DRIEHAUS MUTUAL FUNDS

Transcription

1 DRIEHAUS MUTUAL FUNDS Please return this application and your check to: Driehaus Mutual Funds c/o BNY Mellon Investment Servicing (US) Inc. P.O. Box 9817 Providence, RI If mailing via overnight delivery, please use the following address: Driehaus Mutual Funds c/o BNY Mellon Investment Servicing (US) Inc Computer Drive Westborough, MA New Account Application For assistance or to receive information to establish a Driehaus IRA account, please call Shareholder Services at (800) Account Registration Please type or print clearly. Please choose one type of account below: o INDIVIDUAL OR o JOINT ACCOUNT For joint registration, both owners must sign the application. The registration will be as joint tenants with the right of survivorship and not as tenants in common unless otherwise stated. Owner s (First, Middle, Last) Joint Owner s (First, Middle, Last) Social Security Number Joint Owner s Social Security Number Joint Owner s o CUSTODIAL ACCOUNT Uniform Gifts or Transfers to Minors Act (UGMA or UTMA) Custodian s (First, Middle, Last) Minor s (First, Middle, Last) Social Security Number Minor s Social Security Number Minor s Minor s State of Residency o TRUST For a statutory trust, please complete the Legal Entities section instead of this section. Please attach supporting documentation such as the trust agreement and documentation of persons authorized to act for the trust. o I am an exempt recipient as deemed under U.S. federal income tax regulations (e.g., C corporation, financial institution, registered broker-dealer, or tax-exempt organization). Please list your Exempt Payee Code below and certify your statement by signature in Section 11 below. of Trust Trustee of Beneficiary Date of Trust Agreement Trustee s Social Security Number Trustee s Taxpayer Identification Number of Trust Co-Trustee Exempt Payee Code (Please see IRS Form W-9 for a list of exempt payee codes) Additional Trustee s Social Security Number Additional Trustee s 1

2 Legal Entities o LIMITED LIABILITY COMPANY (LLC)* o STATUTORY TRUST o C CORPORATION o S CORPORATION o PARTNERSHIP o GOVERNMENT o OTHER ENTITY * Please attach supporting documentation such as the trust agreement and documentation of persons authorized to act for the trust or organization documents and evidence of authority to act for the entity. Please see Section 3 regarding beneficial owners. Individuals signing this application on behalf of an entity must provide the following personal information: name, date of birth, Social Security number and residential address to verify identity. o I am an exempt recipient as deemed under U.S. federal income tax regulations (e.g., C corporation, financial institution, registered broker-dealer, or taxexempt organization). Please list your Exempt Payee Code below and certify your statement by signature in Section 11 below. of Statutory Trust, Corporation, or Other Entity Trustee or of Authorized Person with control or authority over the account of Trust Beneficiary Date of Statutory Trust Agreement Authorized Person s Social Security Number Authorized Person s Type of Entity Taxpayer Identification Number of Entity Co-Trustee or of Additional Authorized Person with control or authority over the account Exempt Payee Code (Please see IRS Form W-9 for a list of exempt payee codes) Additional Authorized Person s Social Security Number Additional Authorized Person s 2. Owner Address STREET ADDRESS OF OWNER P.O. Box is not acceptable. STREET ADDRESS OF JOINT OWNER/CUSTODIAN/ AUTHORIZED PERSON MAILING ADDRESS (if different from Owner Address) DUPLICATE CONFIRMATION 2

3 3. Certification of Beneficial Owners for Legal Entity Clients Certification of Beneficial Owners for Legal Entity Clients This information is required by federal regulations as a means to identify and document information for individuals who own and/or control a legal entity. To help the government fight financial crime, federal regulation requires certain financial institutions to obtain, verify, and record information about the beneficial owners of legal entity customers. A legal entity includes a corporation, limited liability company, or other entity that is created by a filing of a public document with a Secretary of State or similar office, a general partnership, and any similar business entity formed in The United States of America or a foreign country. A legal entity does not include sole proprietorships, unincorporated associations, or natural persons opening accounts on their own behalf. Do not complete if the entity is publically traded on an exchange or subject to ERISA. Beneficial Owners Identify each individual who owns directly or indirectly through any agreement, arrangement, understanding, relationship, or otherwise 25% or more of the equity interests of the legal entity. o Check this box if no individual owns 25% or more of the legal entity and that you will inform the Fund if/when an individual assumes 25% or more ownership. Beneficial Owner 1: Beneficial Owner 2: Beneficial Owner 3: Beneficial Owner 4: Authorized Controlling Individual Provide information for one individual with significant responsibility for managing the legal entity (ex: CEO, CFO, managing member, general partner, president, treasurer, etc.). 3

4 4. Initial Investment Please indicate your choice of Fund(s) and the amount of initial investment. DRIEHAUS EMERGING MARKETS GROWTH FUND - INVESTOR (003)* $ DRIEHAUS EMERGING MARKETS GROWTH FUND - INSTITUTIONAL (023)*** $ DRIEHAUS INTERNATIONAL SMALL CAP GROWTH FUND (009)* $ DRIEHAUS EMERGING MARKETS SMALL CAP GROWTH FUND (013)* $ DRIEHAUS MICRO CAP GROWTH FUND (014)* $ DRIEHAUS FRONTIER EMERGING MARKETS FUND (015)** $ DRIEHAUS SMALL CAP GROW TH FUND - INVESTOR (016)* $ DRIEHAUS SMALL CAP GROW TH FUND - INSTITUTIONAL (036)*** $ *The Minimum Initial Investment is $10,000. **The Minimum Initial Investment is $250,000. ***The Minimum Initial Investment is $500, Method of Investment o CHECK Enclose your personal check or certified personal check made payable to DRIEHAUS MUTUAL FUNDS. Please note that funds will be held until checks clear. For a purchase of over $100,000, a certified check or wire transfer from your bank is required. Please see the prospectus for the forms of payment the Funds do not accept. o WIRE TRANSFER If you would like to make your initial investment by wire transfer from your bank please check the box, forward this application to Driehaus Mutual Funds at the above address, and a representative from Shareholder Services will contact you with an account number and instructions to initiate your purchase. Please call Shareholder Services at (800) with any questions. Please give your bank the following instructions: Bank of New York Mellon ABA # Credit: Driehaus Funds Consolidated Account Bank Account # Further Credit: (Shareholder name, fund name and account number to be provided) 6. Telephone Transactions (REDEMPTION/PURCHASE/EXCHANGE) TELEPHONE TRANSACTIONS (REDEMPTION/PURCHASE/EXCHANGE) Please note that by engaging in telephone transactions, you may forgo some of the security associated with written requests. For your protection, telephone requests may be recorded in order to verify accuracy. You agree by signing this application to indemnify the Fund and its transfer agent from all loss, liability, cost, damage and expense for acting upon such instructions. Please consult your prospectus for more details or contact Shareholder Services at (800) When making a telephone transaction you may be asked to provide certain account information, including, your account number, the exact name of your account, your social security number or taxpayer identification number and, if the desired transaction is an exchange, the name of the Fund you wish to purchase. Unless you check the box below, your account(s) will automatically have telephone redemption by check and exchange privileges. o I hereby do not authorize Driehaus Mutual Funds and BNY Mellon Investment Servicing (US) Inc., transfer agent, to honor telephone transactions to exchange/redeem shares when directed. Check the appropriate box(es) below to select additional telephone transactions options. o Redemption and Purchase by Automated Clearing House network. o Redemption by wire. (If you elected redemption by wire or redemption/purchase by ACH above, you must provide bank information in Section 10) 4

5 7. Automatic Investment Plan (IMPORTANT: If you choose this option, you must complete Section 10 below) This option allows you to make additional investments in your existing Fund account(s) automatically each month or quarter by electronically debiting your checking or savings account, provided your bank is an Automated Clearing House (ACH) member. Please check with your bank to make sure it is an ACH member and provide the information requested below. The number of days the Automatic Investment Plan takes to establish depends on the timing of your request to initiate this option. For more information, please contact Shareholder Services at On the day of each month or quarter, beginning in the month of, please invest the following amounts in the Fund(s) as indicated. If you do not select a date for Automatic Investment, the 20th of the month will be selected as the investment date. If the selected date falls on a weekend or holiday, your Automatic Investment will take place on the next available business day. The minimum initial investment of $10,000 (or $250,000 for the Driehaus Frontier Emerging Markets fund) must be met to use this option. These instructions apply to the following Fund(s) in the designated amounts: (check all that apply) o DRIEHAUS EMERGING MARKETS GROWTH FUND - INVESTOR (003)* $ o DRIEHAUS EMERGING MARKETS SMALL CAP GROWTH FUND (013) $ o DRIEHAUS MICRO CAP GROWTH FUND (014) $ o DRIEHAUS FRONTIER EMERGING MARKETS FUND (015) $ o DRIEHAUS INTERNATIONAL SMALL CAP GROWTH FUND (009) $ o DRIEHAUS SMALL CAP GROWTH FUND - INVESTOR (016) $ [The minimum monthly investment is $100 per Fund account and the minimum investment per quarter is $300 per Fund account] 8. Dividend & Capital Gains Instructions Unless you elect otherwise, all dividends and capital gains will be automatically reinvested in additional shares. o Please check this box if you prefer to be paid in cash. If you have elected to be paid dividends and/or capital gains in cash and would like the amount to be deposited by electronic transfer into a bank account, please complete Section 10 below. 9. Cost Basis Election The Driehaus Mutual Funds are responsible for tracking and reporting to the IRS realized gains and losses on your covered shares. In general, covered shares are shares acquired on or after January 1, Unless you instruct us otherwise, we will use average cost as the cost basis method for the sale of your covered shares. If you wish, you may choose another method from the options below. If your account method is average cost, whether by election or default, and you are receiving a gift, you agree to receive that gift at FMV if received at a loss. You may wish to consult with your tax advisor and/or financial professional before making important tax elections for your account(s). If you determine in the future that you wish to change your cost basis tax reporting method, you may do so by completing a Cost Basis Election Form, which can be found at or by calling Please select one method: o Average Cost (Default Method) AC o First In First Out (FIFO) FI o Specific Lot ID SL o Last In First Out (LIFO) LI o Lowest Cost First Out LO o Highest Cost First Out HI o Highest Cost Long Term First Out H1 o Highest Cost Short Term First Out H2 o Lowest Cost Long Term First Out L1 o Lowest Cost Short Term First Out L2 3

6 10. Bank Account Information Please provide a voided check or encoded deposit slip for the bank account to be used in conjunction with wire and ACH transactions. of Depositor (as shown on bank records) of Bank ABA Number Bank Address:, Country Account Number Bank Address (continued) 11. Signature and Certification To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. For certain entities, such as trusts, estates, corporations, partnerships, or other organizations, identifying documentation is also required. Your account may be restricted and/or closed if we cannot verify this information. We will not be responsible for any losses or damages (including but not limited to lost opportunities) resulting from any failure to provide this information, or from any restriction placed upon, or closing of, your account. By opening an account you signify you agree to these procedures and accept responsibility for any losses or damages resulting from their implementation. By signing this application, you certify that, to the best of your knowledge, the information provided above is complete and correct. I have read the current prospectus and this application and agree to all terms which, to the extent applicable, shall be binding upon my heirs, representatives, and assigns. I certify that I have power and authority to establish the account. I understand that the account is subject to the terms and conditions of the prospectus of the Driehaus Mutual Funds, as amended from time to time. In addition, I authorize the instructions in this application. I hold harmless and indemnify Driehaus Mutual Funds and its affiliates or mutual funds managed by such affiliates and each of their respective directors, trustees, officers, employees and agents from any losses, expenses, costs or liability (including attorney fees) which I may incur in connection with these instructions. I hereby authorize Driehaus Mutual Funds and its transfer agent to honor instructions processed under the above-selected account options to purchase/exchange/redeem shares when directed and as specified, by transmitting the proceeds, as applicable, to me at my address of record or by debiting/crediting my preauthorized bank account. I hereby ratify any such instructions. I understand that if I submit a change of address certain privileges will be suspended for a period of 30 days, and that all checks will be issued in the name(s) of all registered owner(s). I understand that, if no activity occurs in my account within the time period specified by applicable state law, the assets in my account may be considered abandoned and transferred (also known as escheated ) to the appropriate state regulators. I understand that the escheatment time period varies by state. I certify under penalties of perjury that: 1. The Social Security number and/or other taxpayer identification number shown on this form is correct; 2. I am a U.S. person (including a U.S. resident alien); 3. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Exemption from FACTA reporting code (if any): ; and 4. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding. If you are subject to backup withholding, check the box in front of the following statement: o The IRS has notified me that I am subject to backup withholding. The Internal Revenue Service does not require your consent to any provision of this document other than the above certifications required to avoid backup withholding. Signature: Owner, Authorized Person, etc. (exactly as it appears in Section 1) Signature: Joint Owner, Additional Authorized Person, etc. (exactly as it appears in Section 1) 4