Luxembourg investment company with variable capital () SUBSCRIPTION FORM To be sent to the Agent: EDMOND DE ROTHSCHILD ASSET MANAGEMENT (Luxembourg) 20 Boulevard Emmanuel Servais - L-2535 Luxembourg - Swift: PRIBLULB Fax: (352) 24 88 8617 Contact details f individual invests: EDRAM: Tel (352) 2488 2250 / CSM-TA@bpere.eu Otherwise, please contact: CACEIS: Tel (352) 4767 6299 / EDRAM-TA@caceis.com 1. Details of the Invest(s) (to be used f all communication) 1. Full name company name: 2. Full name company name (*): (*) In the case of joint Invests, all Invests must sign the present subscription fm. However, the Fund shall only recognise the person appointed to exercise the rights relative to each of the shares of the Fund. With the exception of an objection by the Board of Directs, the person appointed to exercise these rights shall be the person whose name appears first on the present subscription fm. Agent client reference number (appearing on the confirmation of subscription f existing Invests who have already subscribed via the Agent): 2. Official address Address: Postal code: City: Country: Telephone: Fax: Email: 3. Sub-fund selection 3.1. Selection NAMES OF SUB-FUNDS AND CLASSES AVAILABLE FOR SUBSCRIPTION CURRENCY NUMBER OF WHOLE SHARES SUBSCRIBED AMOUNTS SUBSCRIBED DELIVERY (see point 3.2 below) R = Registered shares C = Shares delivered via a clearing system R. C. ASIAN SPECIAL OPPORTUNITIES FUND Class A CHF ISIN: LU1120927733 CHF ASIAN SPECIAL OPPORTUNITIES FUND Class A EUR ISIN: LU1120927493 EUR 1
Luxembourg investment company with variable capital () ASIAN SPECIAL OPPORTUNITIES FUND Class A GBP ISIN: LU1120927816 GBP ASIAN SPECIAL OPPORTUNITIES FUND Class A HKD ISIN: LU1120928111 HKD ASIAN SPECIAL OPPORTUNITIES FUND Class A JPY ISIN: LU1120928202 JPY ASIAN SPECIAL OPPORTUNITIES FUND Class A SGD ISIN: LU1120928038 SGD ASIAN SPECIAL OPPORTUNITIES FUND Class A USD ISIN: LU1120927659 USD ASIAN SPECIAL OPPORTUNITIES FUND Class F2 CHF ISIN: LU1120930364 CHF ASIAN SPECIAL OPPORTUNITIES FUND Class F2 EUR ISIN: LU1120930109 EUR ASIAN SPECIAL OPPORTUNITIES FUND Class F2 GBP ISIN: LU1120930521 GBP ASIAN SPECIAL OPPORTUNITIES FUND Class F2 HKD ISIN: LU1120930950 HKD ASIAN SPECIAL OPPORTUNITIES FUND Class F2 JPY ISIN: LU1120931099 JPY ASIAN SPECIAL OPPORTUNITIES FUND Class F2 SGD ISIN: LU1120930794 SGD 2
Luxembourg investment company with variable capital () ASIAN SPECIAL OPPORTUNITIES FUND Class F2 USD ISIN: LU1120930281 USD ASIAN SPECIAL OPPORTUNITIES FUND Class I CHF ISIN: LU1120926842 CHF ASIAN SPECIAL OPPORTUNITIES FUND Class I EUR ISIN: LU1120926685 EUR ASIAN SPECIAL OPPORTUNITIES FUND Class I GBP ISIN: LU1120926925 GBP ASIAN SPECIAL OPPORTUNITIES FUND Class I HKD ISIN: LU1120927147 HKD ASIAN SPECIAL OPPORTUNITIES FUND Class I JPY ISIN: LU1120927220 JPY ASIAN SPECIAL OPPORTUNITIES FUND Class I SGD ISIN: LU1120927063 SGD ASIAN SPECIAL OPPORTUNITIES FUND Class I USD ISIN: LU1120926768 USD ASIAN SPECIAL OPPORTUNITIES FUND Class Z USD ISIN: LU1120931842 USD 3.2. Delivery Delivery of registered shares By selecting R from the table above, I understand that physical certificates shall not be issued f registered shares. Instead, the Agent shall enter an der confirmation in the shareholders register, which is held at the registered office of the Agent. Confirmation of shares recded in the shareholders register shall be sent to the shareholder within the time limit specified in the prospectus. 3
Luxembourg investment company with variable capital () Delivery via a clearing system By selecting C from the table above, I request the delivery of my shares via a clearing system and the registration of the subscription in the name of the clearing system its custodian accding to the details below: Name of clearing establishment: Country: Account name: Account number: 4. Bank details of Invest Details of the bank through which subscription payments shall be made. The proceeds of redemptions, and where applicable, dividends, shall be transferred to the same account. Account name: Account number: Name of bank: Swift code: Address: Postal code: City: Country: Intermediary bank involved in the payment: Swift code: Country: 5. Bank details of the fund custodian The total amount payable f subscriptions shall be transferred in favour of Banque Privée Edmond de Rothschild Europe via its crespondent bank in the currencies given below. The Invest s remitting bank must indicate the Invest s name and the name of the fund concerned when making a payment to the crespondent bank of Banque Privée Edmond de Rothschild Europe. Payments by cheque are not accepted. Please find attached our Cash Crespondent Banks (Wiring Instructions) in an annex 4
Luxembourg investment company with variable capital () Declarations and Signature As Invest, I hereby expressly declare and approve the following: 1) I have carefully read a copy of the latest Prospectus of the Fund and have received a copy of the latest available financial repts. I am fully aware of and understand the financial risks associated with a subscription to the Fund and I accept that market fluctuations may lead to a loss of all part of my capital. However, I confirm that this investment is appropriate f my needs. 2) I confirm that I have received and carefully read the relevant Fund s key invest infmation document (KIID) and that I received it in good time befe my application f shares in the Fund and accdingly, by ticking the box hereinafter, I expressly agreed to only receive the Fund s KIID by means of a consultation of the website www.edmond.de.rothschild.eu. By ticking this box I also confirm that I have been given the choice to receive the Fund s relevant KIID on paper and accept to access it only through the afementioned website : (To the extent, you ticked the box, please do not fget to indicate your email address under section 2 of this subscription fm.) 3) The present subscription der is binding on me. However, I understand that the Fund its Transfer Agent may reject this subscription der in full in part without having to justify its decision and that the Fund its Transfer Agent has the right to request and obtain infmation, documents other items f the purpose of identifying the beneficiary of this subscription as well as any document that the Fund may consider necessary to enable it to meet its legal and regulaty obligations and to maintain its relationship with me. In particular, I confirm that I meet all the conditions of eligibility. The Fund is authised to request a compulsy redemption at the redemption price of the valuation date applicable. I shall be obliged to compensate the Fund f any possible losses incurred. The subscription der may be deferred until the next valuation date following the date on which the Fund its Agent has received all the infmation concerning myself in a fm satisfacty to the Fund its Agent. Where necessary, any payment made befe the fmal acceptance of the subscription shall be deposited in a non interest-bearing account. 4) I agree to transfer under good value date the crect subscription amount in the crect currency. I understand that in the case of non-payment of the crect subscription amount under good value date, the subscription may be cancelled and you shall bear the costs of such a cancellation. The Fund may therefe take repeated judicial non-judicial action against me any representative as a result of non-payment. 5) The present subscription fm may be sent by post fax and the subscription ders may be sent by Swift. The Fund its Agent shall not be held responsible f the acceptance of a subscription der sent by fax. I undertake to fward immediately the iginal subscription fm to the Fund its Agent by express priity mail at my own expense. The Fund its Agent may refuse any subscription der received cancel any subscription ders accepted by fax, if the iginal subscription fm does not reach them within five Luxembourg bank business days following the appropriate valuation date. The absence of the iginal may not be used against the Fund its Agent. The Invest agrees to compensate the Fund f any losses resulting from the cancellation of a subscription. 6) The Fund its Agent shall communicate all crespondence to me at my own risk by dinary post by registered post if the laws and regulations of Luxembourg deem it necessary, to the address indicated on the present subscription fm ( to any other address which I may notify the Fund its Agent in the future). I accept that all crespondence sent by the Fund its Agent is considered as being valid from the time it has been sent to the afementioned address, the presumed date of dispatch being the date appearing on the copy ( the dispatch list) kept by the Fund its Agent. 7) Any requests complaints that I may have relative to any transaction of the Fund shall be sent in writing to the Fund its Agent. 8) The Fund and its Agent compare the signatures sent to them with the specimens held at their offices without having to proceed with a me detailed investigation. To the extent permitted by Luxembourg laws, the Fund and its Agent are only bound by a best-efft obligation ( obligations de moyens ) and are only liable in the case of gross wilful misconduct. 9) Once the signature complies at first glance with the specimens held at their offices, the Fund its Agent shall not be held responsible f any damages caused by the fact that the signatures on the instructions given to the Fund its Agent are fraudulent. The Fund its Agent may trust the signature below without having to proceed with a me detailed investigation and decline all responsibility f damages that could result from the absence of any legitimization any undetected fgery. 5
Luxembourg investment company with variable capital () 10) Without prejudice to the above, the Fund and its Agent are not liable f damages which may be directly indirectly caused by the lack of authenticity validity of the authisations which refer to me third parties with the legal capacity to act on my behalf. 11) The Fund its Agent reserves the right to refuse to process an instruction from any person whose identity and permissions have not been sufficiently established in the eyes of the Fund its Agent. 12) The Fund its Agent shall not be responsible f damages caused in the event of my legal incapacity third party authised to act on my behalf, provided the Fund its Agent has not received pri written notice of the fact. 13) I shall compensate and reimburse the Fund its Agent f all complaints, claims, legal action, fees, expenses, damages, losses other sums paid responsibilities incurred by the Fund its Agent resulting from the execution by the Fund its Agent of an instruction on my part. 14) The Fund its Agent are permitted to recd telephone conversations with the Fund its Agent, which shall serve as evidence in the case of disagreement. The absence of recdings of telephone conversations may not be used against the Fund its Agent. 15) The present subscription fm as well as all ders resulting from it are exclusively governed by Luxembourg law and all disputes shall be referred to the courts of the District of Luxembourg City. However, I acknowledge that the Fund its Agent may take legal action befe another court which would have been qualified if the afementioned jurisdiction had not been chosen, in particular within the jurisdiction of my area of residence of that of the Agent approved intermediary. 16) I understand that the personal data requested above must be transmitted in der to proceed with the subscription. Should I refuse to communicate it, the Fund its Agent will refuse the subscription. I understand that my personal data (relating mainly to my identity, address, personal and marital status), specific infmation concerning my assets and transactions carried out on my behalf, may be recded in one several databases of the Fund the Agent in accdance with applicable legislation. Under this legislation, the Fund the Agent may outsource the processing and stage of this data. I expressly authise the Fund its Agent to collect and process personal data relating to me as described in this clause. I understand that I can consult the data concerning me and rectify any inaccuracies in this data. The Fund its Agent may recd process my personal data f the purpose of managing the registration of the investment funds, carrying out my transactions, managing contractual relations and in general f the purpose of carrying out their obligations in particular regarding the identification of the invests as provided f under FATCA regulation, and improving the services provided to me. 17) With regard to the tax, legal, currency and other economic considerations related to this investment, I have only relied on the advice of, have only consulted with, my own professional advisers. 18) I have such knowledge and experience in financial and business matters as to be capable of evaluating the merits of, and I am able to bear the economic risk of an investment in the Fund. 19) I undertake to provide the Fund and/ its Agent, upon request, with all documents, fms and infmation in der f them to comply with their respective legal regulaty obligations Date: Signature: Full name (in capital letters) of the Invest representative of the company and his/her position With his/her signature, the Invest expressly and specifically accepts the limits of responsibility in favour of the Fund stipulated in the paragraph Declarations and Signature. Signature: Full name (in capital letters) of the Invest representative of the company and his/her position 6
Luxembourg investment company with variable capital () IDENTIFICATION DOCUMENT FOR INSTITUTIONAL INVESTORS (FUNDS, SUB-FUNDS OR CLASSES DEDICATED TO INSTITUTIONAL INVESTORS IN THE MEANING OF THE LAW OF ART. 174 (2) OF THE LAW OF 17/12/2010) C/o Agent: EDMOND DE ROTHSCHILD ASSET MANAGEMENT (Luxembourg) 20 Boulevard Emmanuel Servais - L-2535 Luxembourg Swift: PRIBLULB Fax: (352) 24 88 8617 Contact details f individual invests: EDRAM: Tel (352) 2488 2250 / CSM-TA@bpere.eu Otherwise, please contact: CACEIS: Tel (352) 4767 6299 / EDRAM-TA@caceis.com The undersigned certify the accuracy of the following infmation: 1. Name and address of the institutional invest 2. Activity 3. Local supervisy authity Please specify the name and website of your supervisy authity: 4. Subscription Please confirm whether the subscription is made on your own behalf, in your name but on behalf of a third party entity: Yes, on our own behalf. No, in our own name but on behalf of a third party: which is an institutional invest. * which is a non-institutional client managed on the basis of a discretionary management mandate. The name of such non-institutional client(s) will not appear in the Shareholder Register of the Fund and accdingly will not have recourse to the shares of the sub-fund concerned. ** 7
Luxembourg investment company with variable capital () * The invest expressly confirms by the signature of this document that the client on whose behalf it is acting is an institutional invest. Should the invest s client lose its institutional quality, the undersigned hereby undertakes to infm the Fund / Agent of such change immediately and to redeem convert its shares as the case may be. ** In case of a Credit Institution other Professional of the Financial Sect subscribing to shares on behalf of clients which do not qualify themselves as institutional invests, the Fund will only issue shares to such credit institutions other professionals of the financial sect expressly confirming by the signature of this document they have entered into a discretionary ptfolio management agreement with the clients on whose behalf they are acting. In the case the discretionary management mandate is cancelled, the undersigned hereby undertakes to infm the Fund / Agent of such cancellation and to redeem convert its shares as applicable. 8
Luxembourg investment company with variable capital () General Provisions I) Subscription conditions Subscriptions will only be accepted if accompanied by the Identification Documents (see page 1). The Fund / Agent may request any additional infmation (including, but not limited to, a copy of the discretionary management mandate) in der to assess the qualification of the Invest as an institutional invest. If the Fund / Agent consider that the Invest does not qualify as an institutional invest (see definition below) if the Fund / Agent is unable on the basis of the documents provided by the Invest to ascertain that the Invest qualifies as an institutional invest, the Fund / Agent may at its full discretion, refuse the subscription request. Meover, the Commission de Surveillance du Secteur Financier ( CSSF ) may require the Fund / Agent to reveal the identity of the shareholders which hold shares in the Fund, Sub-Funds Classes reserved to institutional invests. In such case, the Fund / Agent is entitled to fward all infmation and documents received in relation to the relevant shareholders to the CSSF. II) Compulsy redemption If it appears to the Fund that any shareholder, acting either alone in conjunction with any other person, does not qualify as an institutional invest if a subscription has been made on behalf of non-institutional clients on the basis of a discretionary management mandate and such mandate has been cancelled, the Fund may instruct such shareholder to sell his shares. If such shareholder fails to comply with such instruction within 30 days, the Fund may compulsily redeem cause to be redeemed all shares held by such shareholder at the then prevailing net asset value less redemption charges, if any. The shareholder undertakes to indemnify the Fund its Agent and hold the Fund its Agent harmless against all demands, claims, actions, costs, expenses, damages, losses other monies paid liability incurred by the Fund its Agent as a result of the fact that it appears that the concerned shareholder does not qualify, at any date after the subscription, as an institutional invest within the meaning of the 2010 Law. Date: Institutional Invest represented by: Signature Name 9
Luxembourg investment company with variable capital () FOREIGN ACCOUNT TAX COMPLIANT ACT ( FATCA ) 1 C/o Agent: EDMOND DE ROTHSCHILD ASSET MANAGEMENT (Luxembourg) 20 Boulevard Emmanuel Servais - L-2535 Luxembourg - Swift: PRIBLULB Fax: (352) 24 88 8617 Contact details f individual invests: EDRAM: Tel (352) 2488 2250 / CSM-TA@bpere.eu Otherwise, please contact: CACEIS: Tel (352) 4767 6299 / EDRAM-TA@caceis.com On March 18, 2010, the United States of America enacted provisions commonly known as the Feign Account Tax Compliant (FATCA). Accding to the FATCA Rules, FFIs, unless they can rely under ad-hoc lighter exempted regimes, need to rept to the IRS certain holdings by / and payments made to a/ certain U.S. invests b/ certain U.S. controlled feign entity invests, c/ non U.S. financial institution invests that do not comply with their obligations under FATCA and d/ invests that are not able to document clearly their FATCA status. Meover, any account that is not properly documented may have to suffer a 30% WHT. On March 24 th, 2014, Luxembourg and U.S. governments entered into a Model I IGA which aims to codinate and facilitate the repting obligations under FATCA with other U.S. repting obligations of Luxembourg financial institutions. Accding to the IGA, Luxembourg FFIs will generally have to rept to the Luxembourg tax authities instead of directly to the IRS. Infmation will be communicated onward by the Luxembourg authities to the IRS under the general infmation exchange provisions of the U.S. Luxembourg income tax treaty. In der to comply with its obligations, the Fund needs to gather from subscriber(s) a series of additional infmation and documents relating to subscriber(s) and potential beneficial owners. The Fund, subject to the Fund s constitutive documents and prospectus / offering memandum and any applicable laws may: (i) (ii) (iii) (iv) Withhold the payment of any dividend redemption proceeds to a Unitholder / Shareholder of the Fund until the Fund holds sufficient infmation; Reject at its discretion any subscription f Units / Shares; Compulsily redeem at any time the Units held by Unitholder / Shareholders who are excluded from purchasing holding Units / Shares; and decline to register the transfer of Units to any person who is excluded from purchasing holding Units. (v) take any additional measures authized by the Fund s constitutive documents and prospectus / offering memandum. A. In this connection, the undersigned subscriber hereby declares and certifies, by ticking the crespondent box that, in accdance with the principles of FATCA, the regulations relating to Infmation Repting by Feign Financial Institutions and Other Feign Entities released by the IRS on 28 th January 2013 (the FATCA Regulations ), all subsequently published FATCA announcements and as the case may be, the provisions of the intergovernmental agreement (IGA) entered between the country of residence of the subscriber and the United States of America to improve International Tax Compliance and with respect to FATCA, as well as relevant national Laws: 1 FATCA means the Feign Account Tax Compliance Act such as enacted and adopted by the United States of America on March 18, 2010, requiring US individuals to rept their financial accounts held outside of the United States and feign financial institutions to rept to the Internal Revenue Service about their US clients 10
Luxembourg investment company with variable capital () Name and address registered office of the invest 1. I AM / WE ARE US RESIDENT (F further details please refer to definition below 2. F joint accounts, each subscriber shall provide the relevant confirmation). a) If I am / we are individual(s): We undertake to provide the Fund and/ its Agent a W9 Fm duly filled and electronically signed in accdance with the principles of the US Tax laws. b) If I am / we are Cpate entities: The Cpate entity is a company having its headquarter registered office in the U.S.; OR The Cpate entity is a company incpated in the U.S. (U.S. cpation) We undertake to provide the Fund and/ its Agent a W9 Fm duly filed and electronically signed in accdance with the principles of the US Tax laws. 2. I AM / WE ARE NOT US RESIDENT (F joint accounts, each subscriber shall provide the relevant confirmation) a) If I am / We are individuals: (Please tick as much cases as relevant to your own situation) (aa) 2 Within the meaning of the U.S. Internal Revenue Code and subject to any amendments to the legal definition which may be from time to time adopted, shall qualify as US Person the following: US Person (Cpate entity): (i) any company incpated in the US (US cpation); (ii) any US partnership (domestic partnership); (iii) any trust if a US court is able to control the trust administration and one several US persons are entitled to control any substantial decisions of the trust; (iv) any states of the United States; (v) any company that has a bank account located in the US; (vi) any company having its headquarter registered office in the US; (vii) any company having its headquarter registered office located outside the US but having one me US beneficial owner(s). US Person (Individual): (i) US citizen (including double multiple nationality and US place of birth); (ii) US residents owner of a permanent residence title ( Green Card ); (iii) Individual having resided in the USA f a substantial period of time in the course of the year N and / the two years befe. Example of substantial period of time: (a) Residence in the US f me than 183 days in the course of the year N; (b) Stay of me than 31 days in the course of the year N in the US, if the total of a) this period, plus b) the number of days of residence in N-1 divided by 3, plus c) the number of days of residence in N-2 divided by six, exceeds 183 days; (iv) If the issuer country of the ID passpt is a US territy; (v) If the primary address and / the mailing address (as set fth in part IV d) above) are within US territy (vi) if at least one of the subscribers is a US Citizen (joint account, as set fth in part IV a) above. In case of doubt with respect to their situation re FATCA Regulation, subscribers should consult with their legal tax advis. 11
Luxembourg investment company with variable capital () I / We have no US Bank account(s); My / our primary address and / mailing address are not within the U.S. territy; I / We do not have a U.S. phone fax number; I / We do not have a power of attney signaty authity granted to an individual having a primary address and / mailing address within the U.S. territy. AND (bb) I / We have not a US place of birth If I / we ticked ALL the above boxes under (A.2.a.aa.) and (A.2.a.bb.), I am / we are not required to provide the Fund and/ its Agent with any further documentation f FATCA identification purposes; If I /we ticked the above box under (A.2.a.bb.) but did not tick any box in section (A.2.a.aa.) above, I / we undertake to provide the Fund and/ its Agent with a W8-BEN fm duly filled and electronically signed in accdance with the principles of the US Tax laws; If I / we ticked the above box under (A.2.a.bb) but did tick certain but not all boxes in section (A.2.a.aa.) above, I / we undertake to provide the Fund and/ its Agent with a W8-BEN fm duly filled and electronically signed in accdance with the principles of the US Tax laws; If I / we did not tick the box in section (A.2.a.bb.) above, I / we undertake to provide the Fund and/ its Agent with a W8-BEN fm duly filled and electronically signed in accdance with the principles of the US Tax laws as well as a US nationality renunciation certificate. Should I / we not be in the capacity to provide a US nationality renunciation certificate, then I / we undertake to provide a W9 Fm. F the completion of the fegoing US Tax fms, Individuals are herein requested to provide the Fund and/ its Agent with an email address which shall allow the Fund and/ its Agent to provide you with an internet link, as the case may be: E-mail: b) If I am / We are Cpate entities: If the Cpate entity is a company NOT having its headquarter registered office in the U.S; AND/OR If the Cpate entity is NOT a company incpated in the U.S. (U.S. cpation) we undertake to provide the Fund and/ its Agent with a W8-BEN-E Fm duly filled and electronically signed in accdance with the principles of the US Tax laws (Please note that you are requested to complete the BO Section of the W8-BEN-E Fm, when applicable, by indicating the exact US tax payer identification number (TIN)). 12
Luxembourg investment company with variable capital () B. The undersigned subscriber further declares that: 1. Subscriber (cpate entities) a. It has the following FATCA Status by ticking the appropriate box, adding its signature. Also, it undertakes the necessary actions to answer to any other request to confirm its status and send immediately to the Fund and/ its Agent the appropriate related US tax Fm. Specified US Person US Person that is not a Specified US Person Luxembourg FI FI in a jurisdiction having signed an IGA (Registered and repting FI under an IGA 1 IGA 2 model) Participating FFI (other than case 3) in a jurisdiction not having signed an IGA Deemed compliant FFI (other than case 3) (Non registered and non repting FFI compliant with FATCA under Final Regulations IGA jurisdictions) Exempt beneficial owner (other than case 3) Active NFFE Passive NFFE o o non of which controlling persons are US citizens resident; which controlling persons are US citizens resident Non participating FFI (including a Luxembourg Financial Institution other Partner Jurisdiction Financial Institutions treated by the IRS as non participating Financial Institutions) b. The undersigned deposit holder confirms, by ticking the cresponding box that: YES, it has registered on the IRS Ptal its appropriate FATCA Status. Please confirm GIIN Code: NO, it has not registered on the IRS Ptal due to its FATCA Status It will register later and undertakes to send immediately to the Fund and/ its Agent its FATCA status and GIIN number 13
Luxembourg investment company with variable capital () 2. F Passive NFFE with U.S. controlling person(s): In case you selected under B.1.a. above Passive NFFE with U.S. controlling person(s), please provide U.S. Taxpayer identification number (SSN ITIN) f the ultimate relevant beneficial owner and a W9 Fm duly filled and electronically signed in accdance with the principles of the US Tax laws. The subscriber herein declares that the infmation of Section IV of this application fm is, to the best of its knowledge and belief, true, crect and complete. Subscriber undertakes to infm the Fund and/ its Agent without delay of any change in his / her / its situation that would make above declaration no longer valid. Signed by: Name [and Title: F and on behalf of] Dated: 14
Luxembourg investment company with variable capital () INSTITUTIONAL INVESTORS IN THE MEANING OF THE LAW OF ART. 174 (2) OF THE LAW OF 17/12/2010 In der to ensure that the invest is an institutional invest, the Fund / Agent will examine the infmation as provided by the invest in der to ascertain whether the invest falls within one of the following categies: Financial professionals This categy concerns credit institutions other professionals of the financial sect (ie supervised entity equivalent as those defined in the meaning of the Luxembourg law dated 5 April 1993 as amended), insurance companies reinsurance companies and social security institutions. Insurance companies may be considered as institutional invests, even if the beneficiaries of the insurance policies are private invests, provided the insurance companies remain the sole Invests of shares. Credit institutions other professionals of the financial sect subscribing to shares in their own name may be considered as institutional invests, even if the investment in the Fund is made on behalf of a person not qualifying as an institutional invest, provided that such person has entered into a discretionary management relationship with the relevant credit institution other professional of the financial sect. Companies having substantial assets under management Industrial commercial companies having substantial assets under management and regularly acting on the financial markets may also be considered as institutional invests. Holding companies Holding companies similar vehicles, whether established in Luxembourg abroad may be regarded as institutional invests, even if their own shareholders may not be regarded as being institutional invests, provided that the relevant holding companies similar vehicles prove to have substance, in the sense that they must have their own structure and activities and hold significant financial interests. Other categies of institutional invests Undertakings f collective investment, including pension funds ganised by a company f its employees, may be considered as institutional invests, even if their own invests may not be regarded as being institutional invests. Local authities, such as regions, provinces, cantons, municipalities, may also be considered as institutional invests. 15
Luxembourg investment company with variable capital () ENTITY S TAX RESIDENCE SELF CERTIFICATION FOR AEI - CRS Instructions to complete this fm. (Mandaty fields are marked by an *). The AEoI-CRS (Automatic Exchange of Infmation Common Repting Standard) provides f tax authities to require the financial institutions under their supervision to collect certain infmation on their register account s holders and, where appropriate, to use such infmation to satisfy repting requirements. Pursuant to this standard, please complete the sections below as indicated and provide all additional infmation requested concerning your entity. Please note that in some circumstances we will be required to rept this infmation (as well as the register account balance and the amount of revenues and sale proceeds paid credited to the register account) to our supervisy tax authity, which will in turn send it to the tax authity of each state in which the entity that you represent is resident f tax purposes. If you have any questions about the identification of your status as entity (section 2) your Tax Identification Number (TIN), please contact your tax adviser your local tax authity. You must rept the residence of register account s holder f tax purposes. The register account s holder is the legal person(s) that benefit(s) from the revenue and/ assets associated with a register account. Please refer to the definitions provided in the appendix "Definitions to help you to complete this fm. If the register account s holder is a Passive NFE (non-financial entity) a professionally managed investment entity in a country not participating in the AEoI - CRS (Automatic Exchange of Infmation - Common Repting Standard), then you must also provide infmation on the individuals who exercise control over the entity ("Controlling Person") by completing section 6 "Identification of Controlling Persons ( beneficial owners)" f each person exercising an effective control over the entity. Please note: If you are not the register account s holder and you complete and sign the fm on behalf of the register account s holder, you must specify in which capacity you are authised to sign section 7. Do not use this fm if the register account s holder is an individual. In such case, please use and complete the "Individual's tax residence self-certification" fm. If any of the infmation below is amended following a change in circumstances, your must immediately provide the Financial Institution with a new self-certification fm, updated showing this change in circumstances. You can send us this completed and signed self-certification fm either electronically (e-mail, fax) by post. Section 1 Identification of the register account s holder A. Name of the entity * B. Place of ganisation * C. Effective place of activity * D. Address of permanent residence Line 1 (name of street, number, etc.) Line 2 (town) 16
Luxembourg investment company with variable capital () COUNTRY * POSTCODE E. Country of residence f tax purposes * Section 2 Entity / Legal person's status 1. Please tick the appropriate box f the entity/legal person's status * Please refer to the definitions provided in the appendix "Definitions" to help you to complete this section and identify your status. (a) Financial Institution Professionally managed investment entity (b) Financial Institution - Other (c) Active NFE Cpation that is publicly traded an affiliate of a publicly traded cpation (d) Active NFE Government entity (e) Active NFE International ganisation (f) Active NFE Categy of entity other than those listed in (c) to (e) (g) Passive NFE (see definition in the appendix "Definitions" to this fm). If you are a passive NFE (g) OR a professionally managed investment entity that is resident in a country that is NOT a signaty to the AEoI-CRS agreement, you must complete section 6 "Identification of Controlling Persons ( beneficial owners)". Section 3 Tax Identification Number (TIN) A. Tax identification number recognised by the tax authity:* B. The country of residence f tax purposes does not provide a TIN to its residents (tick the box if appropriate) Section 4 Confirmation of your tax residence (Complete section 4 if the register account s holder has tax residence in just one country, section 5 if the register account s holder has tax residence in me than one country, then read and sign the statement in section 7) We certify that the register account s holder is not a resident f tax purposes in a country other than the country indicated in section 1 above (tick the box). 17
Luxembourg investment company with variable capital () Section 5 Additional countries of residence f tax purposes (if any) We certify that, in addition to the country indicated in section 1, the register account s holder is resident f tax purposes in the following countries, that the TIN attached to each additional country is shown below that we have ticked the box to indicate that the TIN is not issued by one of these countries any other situation substantiated below (please use a separate sheet if resident f tax purposes in me than two additional countries): COUNTRY* TIN* TIN not issued Other; explain COUNTRY* TIN* TIN not issued Other; explain Section 6 Identification of Controlling Persons ( beneficial owners) Please note the following: You must complete this section ONLY if you have selected the status of passive NFE OR professionally managed investment entity that is resident in a country that is NOT a signaty to the AEoI-CRS agreement in section 2. Complete the infmation below if your entity has one me Controlling Persons. If any of the infmation below is amended following a change in circumstances, your must immediately provide the Financial Institution with a new self-certification fm, updated showing this change in circumstances. The definitions of "controlling person" and "changes in circumstances" are shown in the appendix "Definitions". Please refer to it to complete section 6. A. Controlling Person No.1 Type of Controlling Person*: - Directly indirectly owning the control of an entity through the ownership of the entity's shares, units voting rights - Or, where no person owns such an interest, exercising effective control over the entity - Or, where there is no effective control, holding the position of company direct. Last name * First name(s) * Place of birth Town of birth * Country of birth* Date of birth (dd/mm/yyyy) * 18
Luxembourg investment company with variable capital () Address of permanent residence: Line 1 (name of street, number, etc.) * Line 2 (town)* Postcode * COUNTRY * Country of residence f tax purposes * TIN * We certify that, in addition to the country indicated below, the Controlling Person No.1 is resident f tax purposes in the following countries, that the TIN attached to each additional country is shown below that we have ticked the box to indicate that the TIN is not issued by one of these countries any other situation substantiated below (please use a separate sheet of paper if the Controlling Person No.1 is resident f tax purposes in me than two additional countries). COUNTRY* TIN* TIN not issued Other; explain COUNTRY* TIN* TIN not issued Other; explain B. Controlling Person No.2 Type of Controlling Person*: - Directly indirectly owning the control of an entity through the ownership of the entity's shares, units voting rights - Or, where no person owns such an interest, exercising effective control over an entity - Or, where there is no effective control, holding the position of company direct. Last name * First name(s) * Place of birth Town of birth * Country of birth* Date of birth (dd/mm/yyyy) * Address of permanent residence: Line 1 (name of street, number, etc.) * Line 2 (town)* Postcode* COUNTRY * 19
Luxembourg investment company with variable capital () Country of residence f tax purposes * TIN * We certify that, in addition to the country indicated below, the Controlling Person No.2 is resident f tax purposes in the following countries, that the TIN attached to each additional country is shown below that we have ticked the box to indicate that the TIN is not issued by one of these countries any other situation that we justify (please use a separate sheet of paper if the Controlling Person No.2 is resident f tax purposes in me than two additional countries). COUNTRY* TIN* TIN not issued Other; explain COUNTRY* TIN* TIN not issued Other; explain C. Controlling Person No.3 Type of Controlling Person*: - Directly indirectly owning the control of an entity through the ownership of the entity's shares, units voting rights - Or, where no person owns such an interest, exercising effective control over the entity - Or, where there is no effective control, holding the position of company direct. Last name * First name(s) * Place of birth Town of birth * Country of birth* Date of birth (dd/mm/yyyy) * Address of permanent residence Line 1 (name of street, number, etc.) * Line 2 (town)* Postcode * COUNTRY * Country of residence f tax purposes * TIN * We certify that, in addition to the country indicated below, the Controlling Person No.3 is resident f tax purposes in the following countries, that the TIN attached to each additional country is shown below that we have ticked the box 20
Luxembourg investment company with variable capital () to indicate that the TIN is not issued by one of these countries any other situation that we justify (please use a separate sheet if the No.3 Controlling Person is resident f tax purposes in me than two additional countries). COUNTRY* TIN* TIN not issued Other; explain COUNTRY* TIN* TIN not issued Other; explain If there are me than three Controlling Persons, please use a separate sheet of paper and sign it. Section 7 Statement and signature We acknowledge and accept that the infmation concerning our register account(s) and the infmation contained in this fm can be sent to exchanged with the tax authities of the country(ies) in which this(these) register account(s) is(are) held and exchanged with the competent tax authities of a country countries in which we may be resident f tax purposes and which have signed electronic infmation exchange agreements. We undertake to immediately infm our Financial Institution and its transfer agent of any change in circumstances and to provide it with a new self-certification fm, updated and highlighting such change in circumstances. We certify that we are the holders of the register account accounts f which this fm has been completed, are authised to sign f the holder of such account(s). We certify that all the statements made in this fm are accurate and complete. We agree to complete a new selfcertification fm if one me elements of this self-certification fm is(are) no longer crect. Signature of the person(s) authised to sign on behalf of the entity holder of the register account : Authised person No.1: Last name and first name*: Date *: Capacity *: Signature *: Authised person No.2 (if different from authised person No.1): Last name and first name *: Date *: 21
Luxembourg investment company with variable capital () Capacity *: Signature *: In accdance with the provisions of the Luxembourg applicable data protection law on the protection of persons with regard to the processing of personal data (the Data Protection Law ), you benefit from a right of access and amendment of your personal data. Any complaint relating to your rights under the Data Protection Law shall be addressed to the Transfer agent acting on behalf of the financial institution. F your infmation, the Transfer agent acting on behalf of the financial institution will recd and process your personal data in der to carry on the relevant requirements vis-à-vis the relevant tax administration f the purpose of the AEOI-CRS Regulations. In case of circumstances changes, thank you to highlight infmation you have changed. 22
Luxembourg investment company with variable capital () INDIVIDUAL S TAX RESIDENCE SELF-CERTIFICATION FOR AEI-CRS Instructions to complete this fm (Mandaty fields are marked by an *) The AEoI-CRS (Automatic Exchange of Infmation Common Repting Standard) provides that tax authities require the financial institutions under their supervision to collect certain infmation on their invests and, where appropriate, to use such infmation to satisfy repting requirements. Pursuant to this standard, please complete the sections below as indicated and provide all additional infmation requested. Please note that in some circumstances your Financial Institution will be required to rept this infmation (as well as the register account balance and the amount of revenues and sale proceeds paid credited to the register account) to its supervisy tax authity, which will in turn send it to the tax authity of each country in which you are resident f tax purposes. In der to comply with the requirements placed on you as holder of a register account (person entitled to the revenue and/ assets associated with a financial account), you are required to disclose the country(ies) in which you are resident f tax purposes. Please complete the sections below as indicated and provide all additional infmation requested. The definitions in the appendix will help you to identify the holder of the register account and to complete this fm. If you have any questions concerning your Tax Identification Number (TIN), please contact your tax adviser your local tax authity. You can send us this self-certification fm completed and signed either electronically (e-mail, fax) by post. Please note: If you are not the holder of a register account and you complete and sign the fm on behalf of the holder of a register account, you must specify in which capacity you are authized to sign section 5, and attach a copy of your power of attney. Do not use this fm if the holder of a register account is not an individual. If the holder of a register account in not an individual, please use and complete the "Entity's tax residence self-certification" fm. If any of the infmation below is amended following a change in circumstances, you must immediately provide the Financial Institution with a new self-certification fm, updated showing this change in circumstances. Section 1 Identification of the Individual register account s holder D. Name of the register account s holder: Last name* Title: First name(s): * E. Date of birth* F. Place of birth Town of birth* Country of birth* 23
Luxembourg investment company with variable capital () G. Address of permanent residence Line 1 (name of street, number, etc.) Line 2 (town) Country:* Postcode: H. Country of residence f tax purposes*: Section 2 Tax Identification Number TIN * Complete A B A. Tax Identification Number in the country of residence f tax purposes:* B. The country of residence f tax purposes does not provide a TIN to its residents (tick the box if appropriate) Section 3 Confirmation of your residence f tax purposes (Complete section 3 if the holder of a register account has residence f tax purposes in just one country, OR section 4 if the holder of a register account has residence f tax purposes in me than one country, then read and sign the statement in section 5) I certify that the register account s holder is NOT a resident f tax purposes in a country other than the country indicated in section 1 above (tick the box). Section 4 Additional countries of residence f tax purposes (if any) I certify that, in addition to the country indicated in section 1, the holder of a register account is resident f tax purposes in the following countries and that the TIN attached to each additional country is shown below that I have ticked the box to indicate that the TIN of one of these countries is unavailable (please use a separate sheet of paper if you are resident f tax purposes in me than three additional countries): Country: * TIN:* TIN unavailable: Country: * TIN:* TIN unavailable: Country: * TIN:* TIN unavailable: 24
Luxembourg investment company with variable capital () Part 5 Statement and signature I acknowledge and accept that the infmation concerning my register account(s) and the infmation contained in this fm can be sent to the tax authities of the country in which this(these) register account(s) is(are) held. Such infmation can also be exchanged with the tax authities of another country countries in which I am resident f tax purposes and which have concluded electronic infmation exchange agreements. I undertake to immediately infm the financial institution of any change in circumstances and to provide it with a new self-certification fm, updated highlighting such change in circumstances. I certify that all the statements made in this fm are accurate and complete. Signature of the register account s holder ( of the authised person): Last name, first name*: Date * *Please indicate the capacity in which you have signed, and attach a copy of your power of attney. Capacity*: In accdance with the provisions of the Luxembourg applicable data protection law on the protection of persons with regard to the processing of personal data (the Data Protection Law ), you benefit from a right of access and amendment of your personal data. Any complaint relating to your rights under the Data Protection Law shall be addressed to the Transfer agent acting on behalf of the financial institution. F your infmation, the Transfer agent acting on behalf of the financial institution will recd and process your personal data in der to carry on the relevant requirements vis-à-vis the relevant tax administration f the purpose of the AEOI-CRS Regulations. In case of circumstances changes, thank you to highlight infmation you have changed. 25
Luxembourg investment company with variable capital () APPENDIX Definitions These definitions are those provided as part of the OECD's Common Repting Standard (CRS) f the Automatic Exchange of Infmation. If you have any questions about these definitions, if you would like me details, please contact your tax adviser your local tax authity. "Account Holder" The term "account holder" means the person listed identified as the holder of a financial account. A person who is the holder of a financial account f the benefit of another person as agent, custodian, nominee, signaty, investment adviser, intermediary legal guardian is not treated as holding the account. Such other person is treated as holding the account. F example, in the case of a parent/child relationship where the parent acts as legal guardian, the child is treated as holding the account. In the case of a jointly held account, each joint holder is treated as an account holder. "Financial Account" A financial account is an account maintained by a financial institution and includes: deposit accounts; securities accounts (custodian accounts); equity securities debt issued by investment entities; life insurance policies with a cash surrender value; and annuity contracts. "Change in Circumstances" Generally speaking, a "change in circumstances" means any change that results in the addition of infmation relevant to a person's status (tax residence) otherwise conflicts with such person's previously declared status. A change in circumstances also means any change addition of infmation to the account holder's account (including the addition of a new holder, change of country, etc.) OR any change addition of infmation to any account associated with such account if such change addition of infmation affects the account holder's status. 26
EDMOND DE ROTHSCHILD (EUROPE) STANDARD SETTLEMENT INSTRUCTIONS FOR CASH PAYMENTS Please note that the payments have to be made f the benefit of CACEIS Bank Luxembourg (Swift Code: BSUILULL).