Application for a Certificate in Relation to a Company Issuing Units of an Unclassified

CIF/I C

Application for a 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)

This 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. Where the application is for an umbrella fund in the form of an incorporated cell company (ICC) this application form is to be used. Please note each IC of an ICC will need to complete the whole of the IC certificate application form. Where the application is solely for a fund in the form of an incorporated cell (IC) of an incorporated cell company (ICC) the CIF/UCF application form is to be used. 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.” Answers are to be written in black ink in BLOCK CAPITALS or typed.

Section A – details of the application All questions in this section are to be completed by all applicants.

Section B – details of the ICC All questions in this section are to be completed by the ICC. Section B.1: The Jersey Financial Services Commission (the JFSC) requires that each holder of a certificate (Certificate Holder) nominates only one person as general contact for all correspondence relating to all certificates under the Law granted to the Certificate Holder. Section B.11: A Principal Person is defined in Article 1 of the Law. Personal Questionnaires, Additional Appointments and Notification of Ceasing to Act Forms can be downloaded from the JFSC website www.jerseyfsc.org

Section C - the declaration To be completed by the ICC.

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Section D - details of the IC as Applicant 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.

Section D.15 See the note above regarding Section B.11.

Payment of fees For the Application to be valid, the correct fee must be paid. However application fees need not be submitted with this application form. An invoice will be provided with the registration documents when issued. The JFSC will regard any statutory requirement for a fee to accompany an application as having been met so long as such fees are duly settled per the terms of the invoice issued. The JFSC reserves the right to vary or determine commercial settlement periods for invoices based on operating procedures in place at any given time. It should be noted that application fees are for considering an application, not necessarily granting it. If an application does not progress to the point of issue any application fee may still be due and will therefore be invoiced. For details of fees payable, see the notice published on the JFSC website in accordance with Article 15 of the Financial Services Commission (Jersey) Law 1998, as amended and Articles 8A(2)(e) and 8B(13) of the Collective Investment Funds (Jersey) Law 1988, as amended. Completed application forms should be sent with all accompanying information by email to: [email protected]. If email is not possible then by mail to: The Senior Manager, Funds Authorisation Jersey Financial Services Commission PO Box 267, 14-18 Castle Street, St Helier, Jersey, JE4 8TP

Data Protection (Jersey) Law 2005 The Jersey Financial Services Commission (JFSC) will process the personal data you send us together with other information, which comes from or relates to you, to discharge its functions effectively. Processing includes obtaining, keeping, altering, disclosing and deleting personal data. The JFSC may disclose personal data in order to verify the information in this application. You have the right to ask for a copy of the personal data the JFSC holds on you, for which the JFSC will charge a fee. You also have the right to have inaccuracies corrected. Please contact the Information Compliance Manager, Jersey Financial Services Commission, PO Box 267, 14-18 Castle Street, St Helier, Jersey, JE4 8TP if you require assistance.

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Section A Details of the Application

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A.1 Full legal name of ICC:

A.2 Full legal name of IC:

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 Yes No waiting to be granted a certificate in relation to an Unclassified Fund under the Law? If yes, please state 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:

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Section B Details of the ICC

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B.1 Certificate contact name and address for the ICC and each IC of the ICC in relation to any certificate to be issued: (see notes) Name:

Address:

E-mail address:

Telephone: Facsimile:

B.2 Is the registered office address different to answer B.1? Yes No (If yes, please enter details below)

B.3 Is the principal place of business different to answer B.1? Yes No (If yes, please enter details below)

B.4 Name and Address of Statistics Officer for ICC and each IC of the ICC: Name:

Address:

Email address:

Telephone: Facsimile:

B.5 Name and Address of Alternate Statistics Officer (in case of absence):

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Name:

Address:

Email address:

Telephone: Facsimile: Please note: 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 of ICC (including partnership/trust etc.)

(c) Country of formation of ultimate Beneficial Owner Please provide an ownership structure chart showing all owners (with respective percentages held) of the ICC. (d) Does the ICC issue management shares or similar: Yes No (If yes, please state the name of all legal and ultimate beneficial owners of the management shares)

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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 Yes No 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 Yes No any self-regulatory organisation, professional body, investment exchange or clearing house in the UK or overseas? (b) If yes, please give details Organisation:

Membership no: Date: / /

B.11 Principal Person information of the ICC, please indicate clearly who from the list of Principal Persons is the CEO (see notes).

Capacity which makes PQ already % Jersey Full name you a Principal Person submitted to Beneficial Resident e.g. Director, CEO etc the JFSC on? Ownership Yes/No / / Yes/No / / Yes/No / / Yes/No / / Yes/No / / Yes/No / /

B.12 (a) Please state the name of the Compliance Officer:

(b)Please state the email address of the Compliance Officer:

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B.13 (a) Please state the name of the Money Laundering Reporting Officer:

(b)Please state the email address of the Money Laundering Reporting Officer:

B.14 (a) Please state the name of the Money Laundering Compliance Officer:

(b)Please state the email address of the Money Laundering Compliance Officer:

B.15 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 Yes No 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):

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Section C Declaration

The ICC is required to notify the JFSC immediately of: (a) any other information which it considers relevant to this application; and (b) 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: (a.i) Section A above (a.ii) Section B above (a.iii) 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 PQs have been submitted or are enclosed with this application together with the relevant certificate fees. Sanctions: Higher Risk Factors As part of this application the ICC is required to confirm that all due regard has, and will, be given to any applicable Sanctions framework relevant to, or associated with, activity in respect of any activity the ICC intends to provide pursuant to this application. Consideration includes (but is not limited to) completing due diligence and relevant risk assessments specifically in relation to sanctioned jurisdictions, sanctioned entities, sanctioned individuals and any related sanctioned activity. Sanction frameworks include (but are not limited to) applicable Jersey, EU, UN or OFAC legislation some of which have obligatory reporting requirements within Jersey. In making this application the ICC acknowledges these requirements and that the responsibility for consideration is an ongoing obligation after any approvals are granted. The ICC confirms that in respect of any intended activity to be undertaken by the Applicant it has not identified a sanctioned jurisdiction, entity, individual or activity. Yes: No: If no, detail to be provided below (or per enclosures) regarding the sanctioned jurisdiction, entity, individual or activity that has been identified and the actions taken as a result.

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Outsourcing

Has the ICC outsourced, or does it intend to outsource any of its activities?

Yes: No: Outsourcing means an arrangement of any form between a registered person and a service provider by which the service provider performs any activity that would otherwise be undertaken by the registered person, where a service provider’s failure to perform, or Inadequate performance of, such activity would materially impair the continuing compliance of the registered person’s regulated activity, with the requirements of the regulatory laws.

If yes, does the ICC consider the outsourcing activity to be exempt pursuant to section 3.2.2.5 of the Policy Statement and Guidance Notes on Outsourcing?

Yes: No: If no, please complete and submit with this application form, the JFSC’s Outsourcing Notification which can be found on the JFSC’s website at: https://www.jerseyfsc.org/the_commission/general_information/forms/index.asp

For and on behalf of:

Signatures:

Names:

Positions:

Date: / / / /

This application form must be signed by two Principal Persons of the ICC. Please Note: 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:

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Section D Details of the IC (see notes) as Applicant

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D.1 Full legal name of the IC

D.2 Full legal name of the ICC

D.3 Legal Form of Fund (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 Yes No Guide?

D.5 (a) Date of Formation of IC:

(b) Registration Number of IC: (if applicable) (c) Does the IC issue management shares or similar: Yes No (If yes, please state the name of all legal and ultimate beneficial owners of the management shares)

D.6 Will the IC be compliant with the Codes of Practice under the Law? Yes No If not, please advise the areas of non-compliance.

D.7 If application is in respect of a multi-class IC, please specify: Number of Constituent Parts

D.8 (a) Is the IC or ICC to be licensed/authorised for promotion Yes No elsewhere? (b) If so, where?

D.9 (a) Is this IC of the ICC to be listed? Yes No

(b) If yes, please provide details as to where the IC is to be listed.

D.10(a) Accounting year end of IC: / /

(b) First Accounting date if different / /

D.11Name and address of auditor to the IC: Name:

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Address:

Email address:

Telephone: Facsimile:

D.12Do the Manager and Custodian/Trustee have the same ultimate holding Yes No company?

D.13 (a) Does the IC use, or propose to use a business or trading name different Yes No from that given in the answer to D.2? (b)If yes, please state name:

D.14 (a) Is the IC a member, has applied, or intends to apply for membership of any Yes No self-regulatory organisation, professional body, investment exchange or clearing house in the UK or overseas? (b) If yes, please give details Organisation:

Membership no: Date: / /

D.15Principal Person information of the IC, please indicate clearly who from the list of Principal Persons is the CEO (see notes).

Capacity which makes you PQ already % Jersey Full name a Principal Person e.g. submitted to Beneficial resident Director, CEO, etc the JFSC on? Ownership Yes/No / / Yes/No / / Yes/No / / Yes/No / / Yes/No / / Yes/No / /

If different from the ICC, please fill in the information below:

D.16(a) Please state the name of the Compliance Officer:

(b) Please state the email address of the Compliance Officer:

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(d) Please state the name of the Money Laundering Reporting Officer:

(e) Please state the email address of the Money Laundering Reporting Officer:

(f) PQ already submitted? Yes No

(g) Please state the name of the Money Laundering Compliance Officer:

(h) Please state the email address of the Money Laundering Compliance Officer:

(i) PQ already submitted? Yes No

D.17Investment 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.18Primary investment objective: (Choose one only) 01 Capital Growth 02 Income 03 Both

D.19Minimum investment amount required:

D.20Base Currency:

D.21Which type of investor will the IC be marketed to? (Please tick the appropriate box(es)) General Public High Net Worth

Sophisticated Institutional Single Investor Expert1

D.22Is the IC any of the following: (Please tick appropriate box(es)) Index Tracker Feeder Fund Split Capital None of the above Fund of Funds

1 (as defined in the Jersey Expert Fund Guide)

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D.23Has application been made and subsequently been REFUSED for authorisation in relation to the ICC and/or IC under the rules and laws of any Yes No 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):

D.24Please list all Jersey fund service providers that provide their services to the IC. Name of fund service provider Class(es) of Fund Services Business

Important: the declaration after this page must be completed.

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Declaration

The IC is required to notify the JFSC immediately of: (a) any other information which it considers relevant to this application; and (b) any significant changes in the information provided in this application which occur after the date of submission of the application and prior to the IC 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 in Section D and the information given in Sections A and B signed by the ICC 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. We also declare that all relevant PQs have been submitted or are enclosed with this application together with the relevant certificate fees.

Sanctions: Higher Risk Factors As part of this application the IC is required to confirm that all due regard has, and will, be given to any applicable Sanctions framework relevant to, or associated with, activity in respect of any activity the IC intends to provide pursuant to this application. Consideration includes (but is not limited to) completing due diligence and relevant risk assessments specifically in relation to sanctioned jurisdictions, sanctioned entities, sanctioned individuals and any related sanctioned activity. Sanction frameworks include (but are not limited to) applicable Jersey, EU, UN or OFAC legislation some of which have obligatory reporting requirements within Jersey. In making this application the IC acknowledges these requirements and that the responsibility for consideration is an ongoing obligation after any approvals are granted. The IC confirms that in respect of any intended activity to be undertaken by the IC it has not identified a sanctioned jurisdiction, entity, individual or activity. Yes: No: If no, detail to be provided below (or per enclosures) regarding the sanctioned jurisdiction, entity, individual or activity that has been identified and the actions taken as a result.

Outsourcing

Has the IC outsourced, or does it intend to outsource any of its activities?

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activity would materially impair the continuing compliance of the registered person’s regulated activity, with the requirements of the regulatory laws.

If yes, does the IC consider the outsourcing activity to be exempt pursuant to section 3.2.2.5 of the Policy Statement and Guidance Notes on Outsourcing?

Yes: No: If no, please complete, and submit with this application form, the JFSC’s Outsourcing Notification which can be found on the JFSC’s website at: https://www.jerseyfsc.org/the_commission/general_information/forms/index.asp

For and on behalf of:

Signatures:

Names:

Positions:

Date: / / / /

This application form must be signed by two Principal Persons of the IC.

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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 (North 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

Bond B01 Bond-Global B02 Bond-UK Debt B03 Bond-US Debt B04 Bond-Europe

B05 Bond-Other

Money Market M01 Money Market-Sterling M02 Money Market-US Dollar M03 Money Market-Euro M04 Money Market-Swiss

M05 Money Market-Other

Specialist S01 Specialist-Venture Capital/Private Equity - Emerging Markets S02 Specialist-Venture Capital/Private Equity - Other S03 Specialist-Real Property S04 Specialist-Derivatives S05 Specialist-Traded Endowment Policies S06 Specialist-Hedge/Alternative Investment Funds

S07 Specialist-Other

Mixed X01 Mixed-Mixed Equity and Bond

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