CIF/ IC CIF/ IC Collective Investment Funds (Jersey) Law, 1988 (the Law ) Application For: Certificate in relation to a Company Issuing Units of an Unclassified Fund in relation to an incorporated cell ( IC ) of an incorporated cell company ( ICC ) ** Important: before completing this form, please read carefully Appendix 2: tes on the Completion of Application Form CIF/IC. Section A - Details of the Application A.1 Full Legal Name of ICC A.2 Full Legal Name of IC $ F A.3 Please arrange for the details of each IC to be completed on a separate section D of this form. A.4 Does the ICC have ICs that are already a holder of a certificate or waiting to be granted a certificate in relation to an Unclassified Fund under the Law. If yes, the date on which the previous application form was signed: Please state the name of the ICs for which the previous application was made: A.5 The number of ICs of the ICC: The number of ICs that this application relates to: RAS: Personal data provided to the Commission - a data controller as defined in the Data Protection (Jersey) Law 2005 - will be used by the Commission to discharge its statutory, administrative and operational functions. Further information may be found in the Commission s data protection policy, copies of which are available on request from the Commission and which may also be found on www.jerseyfsc.org
Section B - Details of the ICC B.1 Certificate contact name and address for ICC/IC in relation to any certificate issued: (See note 7) Name: Address: E-mail address: Telephone: Facsimile: B.2 Is the registered office address different to answer B.1? (If yes, please enter details below) B.3 Is the principal place of business different to answer B.1? (If yes, please enter details below) B.4 Name and Address of Statistics Officer for ICC/IC Name: Address: E-mail address: Telephone: Facsimile:
B.5 Name and Address of Alternate Statistics Officer (in case of absence): Name: Address: E-mail address: Telephone: Facsimile: Quarterly fund statistics are required to be submitted to the JFSC electronically. The named Statistics Officer will be responsible for this. B.6 (a) Date of Incorporation of ICC (b) Company Registration Number of ICC B.7 (a) Ultimate Beneficial Owner of ICC (b) Legal structure of ultimate Beneficial Owner (including partnership/trust etc.) (c) Country of formation of ultimate Beneficial Owner (d) Does the ICC issue management shares or similar? (If please state the name of all legal and ultimate beneficial owners of the management shares) Day Mth B.8 Accounting year end date of ICC Name and address of auditor to the ICC: Name: Address: B.9 (a) Does the ICC use, or propose to use, a business or trading name different from that given in the answer to A.1? (b) If yes, please state name B.10 (a) Is the ICC a member, has applied, or intends to apply for membership of any self regulatory organisation, professional body, investment exchange or clearing house in the UK or overseas? (b) If yes, please give details Organisation Membership. Date
B.11 Principal Person information, please indicate clearly who from the list of Principal Persons is the CEO. (see note 8) Full Name: Capacity which makes you a Principal Person E.G. Director, CEO etc Jersey Resident Y/N PQ already submitted to JFSC on? (d/m/y) % Beneficial Ownership Please state the name of the Compliance Officer Compliance Officer Please state the name of the Money Laundering Reporting Officer Money Laundering Reporting Officer Please state the name of the Money Laundering Compliance Officer Money Laundering Compliance Officer
Section C - Declaration The ICC is required to notify the JFSC immediately of: (a) (b) any other information which it considers relevant to this application; and any significant changes in the information provided in this application which occur after the date of submission of the application and prior to the Applicant receiving notification of the JFSC s decision concerning the application. (THE ATTENTION OF SIGNATORIES IS DRAWN TO ARTICLE 16 OF THE LAW) We declare that the information given in: (i) (ii) (iii) Section A above, Section B above, Section D attached, is complete and correct to the best of our knowledge at the time of the application and that there are no other material facts of which the JFSC should be aware. We declare that all relevant Personal Questionnaires and Letters advising of changes are enclosed with this Application together with the relevant certificate fees. For and on behalf of: Signatures: Names: Positions: Date: (dd/mm/yyyy) (dd/mm/yyyy) This application form must be signed by two Principal Persons of the ICC. Please te: If it is preferred that during the period when this application is being considered, any correspondence relating only to this application should be addressed to someone other than the person named in B.1 above, please give details below:
Section D - Details of the IC (See note 10) Please photocopy this section as many times as needed and complete for each IC to which this application relates. D.1 Full Legal Name of the ICC $ D.2 Full Legal Name of the IC F D.3 Legal Form of IC (please tick the appropriate box) Closed Ended Investment Company Open Ended Investment Company D.4 Is the IC an Expert Fund as defined in the Jersey Expert Fund Guide? D.5 (a) Date of Formation of IC (b) Registration Number of IC (c) Does the IC issue management shares or similar? (If please state the name of all legal and ultimate beneficial owners of the management shares) D.6 If application is in respect of a multi-class IC, please specify: Number of Constituent Parts D.7 (a) Is the IC or ICC licensed/authorised for promotion elsewhere? (b) If so, where? D.8 Is this IC of the ICC to be listed? (please provide details below) D.9 (a) Year end of IC: (dd/mm/yyyy) (b) First Accounting date if different (c) When will annual reports be published? D.10 Name and Address of Auditor to the IC: Name: Address: E-mail Address: Telephone: Facsimile: D.11 Do the Manager and Custodian/Trustee have the same ultimate holding company? D.12 (a) Does the IC use, or propose to use a business or trading name different from that given in the answer to D.2? (b) If yes, please state name
D.13 (a) Is the IC a member, has applied, or intends to apply for membership of any self regulatory organisation, professional body, investment exchange or clearing house in the UK or overseas? (b) If yes, please give details Organisation Membership. Date D.14 Principal Person information, please indicate clearly who from the list of Principal Persons is the CEO. (see note 8) Full Name: Capacity which makes you a Principal Person E.G. Director, CEO etc Jersey Resident Y/N PQ already submitted to JFSC on? (d/m/y) % Beneficial Ownership If different from the ICC, please fill in the information below Please state the name of the Compliance Officer Compliance Officer Please state the name of the Money Laundering Reporting Officer Money Laundering Reporting Officer Please state the name of the Money Laundering Compliance Officer Money Laundering Compliance Officer
D.15 Investment Policy Please refer closely to Appendix 1 (codes for Investment Policy) and enter below the code and description that most closely matches the investment policy of the fund/constituent part: Code Description D.16 Primary investment objective: 01 Capital Growth 02 Income 03 Both (Choose one only) D.17 Minimum investment amount required: D.18 Base Currency: D.18 Which type of investor will the IC be marketed to? (Please tick the relevant box(es)) General Public Sophisticated Single Investor High Net Worth Institutional Expert (as defined in the Expert Fund Guide) D.19 Is the IC any of the following: (please tick appropriate box(es)) Index Tracker Split Capital Fund of Funds Feeder Fund ne of the above D.20 Has application been made and subsequently been REFUSED for authorisation in relation to the ICC and/or IC under the rules and laws of any regulatory body, or for the units to be admitted to the listing of any Stock exchange or other principal market? (If yes, please enter details below) Important: Please te - The Declaration after this page must be completed.
Declaration The IC is required to notify the Jersey Financial Services Commission (the JFSC ) immediately of: (a) (b) any other information which it considers relevant to this application; and any significant changes in the information provided in this application which occur after the date of submission of the application and prior to the Applicant receiving notification of the JFSC s decision concerning the application (THE ATTENTION OF THE SIGNATORIES IS DRAWN TO ARTICLE 16 OF THE LAW) We declare that the information given herein is complete and correct to the best of our knowledge at the time of the application and there are no other material facts of which the JFSC should be aware. For and on behalf of: Signatures: Names: Positions: Date: (dd/mm/yyyy) (dd/mm/yyyy) This application form must be signed by two Principal Persons of the IC.
Appendix 1: Codes for Investment Policy Code Description Equity E01 Equity-UK E02 Equity-Europe (Including UK) E03 Equity-Europe (Excluding UK) E04 Equity-US (rth America) E05 Equity-Japan E06 Equity-Far East (Including Japan) E07 Equity-Far East (Excluding Japan) E08 Equity-Global Emerging Markets E09 Equity-Global Equity E10 Equity-Other B01 B02 B03 B04 B05 Bond Bond-Global Bond-UK Debt Bond-US Debt Bond-Europe Bond-Other M01 M02 M03 M04 M05 Money Market Money Market-Sterling Money Market-US Dollar Money Market-Euro Money Market-Swiss Money Market-Other S01 S02 S03 S04 S05 S06 S07 Specialist Specialist-Venture Capital/Private Equity - Emerging Markets Specialist-Venture Capital/Private Equity - Other Specialist-Real Property Specialist-Derivatives Specialist-Traded Endowment Policies Specialist-Hedge/Alternative Investment Funds Specialist-Other X01 Mixed Mixed-Mixed Equity and Bond
Appendix 2: tes on the Completion of Application Form CIF/IC GENERAL (1) The form is to be completed in accordance with the requirements of the Collective Investment Funds (Jersey) Law, 1988 as amended (the Law ), and any associated Orders and Regulations. (2) Where the application is for a fund in the form of an incorporated cell ( IC ) of an incorporated cell company ( ICC. ) the IC certificate application form is to be used. Please note the IC of an ICC will need to complete the whole of the IC certificate application form. (3) If more space is needed the answer should be written on a separate sheet of paper with the heading: Continuation of answer to Question _ of Application form CIF/IC. (4) Answers are to be written in black ink in BLOCK CAPITALS or typed. Section A - The Application (5) All questions in this section are to be completed by all applicants. Section B - Details of the Application (6) All questions in this section are to be completed by all applicants. (7) The Commission requires that each holder of certificates ( Certificate Holder ) nominates only one person as general contact for all correspondence relating to all certificates under the Law granted to the Certificate Holder. (8) Section B11. A "Principal Person" is defined in Article 1 of the Collective Investment Funds (Jersey) Law 1988 (as amended). Personal Questionnaires and Letters advising changes can be downloaded from the Commission's website. (www.jerseyfsc.org). Section C - The Declaration (9) To be completed by all applicants. Section D - Details of the IC (10) To be completed by all applicants, photocopies should be taken and a separate sheet should be completed in respect of each IC of the ICC. Payment of Fees (11) For the Application to be valid, the correct fee must accompany each form. (12) For details of fees payable, see the notice published on the Commission's website in accordance with Article 15 of the Financial Services Commission (Jersey) Law 1998 as amended and Article 7(12) of the Collective Investment Funds (Jersey) Law 1988 as amended. (13) If paying by cheque, please make the cheque payable to the "Jersey Financial Services Commission" and crossed "A/C payee". COMPLETED APPLICATION FORMS should be sent to: The Senior Manager Securities-Authorisation Jersey Financial Services Commission, PO Box 267, 14-18 Castle Street, St Helier, Jersey JE4 8TP Jersey Financial Services Commission, PO Box 267, 14-18 Castle Street, St Helier, Jersey, JE4 8TP