PLEASE USE CAPITAL LETTERS! *REQUIRED INFORMATION CARVE 2 SUBSCRIPTION FORM FOR INDIVIDUALS *First name *Last name *Official registered address *Postal code *City/town *Country *Tel. daytime (incl. country and area codes) Fax (incl. country and area codes) *Country (domicile for tax purposes) New unit-holder in Brummer & Partners Existing unit-holder in Brummer & Partners *Unit-holder No./Personal ID No. *City/town of birth *Country of birth *Taxpayer Identification Number (TIN) (or the equivalent) E-mail address Guardian (if applicable) *Amount (minimal initial investment SEK 500,000, thereafter a minimum of SEK 100,000 per occasion) *Account number/iban (for payment of possible dividends and redemptions) *Bank/Bank account name Guardian's personal ID No. *BIC Investors must wire the payment from an account in your name. IMPORTANT 1. Investors must wire the payment from an account in your name 2. Please have your bank identify your name on the wire transfer. 3. We recommend that your bank charge its wiring fees separately so that the amount you have elected to invest may be invested. *Investment horizon <1 year 1 3 years >3 years The money that is supposed to be invested originates from (this applies for investments of SEK 500,000 or more) salary pension savings inheritance gift property sales corporate sales other,... *Is the money that is supposed to be invested transferred from another country than Sweden? No Yes... *Is the investment made on your own behalf? Yes No (specify on whose behalf)... *Are you a politically exposed person? Yes No *Are you a family member or known close associate to a politically exposed person? Yes No The subscription form must be received by Citco Fund Services (Ireland) Limited not later than five business days before the subscription date 1). After approval by Carve Capital AB, the subscription form will be confirmed. Payment amount must be received at Citibank Europe plc Sweden Branch, not later than two business days before the subscription date 1) in account number 9040-13 108 43. IBAN: SE31 9040 0000 0904 0131 0843. BIC: CITISESX. Please provide personal identification number/corporate registration number and personal/company name with the deposit. A contract note will be provided after payment has been received and the unit value determined. The latter takes place after the end of the month. The complete fund terms and conditions are provided in a separate information memorandum. Signature I solemnly declare that the above information is correct and that I will without delay inform the company about any changes to the information given above in cluding change of domicile, any changes in name, address and bank account number. I confirm that I have read, understood and accept the fund terms and conditions and the information about the Fund as presented in the simplified prospectus and the information memorandum. Furthermore, I assure that I by signing this subscription form and the following purchase of units in the Fund am not violating the laws or regulations in my home country. I confirm that the company may use this information if the authorities so require. For information on our processing of personal data, please refer to our Privacy Notice available on Brummer & Partners web site, www.brummer.se. I am are aware that the company does not provide financial advice of the kind that is referred to in the Act (2003:862) concerning Financial Advice to Consumers; I further confirm that I have not engaged the company to provide any such information. May 2018...... City/town, date Note! A certified copy of good quality of a passport must be enclosed. Carve 2 is a special fund as defined in Chapter 5, Section 1 of the Swedish Investment Funds Act (2004:46). Hence Carve 2 is not a so called UCITS fund. The units of Carve 2 have not been registered and will not be registered in accordance with any securities legislation in the United States, Canada, Japan, Australia or New Zealand or elsewhere and may not be offered or sold to or within the United States, Canada, Japan, Australia or New Zealand or in such countries where such offer or sale would be in conflict with applicable laws or regulations. Foreign law may prevent investors domiciled outside Sweden from investing in Carve 2. Carve Capital AB has no responsibility whatsoever for determining that an investment from a country outside Sweden is being made in accordance with the laws of such country. The information received from the company shall not be regarded as a recommendation by the company to subscribe for units in the fund, and it is the responsibility of individuals to make their own assessment of an investment Signature... Clarification of signature in the fund and of the risks associated with such an investment. There is no guarantee that an investment in Carve 2 will generate a positive return, even if financial markets perform favourably. Past performance is no guarantee of future return. The value of the captial invested in the fund may increase or decrease and investors cannot be certain of recovering all or parts of their invested capital. An investment in Carve 2 should be regarded as long-term in nature. Any dispute, controversy or claim relating to the fund or information about the fund shall be settled exclusively in accordance with Swedish law and in a Swedish court. Except for certain information related to market specific conditions, this form is prepared in the Swedish language and translated into English. In the event of any discrepancy between the two versions, the Swedish version shall have priority. Reg. no 5566887-9331, Registered office: Stockholm CARVE CAPITAL AB BOX 7030, SE-103 86 STOCKHOLM VISIT: NORRMALMSTORG 14 www.brummer.se
How to subscribe for units in the Carve 2 fund These instructions are a summary of the subscription rules provided in the Fund s information memorandum. 1. Fill in the enclosed subscription form and the form Self-certification for individuals. 2. Send the form by e-mail or fax to: Citco Fund Services (Ireland) Limited Custom House Plaza, Block 6 International Financial Services Centre Dublin 1 Ireland Attention: Investor Relations Group Tel: +353 1 636 73 00 Fax: +353 1 636 73 01 E-mail: dubirorders@citco.com (for subscriptions and redemptions), dublinweb@citco.com (for general investor enquiries) Remember to enclose the necessary documents pursuant to the Act on Measures against Money Laundering (see below). Your application to subscribe must reach us no later than 4 business days before the applicable subscription date. The Fund s subscription date is the last business day in each calendar month. For exact date, see www.brummer.se. 3. Pay in the subscription amount to the Fund s bank account IBAN: SE31 9040 0000 0904 0131 0843 BIC: CITISESX not later than two business days before the applicable subscription date. For exact date, see www.brummer.se. THE ACT ON MEASURES AGAINST MONEY LAUNDERING AND TERRORIST FINANCING There are rules in Sweden to prevent the financial system from being used for money laundering and terrorist financing. The rules are derived from the EU third money laundering directive, which means that the same rules are applicable in other EU countries. The rules states, i.a., that financial institutions have to collect information in order to "know their clients". Documentation requirements The new rules require the following documents to be handed over to the Administrator (at the above address) in connection with subscriptions to and redemptions of fund units. 1. Please provide the following to the Administrator along with the application: (a) a certified* copy of your passport (or national identity card) showing the photograph and signature; (b) if the applicant is resident outside of Sweden: two items of proof of address: for example an original or certified** copy of a recent utility bill or bank statement (not more than 3 months old); and (c) if you are acting as a nominee/custodian you fill in a Comfort Letter such as the letter enclosed in Appendix A. Please note: In certain limited circumstances the documentation requirements described below may be reduced. The Administrator will advise applicants if the circumstances apply on an individual basis. Politically exposed persons A politically exposed person is a person who holds or has held an important public position in a state or an international organisation. Individuals in important public positions are, among others, Heads of State, members of parliament, ministers, supreme court and supreme administrative court judges, national audit officers, members of the executive board of central banks, ambassadors, officers of high rank, directors or members of the board of state owned companies, or a member of senior management in an international organisation. Certification To certify means to witness and confirm/verify that an abstract or copy is an identical copy of the original. For a copied identity document to be regarded as correctly certified it shall be endorsed by one person (other than the person who wishes to subscribe to units in the fund) by writing his signature, his name in block capitals and his telephone number direct on the copy together with wording to the effect that the copy is an identical copy of the original. Example: I herewith certify that this copy is an identical copy of the original document: FIRST NAME LAST NAME, TEL +12 123 456 78...
Appendix A SAMPLE NOMINEE /CUSTODIAN COMFORT LETTER TO BE PROVIDED ON LETTERHEAD OF THE NOMINEE/ CUSTODIAN Citco Fund services (Ireland) Limited Custom House Plaza Block 6 International Financial Services Centre Dublin 1 Ireland (date) Re: Introduction of underlying Clients for (insert name of Nominee / Custodian) Dear Sir or Madam, We, (insert name of Nominee / Custodian) are regulated for the purposes of financial services as a (description of entity, ie. Investment Company, bank, insurance broker, etc.) by (the regulator name) in (jurisdiction). We hereby confirm to Citco Fund Services (Ireland) Limited that we perform the verification of identity of all our customers in line with the requirements of the local regulator and the money laundering legislation applicable to us including the Financial Action Task Force Recommendations as amended from time to time. We confirm that this customer verification of identity documentation is retained on file and that upon request, copies of the relevant customer records referred to above will be made available to your office to the extent permissible by law. In the event that we are prevented by local laws from supplying the documents used to identify clients to you, we will only release such information on the request of a competent authority. We confirm that the documentation will be retained on file for a period of at least 5 years from the date the relationship with the customer has ended. We furthermore confirm that we have adopted measures to prevent and detect the commission of an offence of financing terrorism and that all employees, directors and other officers have received the appropriate level of training to enforce these measures. We are aware that Citco Fund Services (Ireland) Limited is placing reliance upon the anti-money laundering and counter-terrorist financing identification carried out by us for the shareholders and underlying beneficial shareholders and that such reliance may result in detriment to you if there is a deficiency in the anti-money laundering and counter-terrorist financing identification carried out by us. Should our licence or registration as noted above, be revoked or altered at any future time, we undertake to advise you immediately. Yours faithfully, (Signature) (Name) (Title) (Signature) (Name) (Title)
INDIVIDUAL SELF-CERTIFICATION This self-certification form is collected to comply with existing and any future legislation enacted by any jurisdiction that provides for or is intended to secure the exchange of information (including, without limitation, under US FATCA and related Intergovernmental Agreements ( IGA ), various Agreements to Improve International Tax Compliance entered into and the OECD Common Reporting Standard for Automatic Exchange of Financial Account Information ( CRS ) including the EU Directive 2011/16/EU on Administrative Cooperation in the field of Taxation, as amended ( EU DAC ), or any other jurisdiction's legislation which is similar in effect to any of the above), any official interpretations or guidance thereof, or any law or regulations implementing an intergovernmental approach thereto, or any agreements made pursuant to the implementation of the foregoing, in each case as enacted, made, amended or replaced from time to time. US FATCA, CRS, EU DAC, applicable laws, regulations and/or guidance notes, are together referred to as the Automatic Exchange of Information ( AEOI ) regimes. Please seek professional advice when completing this form. Please type directly into this form and return a signed copy. SECTION 1 - INDIVIDUAL IDENTIFICATION 1 1. 2. First Name Last Name Date of birth (DD/MM/YYYY) 3. Place and Country of birth 4. Country of citizenship (if more than one, please state all) May 2018 5. Residential address Do not use a P.O. box or in-care-of address. 6. Mailing address (if different from above) City/Town State/Province Postal Code/Zip Code Country City/Town State/Province Postal Code/Zip Code Country 1 For Citco use only: C&T: Individual TE Number: CB: Account Number:
SECTION 2 - DECLARATION OF TAX RESIDENCE I hereby confirm that I am, for tax purposes, resident in the following countries. When the Individual is US citizen/us passport holder and/or resident in the US for tax purposes (green card holder or resident under the substantial presence test 2 ), an IRS form W-9 must be completed and attached. If the Individual is no longer a US citizen, the Individual must provide a certificate of loss of nationality of the United States and a copy of the foreign passport. Country/Countries of Tax Residence Tax Reference Number ( TIN ) or functional equivalent Overview of the Tax Identification Numbers domestic rules: http://www.oecd.org/tax/automatic-exchange/crs-implementation-and-assistance/tax-identification-numbers/ SECTION 3 - 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 undertake to advise the recipient promptly and provide an updated Self- Certification form within 30 days where any change in circumstances occurs, which causes any of the information contained in this form to be inaccurate or incomplete. Where legally obliged to do so, I hereby consent to the recipient sharing this information with the relevant tax information authorities. I acknowledge that the information contained in this form may be reported to the relevant tax authorities pursuant to international agreements and domestic laws under the AEOI regimes. Complete Information Print name of signer Date (DD/MM/YYYY) : Position/ Title Sign Here Authorized Signature 2 For further information on US tax residency for non-us citizens, refer to the Publication 519 in the IRS website: https://www.irs.gov/publications/p519/ch01.html