FORMOSA ASIA OPPORTUNITY LIMITED ( 本基金 ) c/o HSBC Institutional Trust Services (Asia) Limited (the Services Provider ) 17/F, Tower 2 & 3, HSBC Centre 1 Sham Mong Road Subscription value on Kowloon, Hong Kong Fax No.:(852) 3409-2690 (Dealings) (852) 3409-2693 (Enquiries) Attn: Transfer Agency 投資者服務 Signature: SUBSCRIPTION FORM 認購表 U6 Please complete this Subscription Form in English using block capitals. Complete details must be given to ensure that your subscription request is properly processed. 請以英文正楷填寫本認購表之英文部分 閣下須填入完整詳細之資料, 方可確保閣下之認購要求得以妥當執行 1.Subscription Details 認購詳情 *I/We confirm that *I/we have received and read the latest Information Memorandum, the Addenda thereto and the financial reports of Formosa Asia Opportunity Limited (the "Fund") and wish to invest in the Fund subject to the terms of the Information Memorandum, the Addenda thereto and the Memorandum and Articles of Association of the Fund. 本人 / 我等確認本人 / 我等已收到並細閱最新之基金說明書 其附錄及 本基金 之財務報告, 有意根據基金說明書 其附錄及本基金章程之條件投資本基金 The Sub-Funds and Classes thereof available for investment are listed below. Please state the amount which you wish to invest in the relevant Class(es). The minimum investment amount for each Class is stated in the Addendum relating to the relevant Sub-Fund of which such Class forms part. 可供投資之附屬基金如下, 請註明閣下有意投資附屬基金之金額 各附屬基金最低投資額載於有關附屬基金之附錄 Sub-Fund 附屬基金 Class 股份等級 # Net Investment Amount (please state the currency of your payment) 淨認購股份金額 ( 請註明幣別 ) Dealing fee 另行支付之申購手續費 ( 請註明幣別 ) cheque or banker's draft in (state currency), issued in favour of "HSBC Institutional Trust Services (Asia) Limited - AFS Subscription Account", crossed "Account Payee, Not Negotiable", stating the name of the applicant and the relevant Sub-Fund/Class on the back, and sent to the address as printed at the top of this form. 開立 ( 註明幣別 ) 之支票或銀行匯票, 以 HSBC Institutional Trust Services (Asia) Limited - AFS Subscription Account 為受款人, 劃線標記 Account Payee,Not Negotiable 並於支票背面註明申購人姓名及附屬基金 / 股份等級名稱後, 寄往表格上方所示之地址 3.Investor's Details 投資者資料 : Do you have an existing account in the Fund 閣下目前是否已在本基金開立帳戶? please tick (V) one box only 請僅於其中一項方格內劃勾 (V) No 無 Yes 有 If so, please indicate the Account Name and Holder ID: 請註明帳戶名稱及編號 : *My/Our personal details are as follows 本人 / 我等個人資料如下 : UG Greater China Multi-Strategy Fund C * Passport 護照號碼 / Company Registration No. 公司登記證號碼 Country of *Issue 簽發 / Incorporation 註冊國家 # Please refer to Note 6 請參考注意事項第 6 點 2.Payment Details 付款詳情 * I/We wish to pay the investment amount by 本人 / 我等希望通過下述方式支付投資金額 : (please tick (V) your preferred choice 請以 V 示意閣下屬意之選擇 ) telegraphic transfer to 電匯至 : Bank name and address 銀行名稱及地址 Swift Code 電報代碼 HSBC New York 452 Fifth Avenue, New York, NY 10018, U.S.A MRMDUS33 Contact Address 通訊地址 Telephone No. 電話號碼 Fax No. 傳真號碼 E-mail address 電郵地址 Bank account name 銀行帳戶名稱 Bank account number 銀行帳號 Remarks 備註 HSBC Institutional Trust Services (Asia) Limited AFS Subscription Account 000-14117-8 By order of [name of subscriber 投資者姓名 ] for subscription of [ 附屬基金及股份等級名稱 ] UG Greater China Multi-Strategy Fund C Class and [trust no. 基金戶口號 ]:006-129340-431 Source of Fund 資金來源 Individual Investor only 只限個人投資者 Occupation 職業 Institutional Investor only 只限機構投資者 The investment is made for the company s own account and not on behalf of any other party 是項認購為本公司自己帳戶所做的投資, 不是代其他任何個人或機構投資 YES 是 / No 否 *(delete as appropriate 刪除不適用者 )
4.Joint Shareholders Authorisation 共同持有人授權 If there is more than one Shareholder, details of the other Shareholders should be provided on a separate sheet. A maximum of four persons may be joint holders of Shares in the Fund. 若股份持有人多於一人, 其他持有人之資料應另頁而書 共同持有基金股份之人數最多四人 Please tick (v) one box only 請僅於其中一項方格內劃勾 (V): please tick Yes box if you wish to authorise the Investment Manager, UG Investment Advisers Limited, to act upon the instructions of the only Shareholder named on the Form in respect of dealings in Shares or any other matters relating to the Shares. If Yes box is ticked, correspondence for joint accounts will be sent only to the Shareholder named above. Otherwise, please tick No such authorisation has been made. 若閣下有意授權投資經理 UG Investment Advisers Limited 根據唯一姓名記載於此表格之持有人就股份交易或其他有關事項而發出之指示行事, 請於 有 方格內劃 V 若 有 方格劃 V, 則有關聯合帳戶之信函將僅送交至上述持有人 否則, 請選擇 無此項授權 Yes 有 No such authorisation has been made 無此項授權 5.Bank Account Details 銀行帳戶資料 If you would like future redemption proceeds to be paid into your bank account by telegraphic transfer, please tick (V) the appropriate box to indicate your choice (please note all charges incurred in such transfer will be to your account) 若閣下希望將來的贖回收益通過電匯, 請於適當方格內劃 V, 指明閣下之選擇 ( 請注意電匯過程所產生之費用將記入閣下之帳戶 ) Please use the Bank Account Details in my previous Subscription Form. 請使用先前認購表所記載之銀行帳戶 Please use the following Bank Account Details in respect of a new account or an existing account the details of which have been changed. 新帳戶或資料已變更之現有帳戶, 請使用下述銀行帳戶資料 Bank name & address 銀行名稱及地址 Swift Code 電報代碼 Bank account name 銀行帳戶名稱 Bank account number 銀行帳號 Remarks 備註 6.Financial Adviser / Agent Details 財務顧問 / 代理人詳情 Complete this part only if you are submitting this Subscription Form through a financial adviser or agent. Please note that if you establish your account through a financial adviser or agent, all future instructions on your account should also be submitted through that financial adviser or agent. 若閣下通過財務顧問 / 代理人遞交本認購表, 方需填寫本部分資料 請注意若閣下通過財務顧問或代理人開立帳戶, 未來與閣下帳戶有關之指示亦須通過該財務顧問或代理人傳送 Financial Adviser's / Agent's name 財務顧問 / 代理人姓名 Financial Adviser's / Agent's company chop & signature 財務顧問 / 代理人公司簽章 7.Dealing Fee 交易費用 By Signing hereinafter, *I/we agree to pay an initial charge of % (USD ) of, and additional to, *my/our subscription amount. *I/we also acknowledge that *I/we will have to pay different levels of redemption charge according to relevant Sub-Fund s Addendum when *I/we redeem the Participating Shares. 本人 / 我等於本表簽名時, 即代表本人 / 我等同意於申購金額外另行支付 %(USD ) 之申購手續費 本人 / 我等並明瞭於贖回所持股份時, 本人 / 我等應依照各附屬基金之附錄規定, 支付不同費率之贖回手續費 8.Signature(s) of Shareholders 簽名 Please state "N/A" in the space where no Shareholder's signature is required. 請於無需持有人簽名之處註明 "N/A" : : : : Date 日期 : *(delete as appropriate 刪除不適用者 ) Application of subscription should be received before 5:00 p.m. (Hong Kong time) at least 5 Business Days prior to Dealing Day, and the payment should be made within two Business Days of submitting the completed Subscription Form. 認購表應於交易日前 5 個營業日 5:00 p.m. ( 香港時間 ) 前遞交, 並應在遞交填妥的認購表後兩個營業日內支付 NOTES 注意事項 1. All joint Shareholders must sign this Subscription Form. A corporation should sign under the hand of a duly authorised official together with a company chop or seal. 所有共同持有人須簽署此認購表 若為法人者, 須由一名經妥當授權之負責人簽署, 并加蓋公司印章 2. Investors are required to provide the KYC documents according to the KYC Requirement List requested by the Service Provider. Investors with address in the United States of America MAY NOT be accepted. 持有人需提交依照保管人所要求之身份證明文件 地址在美國之持有人可能不獲接納 3. For applications in currencies other than the currency of account of the relevant Sub-Fund, please contact the Service Agent care of the address, fax number shown at the top of this Form before applying for Participating Shares in the relevant Class. The number of Participating Shares in the relevant Class to be issued for such applications will be determined by the Investment Manager calculating the equivalent of the subscription monies in the currency of account of the relevant Sub-Fund at an exchange rate which the Investment Manager thinks appropriate and after deducting the cost of exchange. All foreign exchange conversion costs or bank charges in respect of banker's drafts or telegraphic transfers will be for the account of the applicant. 若以有關附屬基金之帳戶貨幣以外之貨幣提出申請, 在申請股份之前, 敬請聯絡保管人 其地址 傳真號碼見此表首端代收人一項 就該等申請而簽發的股份將由投資經理根據其認為適當之匯率, 將認購款項折算為有關附屬基金之帳戶貨幣並扣除兌換費用而確定 所有外匯兌換費用或就銀行匯票或電匯而產生之銀行費用將由申請人承擔
4. Applications for Participating Shares in the relevant Class received by telephone, telex or fax will not be acted upon until written confirmation of such instructions has been received and payment of subscription monies received in cleared funds. The Investment Manager may, in its absolute discretion, refuse to act upon any telephone or facsimile instructions purportedly given by the Shareholder or on the Shareholder's behalf and may require original written instructions instead. The Investment Manager is not obliged to verify the authority or identity of the person giving such instructions as long as the Investment Manager in good faith believes that person to be the Shareholder or someone authorised by the Shareholder. 任何通過電話 電傳或傳真收到的股份申請在未收到書面確認及以任何淨額款項支付之認購款項之前不會得以執行 投資經理可完全自主酌情決定拒絕執行持有人或其代表提出之任何電話或傳真指示, 並可要求提供書面指示原件 只要投資經理誠意相信給予指示之人士乃持有人或經其授權人士, 投資經理無義務確證該等人士之授權及身份 5. The Investment Manager may take any action which it considers appropriate to implement such instructions notwithstanding any error, misunderstanding or lack of clarity in the terms of the instructions. The Investment Manager shall not be liable for any direct or indirect loss resulting from its acting on such instructions or on the instructions contained in this Form including, without limitation, arising from the Investment Manager exercising its discretion given in (4) above. 儘管指示之條款有任何錯誤 誤解或不清晰, 投資經理可採取其認為適當之任何行動以執行該等指示 投資經理不就因其執行該等指示或此表所載之指示 ( 包括但不限於投資經理行使上述第 4 項所授予之自主決定權 ) 而導致的任何直接或間接損失而承擔任何責任 6. The actual investment amount is based on the balance received by the Service Provider after deducting all relevant fee charges. The Service Provider will, as soon as possible after receipt of subscription monies in cleared funds, issue a written confirmation to Shareholders confirming their investment in the relevant Class and their registration as Shareholders of the Fund but actual share certificates will not be issued. 持有人之實際投資金額乃依據保管人收到之認購款項扣除所有相關之交易費用後之認購款項淨額 保管人將於收到認購款項淨額後儘快向股份持有人簽發一份確認書, 確認其於有關附屬基金內的投資額以及其已經註冊為本基金股份持有人, 但不會實際簽發股份證書 7. I/We agree that: a. Information supplied on this subscription form and otherwise in connection with my/our subscription may be held by the Administrator and the Service Provider and will be used for the purposes of processing my/our subscription and completion of information on the register of investors, and may also be used for the purpose of carrying out my/our instructions or responding to any enquiry purporting to be given by me/us or on my/our behalf, dealing in any other matters relating to my/our holding (including the mailing of reports or notices), forming part of the records of the recipient as to the business carried on by it, observing any legal, governmental or regulatory requirements of any relevant jurisdiction (including any disclosure or notification requirements to which any recipient of the data is subject). All such information may be retained after the termination of the Fund or the transfer of my/our holding. 本人 / 我們同意本認購表中所載除了與認購相關的一切資料可由保管人持有並因各種目的進行使用, 包括處理認購申請 完成持有人註冊資訊 執行或回應依據本人 / 我們所發出的指示及查詢 處理其他與持股相關事宜 ( 包括寄送報告書或通知函 ) 依保管人業務進行資料記錄 遵守任何與司法相關的法律 / 政府 / 條令規定要求 ( 包括上述各單位各種揭露或通知要求 ) 該資料在本基金清算關閉後或本人 / 我們部位轉讓後仍可能由保管人持有 b. The Administrator and the Service Provider may, subject to the requirements of applicable law relating to personal information, disclose and transfer such information to the Directors, the Custodian, the Auditors, and the Investment Manager including any of their employees, officers, directors and agents and/or their affiliates or to any third party employed to provide administrative, computer or other services or facilities to any person to whom data is provided or may be transferred as aforesaid and/or to any regulatory authority entitled thereto by law or regulation (whether statutory or not) in connection with my/our investment in the Fund, which persons may be persons outside Hong Kong. 本人 / 我們同意保管人可依相關法令需求而揭露或轉讓個人資料予董事會 保管人 稽核員及投資經理, 其中包括但不限於上述各單位之員工 高級職員 董事 銷售代理商及其附屬公司 ; 或予任何被雇用於提供行政 電腦 及任何服務 / 技能之第三方以揭露或轉讓該資料給上述各單位 ; 以及予任何依據本人 / 我們投資於本基金相關的監管機構 前述所有單位可能不位於香港 All individual investors have the right of access to, and to update, all their records (whether held on computer files or manually) held by the Service Provider. A copy of such record will be provided to an Investor who requests it, upon the payment of a modest administration charge to cover the costs of complying with such requests. Requests should be made in writing to the Service Provider at the address in the Information Memorandum. 所有持有人皆有權取得或更新所有保管人持有之電子或人工存檔的個人資料 持有人可透過指示以獲得該資料複本, 該指示會產生合理的行政費用, 持有人需以書面方式通知保管人 ( 地址可於公開說明書查詢 ) 8. I/We consent to the recording of telephone conversations between the Administrator/Service Provider ( HSBC ) and myself/ourselves; and I/we acknowledge that any such tape recordings may be submitted in evidence in any proceedings relating to the service agreements between HSBC and the Fund. 本人 / 我們同意保管人與本人 / 我們之間進行電話錄音, 並知悉該電話錄音可提供作為任何保管人與投資經理間關於保管合約相關訴訟的證據 9. I/We agree to abide by the terms and conditions of any web site through which my/our investment holdings are made available, on acceptance of such terms and conditions by any individual acting on my/our behalf. 本人 / 我們同意並接受網站可查詢本人 / 我們持有股份的相關條款與條件 10. I/We understand and agree that in order for the Administrator, the Service Provider or any of their affiliates to meet their legal and regulatory obligations, their group policies, any request of a public or regulatory authority or pursuant to normal market practice which relate to the prevention of fraud, money laundering, terrorism or other criminal activities or the provision of financial and other services to any persons or entities which may be subject to sanctions (collectively Relevant Requirements ), the Administrator, the Service Provider and their affiliates may take any necessary action including without limitation, the checking of each prospective investor or redeeming investor against lists of persons, entities or organisations included on any so-called watch list or websites containing such information (such checking may be done by automated screening systems) and the interception and investigation of transactions in relation to the Fund (particularly those involving the international transfer of funds) including the source of or intended recipient of funds paid in or out in relation to the Fund. In certain circumstances, such action may delay or prevent the processing of this subscription form, the settlement of transactions in respect of the Fund or performance of the Administrator s and the Service Provider s obligations generally, and the Administrator or the Service Provider may in such circumstances refuse your application for Participating Shares. None of the Administrator, the Service Provider or any of their affiliates will be liable for loss (whether direct or consequential and including, without limitation, loss of profit or interest) or damage suffered by any party arising out of or caused in whole or in part by any actions which are taken by the Administrator, the Service Provider or any of their affiliates to comply with the Relevant Requirements (including, without limitation, those actions referred to in this paragraph). 本人 / 我們了解並同意保管人及其附屬公司為預防欺詐 洗錢 恐怖行動 / 其他犯罪行動 / 提供金錢或服務予任何可能受到法律制裁的個人或單位, 需符合相關法律 / 監管責任 公司集團政策 任何公眾 / 監管機構 / 依據一般市場常規的要求 ( 統稱為 重大規定 ), 為達到重大規定要求, 保管人及其附屬公司可進行必要作業, 包括但不限於 : 針對任一潛在持有人或贖回持有人進行身份確認, 此確認將透過任一包含個人 單位或機構的 觀察名單 或任一網站包含 觀察名單 相關資訊, 亦可透過自動審查系統 ; 截取與調查與基金相關的交易, 特別是國際性轉讓, 包括基金所收取的資金來源以及付款對象 依前述情況可能導致此認購申請 基金相關交易或保管人的工作及義務遭到延遲或阻礙, 以及保管人可能會拒絕受理此認購申請 本人 / 我們知悉保管人及其附屬公司不因為達到包括但不限於本段所述之重大規定, 由保管人及其附屬公司或任何一方主動提出所導致的損失負責, 此損失包括但不限於直接或間接 收益或利息 全部或一部份 11. I/We, hereby acknowledge that I/we have carefully reviewed and accepted the Risk Factor included with the Information Memorandum of the Fund and the Addendum concerning its Sub-Fund. I/we clearly comprehend that my/our subscription in the Sub-Fund may involve various investment/market risks, including but not limited to unexpected fluctuations and/or changes in taxation items, rates, foreign exchange controls, and investment prohibitions, and may also, depending upon my/our nationality, domicile, residence, or registered address, face different legal requirements and/or result in different taxation consequences. I/we understand that these risks and other factors may affect the timely settlement of redemption proceeds. I/we also understand that the value of the Participating Shares of the Fund and the income from them, if any, can fall as well as rise; and that the past performance of the Fund is no guarantee of future results. There is no explicit or implied guarantee of profits. 茲聲明本人 / 我們已詳細閱讀並接受本基金及其附屬基金之公開說明書與附錄內有關風險要素之所有條文 本人 / 本公司確實知悉本人 / 本公司申購前述基金時, 可能涉及各種投資及市場風險, 包括但不限於賦稅項目增立 稅率 外匯管制及投資限制或其他法規要求等極可能無預警變動, 及因本人 / 本公司之國籍 居住地 居留地 登記地而有不同之法令限制或賦稅結果 ; 前述風險要素或將造成贖回收益的正常付款時效受影響 本人 / 本公司亦明瞭基金股份之價值或收入可能上漲或下跌, 過去績效並不代表未來表現, 亦無任何獲利保證 I. Please return this Form to the Service Provider at the address shown at the top of the Form. 請將此表按首端所載地址交還保管人 II. This form is made in both Chinese and English. If there is any conflict, English content will prevail. 本表格內容以中英文同時表述, 若兩者記載不一致時, 以英文為準 I/We, the undersigned, hereby acknowledge that I/We have carefully read and accept all the terms stated on this Subscription Form. 茲聲明本人 / 我們已詳細閱讀並接受本認購表中所述所有細則 SIGNATURE 簽名 : NAME 姓名 : DATE 日期 :
JOINT SHAREHOLDER Personal Detail ( 股份共同持有人資料明細 ) ( 請以英文書寫 ) Name 姓名 / 公司名稱 *Passport/ Company Registration No. 護照 / 公司登記證號碼 Country of *Issue/Incorporation 護照 / 公司登記證發照國家 *Contact Address 通訊地址 Telephone No. 聯絡電話 Fax No. 傳真號碼 E-mail address 電子郵件信箱 Source of Fund 資金來源 Individual Investor only 只限個人投資者 Occupation 職業 Signature 簽名 ( 與護照相同 ): : Date 日期 :
SAMPLE FORMOSA ASIA OPPORTUNITY LIMITED ( 本基金 ) c/o HSBC Institutional Trust Services (Asia) Limited (the Services Provider ) 17/F, Tower 2 & 3, HSBC Centre 1 Sham Mong Road Subscription value on Jul 31,2012 Kowloon, Hong Kong Fax No.:(852) 3409-2690 (Dealings) Chang, Mei-Mei (852) 3409-2693 (Enquiries) Attn: Transfer Agency 投資者服務 Signature: Chang, Xiao Ming. SUBSCRIPTION FORM 認購表 U6 Please complete this Subscription Form in English using block capitals. Complete details must be given to ensure that your subscription request is properly processed. 請以英文正楷填寫本認購表之英文部分 閣下須填入完整詳細之資料, 方可確保閣下之認購要求得以妥當執行 1.Subscription Details 認購詳情 *I/We confirm that *I/we have received and read the latest Information Memorandum, the Addenda thereto and the financial reports of Formosa Asia Opportunity Limited (the "Fund") and wish to invest in the Fund subject to the terms of the Information Memorandum, the Addenda thereto and the Memorandum and Articles of Association of the Fund. 本人 / 我等確認本人 / 我等已收到並細閱最新之基金說明書 其附錄及 本基金 之財務報告, 有意根據基金說明書 其附錄及本基金章程之條件投資本基金 The Sub-Funds and Classes thereof available for investment are listed below. Please state the amount which you wish to invest in the relevant Class(es). The minimum investment amount for each Class is stated in the Addendum relating to the relevant Sub-Fund of which such Class forms part. 可供投資之附屬基金如下, 請註明閣下有意投資附屬基金之金額 各附屬基金最低投資額載於有關附屬基金之附錄 Sub-Fund 附屬基金 UG Greater China Multi-Strategy Fund Class 股份等級 # Net Investment Amount (please state the currency of your payment) 淨認購股份金額 ( 請註明幣別 ) C USD 100,000 Dealing fee 另行支付之申購手續費 ( 請註明幣別 ) USD 1,000 cheque or banker's draft in (state currency), issued in favour of "HSBC Institutional Trust Services (Asia) Limited - AFS Subscription Account", crossed "Account Payee, Not Negotiable", stating the name of the applicant and the relevant Sub-Fund/Class on the back, and sent to the address as printed at the top of this form. 開立 ( 註明幣別 ) 之支票或銀行匯票, 以 HSBC Institutional Trust Services (Asia) Limited - AFS Subscription Account 為受款人, 劃線標記 Account Payee,Not Negotiable 並於支票背面註明申購人姓名及附屬基金 / 股份等級名稱後, 寄往表格上方所示之地址 3.Investor's Details 投資者資料 : Do you have an existing account in the Fund 閣下目前是否已在本基金開立帳戶? please tick (V) one box only 請僅於其中一項方格內劃勾 (V) V No 無. Yes 有 If so, please indicate the Account Name and Holder ID: 請註明帳戶名稱及編號 : 若您已在本基金有開立帳戶, 請勾選 有, 並務必於此填寫您的帳戶名稱 *My/Our personal details are as follows 本人 / 我等個人資料如下 : * Passport 護照號碼 / Company Registration No. 公司登記證號碼 Country of *Issue 簽發 / Incorporation 註冊國家 CHANG, XIAO-MING 12341234 R. O. C # Please refer to Note 6 請參考注意事項第 6 點 2.Payment Details 付款詳情 * I/We wish to pay the investment amount by 本人 / 我等希望通過下述方式支付投資金額 : (please tick (V) your preferred choice 請以 V 示意閣下屬意之選擇 ) telegraphic transfer to 電匯至 : Bank name and address 銀行名稱及地址 Swift Code 電報代碼 Bank account name 銀行帳戶名稱 Bank account number 銀行帳號 Remarks 備註 HSBC New York 452 Fifth Avenue, New York, NY 10018, U.S.A MRMDUS33 HSBC Institutional Trust Services (Asia) Limited AFS Subscription Account 000-14117-8 By order of [name of subscriber 投資者姓名 ] Chang Mei Mei & Chang Xiao Ming for subscription of [ 附屬基 金及股份等級名稱 ] UG Greater China Multi-Strategy Fund C Class and [trust no. 基金戶口號 ]:006-129340-431 Contact Address 通訊地址 Telephone No. 電話號碼 Fax No. 傳真號碼 E-mail address 電郵地址 Source of Fund 資金來源 Individual Investor only 只限個人投資者 Occupation 職業 Institutional Investor only 只限機構投資者 2F, NO 1, ABC ROAD, ZHONG-SHAN DISTRICT, TAIPEI 100, TAIWAN ROC 886-2-1234-1234 886-2-5678-5678 xiaoming@abc.com Personal saving Business Man The investment is made for the company s own account and not on behalf of any other party 是項認購為本公司自己帳戶所做的投資, 不是代其他任何個人或機構投資 YES 是 / No 否 *(delete as appropriate 刪除不適用者 ) 若為首次申購, 請填寫全部欄位 若為再次申購, 則不需填寫 若有任何資料變更, 請另行提出變更申請 每次申購時, 此三欄位均須填寫
若為聯合帳戶, 請勾選是否有此項授權 若為個人帳戶, 則毋需勾選 4.Joint Shareholders Authorisation 共同持有人授權 If there is more than one Shareholder, details of the other Shareholders should be provided on a separate sheet. A maximum of four persons may be joint holders of Shares in the Fund. 若股份持有人多於一人, 其他持有人之資料應另頁而書 共同持有基金股份之人數最多四人 Please tick (v) one box only 請僅於其中一項方格內劃勾 (V): please tick Yes box if you wish to authorise the Investment Manager, UG Investment Advisers Limited, to act upon the instructions of the only Shareholder named on the Form in respect of dealings in Shares or any other matters relating to the Shares. If Yes box is ticked, correspondence for joint accounts will be sent only to the Shareholder named above. Otherwise, please tick No such authorisation has been made. 若閣下有意授權投資經理 UG Investment Advisers Limited 根據唯一姓名記載於此表格之持有人就股份交易或其他有關事項而發出之指示行事, 請於 有 方格內劃 V 若 有 方格劃 V, 則有關聯合帳戶之信函將僅送交至上述持有人 否則, 請選擇 無此項授權 V 若銀行帳戶資料. 有所變更, 除了在右欄註明外, 請提出變更申請 SAMPLE Yes 有 No such authorisation has been made 無此項授權 5.Bank Account Details 銀行帳戶資料 If you would like future redemption proceeds to be paid into your bank account by telegraphic transfer, please tick (V) the appropriate box to indicate your choice (please note all charges incurred in such transfer will be to your account) 若閣下希望將來的贖回收益通過電匯, 請於適當方格內劃 V, 指明閣下之選擇 ( 請注意電匯過程所產生之費用將記入閣下之帳戶 ) Please use the Bank Account Details in my previous Subscription Form. 請使用先前認購表所記載之銀行帳戶 Please use the following Bank Account Details in respect of a new account or an existing account the details of which have been changed. 新帳戶或資料已變更之現有帳戶, 請使用下述銀行帳戶資料 Bank name & address 銀行名稱及地址 Swift Code 電報代碼 Bank account name 銀行帳戶名稱 ABC BANK TAIPEI BRANCH ABCDTWTP CHANG, XIAO-MING Bank account number 銀行帳號 123-123456 Remarks 備註 N/A 6.Financial Adviser / Agent Details 財務顧問 / 代理人詳情 Complete this part only if you are submitting this Subscription Form through a financial adviser or agent. Please note that if you establish your account through a financial adviser or agent, all future instructions on your account should also be submitted through that financial adviser or agent. 若閣下通過財務顧問 / 代理人遞交本認購表, 方需填寫本部分資料 請注意若閣下通過財務顧問或代理人開立帳戶, 未來與閣下帳戶有關之指示亦須通過該財務顧問或代理人傳送 Financial Adviser's / Agent's name 財務顧問 / 代理人姓名 ABC COMPANY Financial Adviser's / Agent's company chop & signature 財務顧問 / 代理人公司簽章 AUTHORIZED SIGNATURE & COMPANY CHOP 7.Dealing Fee 交易費用 By Signing hereinafter, *I/we agree to pay an initial charge of 1 % (USD 1000 ) of, and additional to, *my/our subscription amount. *I/we also acknowledge that *I/we will have to pay different levels of redemption charge according to relevant Sub-Fund s Addendum when *I/we redeem the Participating Shares. 本人 / 我等於本表簽名時, 即代表本人 / 我等同意於申購金額外另行支付 1 %(USD 1000 ) 之申購手續費 本人 / 我等並明瞭於贖回所持股份時, 本人 / 我等應依照各附屬基金之附錄規定, 支付不同費率之贖回手續費 8.Signature(s) of Shareholders 簽名 Please state "N/A" in the space where no Shareholder's signature is required. 請於無需持有人簽名之處註明 "N/A" Chang, Xiao Ming :CHANG, XIAO-MING Chang, Mei-Mei :CHANG, MEI-MEI N/A : N/A N/A : N/A Date 日期 :YYYY-MM-DD *(delete as appropriate 刪除不適用者 ) Application of subscription should be received before 5:00 p.m. (Hong Kong time) at least 5 Business Days prior to Dealing Day, and the payment should be made within two Business Days of submitting the completed Subscription Form. 認購表應於交易日前 5 個營業日 5:00 p.m. ( 香港時間 ) 前遞交, 並應在遞交填妥的認購表後兩個營業日內支付 NOTES 注意事項 1. All joint Shareholders must sign this Subscription Form. A corporation should sign under the hand of a duly authorised official together with a company chop or seal. 所有共同持有人須簽署此認購表 若為法人者, 須由一名經妥當授權之負責人簽署, 并加蓋公司印章 2. Investors are required to provide the KYC documents according to the KYC Requirement List requested by the Service Provider. Investors with address in the United States of America MAY NOT be accepted. 持有人需提交依照保管人所要求之身份證明文件 地址在美國之持有人可能不獲接納 3. For applications in currencies other than the currency of account of the relevant Sub-Fund, please contact the Service Agent care of the address, fax number shown at the top of this Form before applying for Participating Shares in the relevant Class. The number of Participating Shares in the relevant Class to be issued for such applications will be determined by the Investment Manager calculating the equivalent of the subscription monies in the currency of account of the relevant Sub-Fund at an exchange rate which the Investment Manager thinks appropriate and after deducting the cost of exchange. All foreign exchange conversion costs or bank charges in respect of banker's drafts or telegraphic transfers will be for the account of the applicant. 若以有關附屬基金之帳戶貨幣以外之貨幣提出申請, 在申請股份之前, 敬請聯絡保管人 其地址 傳真號碼見此表首端代收人一項 就該等申請而簽發的股份將由投資經理根據其認為適當之匯率, 將認購款項折算為有關附屬基金之帳戶貨幣並扣除兌換費用而確定 所有外匯兌換費用或就銀行匯票或電匯而產生之銀行費用將由申請人承擔
SAMPLE 4. Applications for Participating Shares in the relevant Class received by telephone, telex or fax will not be acted upon until written confirmation of such instructions has been received and payment of subscription monies received in cleared funds. The Investment Manager may, in its absolute discretion, refuse to act upon any telephone or facsimile instructions purportedly given by the Shareholder or on the Shareholder's behalf and may require original written instructions instead. The Investment Manager is not obliged to verify the authority or identity of the person giving such instructions as long as the Investment Manager in good faith believes that person to be the Shareholder or someone authorised by the Shareholder. 任何通過電話 電傳或傳真收到的股份申請在未收到書面確認及以任何淨額款項支付之認購款項之前不會得以執行 投資經理可完全自主酌情決定拒絕執行持有人或其代表提出之任何電話或傳真指示, 並可要求提供書面指示原件 只要投資經理誠意相信給予指示之人士乃持有人或經其授權人士, 投資經理無義務確證該等人士之授權及身份 5. The Investment Manager may take any action which it considers appropriate to implement such instructions notwithstanding any error, misunderstanding or lack of clarity in the terms of the instructions. The Investment Manager shall not be liable for any direct or indirect loss resulting from its acting on such instructions or on the instructions contained in this Form including, without limitation, arising from the Investment Manager exercising its discretion given in (4) above. 儘管指示之條款有任何錯誤 誤解或不清晰, 投資經理可採取其認為適當之任何行動以執行該等指示 投資經理不就因其執行該等指示或此表所載之指示 ( 包括但不限於投資經理行使上述第 4 項所授予之自主決定權 ) 而導致的任何直接或間接損失而承擔任何責任 6. The actual investment amount is based on the balance received by the Service Provider after deducting all relevant fee charges. The Service Provider will, as soon as possible after receipt of subscription monies in cleared funds, issue a written confirmation to Shareholders confirming their investment in the relevant Class and their registration as Shareholders of the Fund but actual share certificates will not be issued. 持有人之實際投資金額乃依據保管人收到之認購款項扣除所有相關之交易費用後之認購款項淨額 保管人將於收到認購款項淨額後儘快向股份持有人簽發一份確認書, 確認其於有關附屬基金內的投資額以及其已經註冊為本基金股份持有人, 但不會實際簽發股份證書 7. I/We agree that: a. Information supplied on this subscription form and otherwise in connection with my/our subscription may be held by the Administrator and the Service Provider and will be used for the purposes of processing my/our subscription and completion of information on the register of investors, and may also be used for the purpose of carrying out my/our instructions or responding to any enquiry purporting to be given by me/us or on my/our behalf, dealing in any other matters relating to my/our holding (including the mailing of reports or notices), forming part of the records of the recipient as to the business carried on by it, observing any legal, governmental or regulatory requirements of any relevant jurisdiction (including any disclosure or notification requirements to which any recipient of the data is subject). All such information may be retained after the termination of the Fund or the transfer of my/our holding. 本人 / 我們同意本認購表中所載除了與認購相關的一切資料可由保管人持有並因各種目的進行使用, 包括處理認購申請 完成持有人註冊資訊 執行或回應依據本人 / 我們所發出的指示及查詢 處理其他與持股相關事宜 ( 包括寄送報告書或通知函 ) 依保管人業務進行資料記錄 遵守任何與司法相關的法律 / 政府 / 條令規定要求 ( 包括上述各單位各種揭露或通知要求 ) 該資料在本基金清算關閉後或本人 / 我們部位轉讓後仍可能由保管人持有 b. The Administrator and the Service Provider may, subject to the requirements of applicable law relating to personal information, disclose and transfer such information to the Directors, the Custodian, the Auditors, and the Investment Manager including any of their employees, officers, directors and agents and/or their affiliates or to any third party employed to provide administrative, computer or other services or facilities to any person to whom data is provided or may be transferred as aforesaid and/or to any regulatory authority entitled thereto by law or regulation (whether statutory or not) in connection with my/our investment in the Fund, which persons may be persons outside Hong Kong. 本人 / 我們同意保管人可依相關法令需求而揭露或轉讓個人資料予董事會 保管人 稽核員及投資經理, 其中包括但不限於上述各單位之員工 高級職員 董事 銷售代理商及其附屬公司 ; 或予任何被雇用於提供行政 電腦 及任何服務 / 技能之第三方以揭露或轉讓該資料給上述各單位 ; 以及予任何依據本人 / 我們投資於本基金相關的監管機構 前述所有單位可能不位於香港 All individual investors have the right of access to, and to update, all their records (whether held on computer files or manually) held by the Service Provider. A copy of such record will be provided to an Investor who requests it, upon the payment of a modest administration charge to cover the costs of complying with such requests. Requests should be made in writing to the Service Provider at the address in the Information Memorandum. 所有持有人皆有權取得或更新所有保管人持有之電子或人工存檔的個人資料 持有人可透過指示以獲得該資料複本, 該指示會產生合理的行政費用, 持有人需以書面方式通知保管人 ( 地址可於公開說明書查詢 ) 8. I/We consent to the recording of telephone conversations between the Administrator/Service Provider ( HSBC ) and myself/ourselves; and I/we acknowledge that any such tape recordings may be submitted in evidence in any proceedings relating to the service agreements between HSBC and the Fund. 本人 / 我們同意保管人與本人 / 我們之間進行電話錄音, 並知悉該電話錄音可提供作為任何保管人與投資經理間關於保管合約相關訴訟的證據 9. I/We agree to abide by the terms and conditions of any web site through which my/our investment holdings are made available, on acceptance of such terms and conditions by any individual acting on my/our behalf. 本人 / 我們同意並接受網站可查詢本人 / 我們持有股份的相關條款與條件 10. I/We understand and agree that in order for the Administrator, the Service Provider or any of their affiliates to meet their legal and regulatory obligations, their group policies, any request of a public or regulatory authority or pursuant to normal market practice which relate to the prevention of fraud, money laundering, terrorism or other criminal activities or the provision of financial and other services to any persons or entities which may be subject to sanctions (collectively Relevant Requirements ), the Administrator, the Service Provider and their affiliates may take any necessary action including without limitation, the checking of each prospective investor or redeeming investor against lists of persons, entities or organisations included on any so-called watch list or websites containing such information (such checking may be done by automated screening systems) and the interception and investigation of transactions in relation to the Fund (particularly those involving the international transfer of funds) including the source of or intended recipient of funds paid in or out in relation to the Fund. In certain circumstances, such action may delay or prevent the processing of this subscription form, the settlement of transactions in respect of the Fund or performance of the Administrator s and the Service Provider s obligations generally, and the Administrator or the Service Provider may in such circumstances refuse your application for Participating Shares. None of the Administrator, the Service Provider or any of their affiliates will be liable for loss (whether direct or consequential and including, without limitation, loss of profit or interest) or damage suffered by any party arising out of or caused in whole or in part by any actions which are taken by the Administrator, the Service Provider or any of their affiliates to comply with the Relevant Requirements (including, without limitation, those actions referred to in this paragraph). 本人 / 我們了解並同意保管人及其附屬公司為預防欺詐 洗錢 恐怖行動 / 其他犯罪行動 / 提供金錢或服務予任何可能受到法律制裁的個人或單位, 需符合相關法律 / 監管責任 公司集團政策 任何公眾 / 監管機構 / 依據一般市場常規的要求 ( 統稱為 重大規定 ), 為達到重大規定要求, 保管人及其附屬公司可進行必要作業, 包括但不限於 : 針對任一潛在持有人或贖回持有人進行身份確認, 此確認將透過任一包含個人 單位或機構的 觀察名單 或任一網站包含 觀察名單 相關資訊, 亦可透過自動審查系統 ; 截取與調查與基金相關的交易, 特別是國際性轉讓, 包括基金所收取的資金來源以及付款對象 依前述情況可能導致此認購申請 基金相關交易或保管人的工作及義務遭到延遲或阻礙, 以及保管人可能會拒絕受理此認購申請 本人 / 我們知悉保管人及其附屬公司不因為達到包括但不限於本段所述之重大規定, 由保管人及其附屬公司或任何一方主動提出所導致的損失負責, 此損失包括但不限於直接或間接 收益或利息 全部或一部份 11. I/We, hereby acknowledge that I/we have carefully reviewed and accepted the Risk Factor included with the Information Memorandum of the Fund and the Addendum concerning its Sub-Fund. I/we clearly comprehend that my/our subscription in the Sub-Fund may involve various investment/market risks, including but not limited to unexpected fluctuations and/or changes in taxation items, rates, foreign exchange controls, and investment prohibitions, and may also, depending upon my/our nationality, domicile, residence, or registered address, face different legal requirements and/or result in different taxation consequences. I/we understand that these risks and other factors may affect the timely settlement of redemption proceeds. I/we also understand that the value of the Participating Shares of the Fund and the income from them, if any, can fall as well as rise; and that the past performance of the Fund is no guarantee of future results. There is no explicit or implied guarantee of profits. 茲聲明本人 / 我們已詳細閱讀並接受本基金及其附屬基金之公開說明書與附錄內有關風險要素之所有條文 本人 / 本公司確實知悉本人 / 本公司申購前述基金時, 可能涉及各種投資及市場風險, 包括但不限於賦稅項目增立 稅率 外匯管制及投資限制或其他法規要求等極可能無預警變動, 及因本人 / 本公司之國籍 居住地 居留地 登記地而有不同之法令限制或賦稅結果 ; 前述風險要素或將造成贖回收益的正常付款時效受影響 本人 / 本公司亦明瞭基金股份之價值或收入可能上漲或下跌, 過去績效並不代表未來表現, 亦無任何獲利保證 I. Please return this Form to the Service Provider at the address shown at the top of the Form. 請將此表按首端所載地址交還保管人 II. This form is made in both Chinese and English. If there is any conflict, English content will prevail. 本表格內容以中英文同時表述, 若兩者記載不一致時, 以英文為準 I/We, the undersigned, hereby acknowledge that I/We have carefully read and accept all the terms stated on this Subscription Form. 茲聲明本人 / 我們已詳細閱讀並接受本認購表中所述所有細則 Chang, Mei-Mei Chang, Xiao Ming. SIGNATURE 簽名 : NAME 姓名 : Chang, Mai Mai & Chang Xiao Ming DATE 日期 : YYYY-MM-DD
SAMPLE ( 聯合帳戶請填寫此表 ) JOINT SHAREHOLDER Personal Detail ( 股份共同持有人資料明細 ) ( 請以英文書寫 ) Name 姓名 / 公司名稱 CHANG, MEI-MEI *Passport/ Company Registration No. 護照 / 公司登記證號碼 Country of *Issue/Incorporation 護照 / 公司登記證發照國家 56785678 R. O. C *Contact Address 通訊地址 10F, NO 1, XYZ ROAD, ZHONG-SHAN DISTRICT, TAIPEI 100, TAIWAN ROC Telephone No. 聯絡電話 886-2-5678-5678 Fax No. 傳真號碼 886-2-3456-3456 E-mail address 電子郵件信箱 meimei@abc.com Source of Fund 資金來源 Individual Investor only 只限個人投資者 Occupation 職業 Personal saving Business Man Signature 簽名 ( 與護照相同 ): Chang, Mei-Mei :CHANG, MEI-MEI Date 日期 :YYYY-MM-DD