FINANCIAL SERVICES (JERSEY) LAW 1998

FUND SERVICES BUSINESS (“FSB”) ANNUAL COMPLIANCE RETURN - 201(select year)

Period of Return: From 1 October – 30 September

Please answer ALL of the following questions. Where answers require further information to be provided, please use a separate sheet and return together with this form to the Jersey Financial Services Commission (the “Commission”).

FSB – Annual Compliance Return – October 2015 Page 1 of 6 Name of Registered Person:

FSB Registration number: Yes No 1 Has there been any material change to the information previously advised to the Commission?

1.1 If yes, please provide comprehensive details of these changes and submit supporting documentation where necessary.

2 Please provide an up-to-date corporate structure chart to include branches and subsidiaries of the Registered Person. For each branch and subsidiary, please indicate their jurisdiction and whether regulated or unregulated in that jurisdiction. 2.1 If regulated, please advise the name of the regulatory authority.

3 Please provide a copy of your latest Business Risk Assessment and the date this was last tabled and approved by the board (mm/yyyy). / Yes No 4 Please confirm that you have a Compliance Policy and when this was last tabled and approved by the board (mm/yyyy). /

Yes No 5 Has the Registered Person made any notifications to its PII Insurers in the last 12 months?

5.1 If yes, please provide further information to the Commission in this regard.

6 Please confirm the number of FSB employees in respect of the Registered

Person as at the date of this return.

6.1 Please provide an up-to-date organisation and staff structure chart.

7 Please provide the number of private and unregulated funds that you provide services to (if none please respond with “0”)

7.1 COBO Only Funds

FSB – Annual Compliance Return – October 2015 Page 2 of 6 7.2 Private Placement Funds

7.3 Very Private Funds

7.4 Unregulated Funds

8 For the period of this return, please advise the number of:

8.1 Complaints received

8.2 Breaches Internal External 8.3 Suspicious Activity Reports (split between internal and external reports)

9 Please confirm: Yes No

9.1 that you have a Compliance Monitoring Plan in place; and 9.2 that appropriate monitoring was conducted on a risk based approach.

10 If “yes” to 9.1:

10.1 Please advise any material issues arising as a result of the compliance monitoring conducted, and what action has been taken in order to address these issues.

Yes No 10.2 Is the Registered Person satisfied that sufficient action has been taken to correct any deficiencies? 10.4 If not, please provide details.

11 Does the Registered Person provide services to an Alternative Investment Yes No Fund?

12.1 If yes, please confirm that the Registered Person has complied with the applicable reporting obligations in the Codes of Practice for Alternative Investment Funds and AIF Services business within the requisite time frame.

FSB – Annual Compliance Return – October 2015 Page 3 of 6 12.2 If non-compliant, please provide further details including any action taken to ensure future compliance.

FSB – Annual Compliance Return – October 2015 Page 4 of 6 DECLARATION

We confirm that all changes in principal persons, as defined in Article 1 of the Financial Services (Jersey) Law 1998, have been notified to the Commission in accordance with the requirements of Article 14 of the Financial Services (Jersey) Law 1998.

We authorise the Commission to make such enquiries and to seek such further information, as it thinks appropriate, to verify the information contained in this Annual Compliance Return.

We declare, on behalf of the Registered Person, that the information supplied on this form, and any supplemental information provided, is complete, true and accurate to the best of our knowledge and belief. We are aware of our obligations under Article 28 of the Financial Services (Jersey) Law 1998, to not knowingly or recklessly provide any information that is false or misleading, in addition to the requirements of Principle 6 of the Codes of Practice for Fund Services Business.

This declaration is signed for and on behalf of the Registered Person by any two directors.

FSB – Annual Compliance Return – October 2015 Page 5 of 6 Director: Date: / / Full Name:

Signature:

Director: Date: / / Full Name:

Signature:

Please provide an appropriate contact name and telephone number in the event that the Commission requires further information regarding this Annual Compliance Return.

Compliance Contact: Contact Number:

Annual Compliance Return Checklist: have you submitted the following Yes No documentation Q2 – up-to-date corporate structure chart Q3 – latest Business Risk Assessment Q6 - up-to-date organisation and staff structure chart

Data Protection (Jersey) Law 2005 (the “Data Protection Law”)

Personal data provided in this form will be used by the Commission – a data controller as defined in the Data Protection Law – to discharge its statutory functions under the Financial Services (Jersey) Law 1998, as amended, and it may be disclosed to third parties for those purposes. Further information in this regard may be found in the Commission’s data protection policy, copies of which are available upon request from the Commission, and which may also be found on www.jerseyfsc.org

FSB – Annual Compliance Return – October 2015 Page 6 of 6