certified) 11. Verify the identity of all beneficial owners beneficially entitled to more than 25% of the entity s share capital or voting rights or otherwise exercises control over the management of the entity (if no beneficial owner holds more than 25%, verification of this is required (e.g., share register)) Documentation which may be required for pension fund accounts in certain countries 1. Confirmation of name and address 2. Pension scheme rules 3. Constitutional/formation document (e.g., trust deed) 4. Confirmation of registration from the relevant tax authorities or pensions board 5. Verification of the principal employer (if applicable) 1 Acceptable Personal Verification documents are a certified copy of a Passport or a Driver s License or National Identity Card. The certified documents must be in date, show a picture of the person, full name, date of birth and signature of the person. 2 Verification documents must be certified by a suitable person/entity, such as; the Companies Registration Office (or the equivalent in the investors jurisdiction) with regard to incorporation documentation, a notary public, a police officer, an embassy/consular official, a chartered or certified public accountant, a practicing solicitor, any Designated Body. Documents should be stamped with the official stamp of the person, dated and signed by that person. 3 Acceptable Address Verification documents are any TWO of the following: electricity bill, gas bill, water bill, telephone bill, cable television bill, bank statement or credit card statement, social insurance documents, household/motor insurance certificates. Documents must originate from a different source, show the full name and residential address of the applicant and must be dated within 6 months of submission. 18

16 6. Name, address and dates of birth of the officers/board members/trustees/directors/governors or equivalent 7. Identity verification for TWO officers/board members/trustees/directors/governors or equivalent 8. Evidence that the person representing the pension scheme is empowered to act (certified) 9. Original authorised signatory list Documentation which may be required for a nominee company 1. Confirmation of name and address of nominee company 2. Original authorised signatory list for the nominee account 3. Confirmation of name and address of parent of nominee 4. Confirmation of regulatory body of parent of nominee 5. Original authorised signatory list of parent 6. Proof of regulation (nominee / parent) 7. Original letter of assurance from parent Documentation which may be required for a trust/foundation/charity 1. Confirmation of name, registered and principal business address 2. Evidence of charitable status (if applicable) 3. Constitutional/formation document (e.g., trust deed or equivalent) 4. Nature and purpose 5. ONE personal verification and TWO address verification documents for at least TWO trustees/directors/governors/board members or ONE trustee/director/governor/board member and ONE authorised signatory (original / certified) 6. ONE personal verification and TWO address verification documents for any settler (where appropriate) 7. ONE personal verification and TWO address verification documents for all beneficiaries who own at least 25% of the capital 8. Original authorised signatory list Please note that the Administrator can only accept application forms from an entity that has legal capacity to enter into contracts on its own right and may require the constitutive document to legitimate legal status. 19

17 ANTI-MONEY LAUNDERING CONFIRMATION FOR NOMINEES/INTERMEDIARIES This confirmation can only be completed by designated bodies regulated for anti-money laundering purposes by the appropriate regulator in one of the following countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Guernsey, Hong Kong, Iceland, Ireland, Italy, Jersey, Luxembourg, Isle of Man, Netherlands, Norway, Portugal, Singapore, Spain, Sweden, Switzerland, United Kingdom, United States (please note this list is subject to change). DESCRIPTION OF APPLICANT DESIGNATED BODY INVESTING AS AN INTERMEDIARY NOMINEE COMPANY RELATIONSHIP OF CONFIRMATION PROVIDER (REGULATED ENTITY) TO APPLICANT APPLICANT PARENT OF APPLICANT UNLESS THE FOLLOWING BOX IS TICKED THE ADMINISTRATOR WILL APPLY THE BELOW CONFIRMATION TO ANY SUBSEQUENT DESIGNATED ACCOUNTS IN THE NAME OF THIS APPLICANT. DO NOT APPLY THE BELOW CONFIRMATION TO SUBSEQUENT DESIGNATIONS Name of regulated entity Name of regulator Address of regulated entity We confirm that we are a designated body regulated for anti-money laundering purposes by the above regulator and hereby confirm the following in connection with the Applicant: 1. We / the Applicant* has performed the anti-money laundering and counter-terrorist financing identification for any parties on whose behalf of the Applicant is purchasing Shares ( underlying investors ). 2. The evidence we / the Applicant* has obtained to verify the identity of the underlying investors, and where appropriate, their beneficial shareholders, meets the requirements of our national anti-money laundering and counter-terrorist financing legislation and regulations. 3. We confirm that all documents and information, which we / the Applicant* may have on our / the Applicant s* files relating to the identity of each underlying investor will be sent to a competent authority as soon as practicable upon the competent authority s request. 4. We confirm that all documents and information, which we / the Applicant* may have on our / the Applicant s* files relating to the identity of each underlying investor will be sent to the Administrator of the Company as soon as practicable upon its request, subject to applicable rules and regulations. 5. We / the Applicant* will retain these documents and information for a period of at least six years after the relationship with an underlying investor has ended. 6. We / the Applicant* will take measures to ensure that the underlying investors are neither individuals nor institutions against whom sanctions have been imposed by the EU or the United Nations or 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 Asset Control (OFAC). 20

18 Yours faithfully, Name: Title: Authorised signatory of regulated entity This should be signed by an authorised member of the Compliance Department or Legal Department (please state position) * delete as applicable 21

19 SCHEDULE A JOINT APPLICANTS (IF APPLICABLE) Second Applicant: Registered Name: Account Designation (if any): Nature and Purpose of Entity: Registered Address (PO of C/O will not be accepted): Mailing Address (if different): Address: Contact Name: Tel No.: Fax No.: Additional Information for Individuals: Source of wealth (e.g., inheritance, income from employment, income from business activities) (if individual): Occupation (If individual or joint account): Third Applicant: Registered Name: Account Designation (if any): Nature and Purpose of Entity: Registered Address (PO of C/O will not be accepted): Mailing Address (if different): Address: Contact Name: Tel No.: Fax No.: Additional Information for Individuals: Source of wealth (e.g., inheritance, income from employment, income from business activities) (if individual): Occupation (If individual or joint account): 22

20 Fourth Applicant: Registered Name: Account Designation (if any): Nature and Purpose of Entity: Registered Address (PO of C/O will not be accepted): Mailing Address (if different): Address: Contact Name: Tel No.: Fax No.: Additional Information for Individuals: Source of wealth (e.g.. inheritance, income from employment, income from business activities) (if individual): Occupation (If individual or joint account): Fifth Applicant: Registered Name: Account Designation (if any): Nature and Purpose of Entity: Registered Address (PO of C/O will not be accepted): Mailing Address (if different): Address: Contact Name: Tel No.: Fax No.: Additional Information for Individuals: Source of wealth (e.g.. inheritance, income from employment, income from business activities) (if individual): Occupation (If individual or joint account): 23

21 Instructions for completion and data protection notice ENTITY SELF-CERTIFICATION FOR FATCA AND CRS We are obliged under Section 891E, Section 891F and Section 891G, or, as applicable, Chapter 3A of Part 38 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 by completing this application form you are providing personal information, which may constitute personal data within the meaning of the Irish Data Protection Acts. 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 a Fund, with the Irish tax authorities, the Revenue Commissioners. They in turn may exchange this information, and other financial information with foreign tax authorities, including tax authorities located outside the EEA. 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: 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 account holders each investor is required to complete a separate Self-Certification form. (Mandatory fields are marked with an *) Investors that are individuals should not complete this form and should complete the form entitled Individual Self- Certification for FATCA and CRS. Section 1: Investor Identification Entity Name*: Country of Incorporation or Organisation: (the Entity ) Current Residence Address*: Number: Street: City, town, State, Province or County: Postal/ZIP Code: Country: Mailing address (if different from above): Number: Street: City, town, State, Province or County: Postal/ZIP Code: Country: 24

22 Section 2: FATCA Declaration Specified U.S. Person*: Please tick either (a), (b) or (c) below and complete as appropriate. a) The Entity is a Specified U.S. Person and the Entity s U.S. Federal Taxpayer Identifying number (U.S. TIN) is as follows (please also complete Sections 4 and 5): U.S. TIN: OR b) The Entity is a U.S. Person but not a Specified U.S. Person (please also complete Sections 4 and 5) OR c) The Entity is not a U.S. Person (please also complete Sections 3, 4 and 5) Section 3: Entity s FATCA Classification* (the information provided in this section is for FATCA, please note your classification may differ from your CRS classification in Section 5): 3.1 Financial Institutions under FATCA: If the Entity is a Financial Institution, please tick one of the below categories and provide the Entity s GIIN at 3.2 I. Irish Financial Institution or a Partner Jurisdiction Financial Institution II. Registered Deemed Compliant Foreign Financial Institution III. Participating Foreign Financial Institution 3.2 Please provide the Entity s Global Intermediary Identification number (GIIN) 3.3 If the Entity is a Financial Institution but unable to provide a GIIN, please tick one of the below reasons: The Entity has not yet obtained a GIIN but is sponsored by another entity which does have a GIIN I. Please provide the sponsor s name and sponsor s GIIN : Sponsor s Name:_ Sponsor s GIIN:_ II. Exempt Beneficial Owner III. Certified Deemed Compliant Foreign Financial Institution (including a deemed compliant Financial Institution under Annex II of the Agreement) IV. Non-Participating Foreign Financial Institution V. Excepted Foreign Financial Institution 3.4 Non-Financial Institutions under FATCA: If the Entity is not a Financial Institution, please tick one of the below categories I. Active Non-Financial Foreign Entity (including Excepted Non-Financial Foreign Entity) II. Passive Non-Financial Foreign Entity (If this box is ticked, please include individual self-certification forms for each of your Controlling Persons) 25

23 Section 4: CRS Declaration of Tax Residency (please note that you may choose more than one country)* Please indicate the Entity s country of tax residence for CRS purposes (if resident in more than one country please detail all countries of tax residence and associated tax identification numbers ( TINs )). NOTE: Provision of a Tax ID number (TIN) is required unless you are resident in a jurisdiction that does not issue a TIN. If the Entity is not tax resident in any jurisdiction (e.g. because it is fiscally transparent), please indicate that below and provide its place of effective management or country in which its principal office is located. Country of Tax Residency Tax ID Number Section 5: Entity s CRS Classification*(the information provided in this section is for CRS. Please note an Entity s CRS classification may differ from its FATCA classification in Section 3): For more information please see the CRS Standard and associated commentary Financial Institutions under CRS: If the Entity is a Financial Institution, please tick one of the below categories I. Financial Institution under CRS (other than (II) below) An Investment Entity located in a Non-Participating Jurisdiction and managed by another Financial Institution (If this box is ticked, please include the name of any Controlling Person(s) of II. the Entity and complete separate individual self-certification forms for each of your Controlling Persons**) 5.2 Non Financial Institutions under CRS: If the Entity is a Non Financial Institution, please tick one of the below categories I. II. III. IV. V. Active Non-Financial Entity a corporation the stock of which is regularly traded on an established securities market or a corporation which is a related entity of such a corporation Active Non-Financial Entity a Government Entity or Central Bank Active Non-Financial Entity an International Organisation Active Non-Financial Entity other than (I)-(III) (for example, a start-up NFE or a non-profit NFE) Passive Non-Financial Entity (If this box is ticked, please complete separate individual self-certification forms for each of your Controlling Persons**) ** Controlling Persons: NB: Please note that each Controlling Person must complete a separate Individual Self-Certification form. If there are no natural person(s) who exercise control of the Entity then the Controlling Person will be the natural person(s) who hold the position of senior managing official of the Entity. For further information on identification requirements under CRS for Controlling Persons, see the Commentary to Section VII of the CRS Standard 26

24 Section 6: Declarations and Undertakings Authorised Signature(s)*: Print Name(s)*: Capacity in which declaration is made*: Date: (dd/mm/yyyy):* 27

25 INDIVIDUAL (CONTROLLING PERSONS) SELF-CERTIFICATION FOR FATCA AND CRS Instructions for completion and data protection notice We are obliged under Section 891E, Section 891F and Section 891G, or, as applicable, Chapter 3A of Part 38 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 by completing this application form you are providing personal information, which may constitute personal data within the meaning of the Irish Data Protection Acts. 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 the Irish tax authorities, the Revenue Commissioners. They in turn may exchange this information, and other financial information with foreign tax authorities, including tax authorities located outside the EEA. 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 account holders each investor is required to complete a separate Self-Certification form. Section 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*: First or Given Name: Family Name or Surname: Current Residence Address*: Number: Street: _ City, Town, State, Province or County: Postal/ZIP Code: Country: Mailing address (if different from above): Number: Street: _ City, Town, State, Province or County: 28