Canaccord Genuity Investment Funds plc

Transcription

1 To us there are no foreign markets. Canaccord Genuity Investment Funds plc Application Form This Application Form, together with the FATCA and CRS Self-Certification Form, the Declaration of Residency and the Money Laundering Verification Form constitutes your agreement to subscribe for Shares in Canaccord Genuity Investment Funds plc (the Company ). All sections must be completed in their entirety. You should post or fax your subscription (in which case the original must also be forwarded) to the Administrator s address below. Please note that if this is your first investment in shares of the Company the original fully signed Application Form must be returned to the Administrator. No dividend payments will be processed prior to receipt of this original signed Application Form and supporting documentation. If you are unable to complete any part of this form, please contact the Administrator at: Transfer Agency Department, Northern Trust International Fund Administration Services (Ireland) Ltd George s Court, Townsend Street, Dublin 2, Ireland T: F: E: [email protected] Section 1 - Application Form 1. Investment details I/We the undersigned declare that the Key Investor Information Document (the KIID ) for the relevant Fund(s) has been provided to me/us in good time prior to making this application for shares and that I/we have read and reviewed the KIID as well as the Prospectus of the Company and its supplements. I/We the undersigned hereby acknowledge and agree that the up-to-date KIID for each share class of the Fund(s) is available at the Marketing Agents website canaccord.com/wm, and that I/we will read and review the most up-to-date version of the relevant KIID prior to making any subsequent applications for shares in the Company. I/We the undersigned acknowledge that by signing this subscription form that I/we give full consent to receiving the KIID by means of electronic communication including these being made available at the Marketing Agents website. I/we the undersigned acknowledge that I/we have regular access to the internet and that the provision of information to me/us by means of a website is appropriate. I/We the undersigned am/are aware that I/we can also obtain upon request and free of charge paper copies of the Prospectus, latest annual and semi-annual reports, KIID and other information from the Administrator at the address above or telephone number above. I/We the undersigned wish to invest (indicate monetary amount or number of shares below) in the following Sub-Fund(s) and share classes: Sub-Funds and share classes CGWM Select Income Fund ISIN Minimum Investment Subsequent Investment Subscription Amount Number of Shares A GBP (Accumulation) IE00B3BRDN43 GBP5,000 GBP1,000 A GBP (Distribution) IE00B3BRDP66 GBP5,000 GBP1,000 CGWM Select Diversity Fund A GBP (Accumulation) IE00B3BRDF68 GBP5,000 GBP1,000 A GBP (Distribution) IE00B3BRDG75 GBP5,000 GBP1,000 CGWM Select Affinity Fund A GBP (Accumulation) IE00B3BRDD45 GBP5,000 GBP1,000 A GBP (Distribution) IE00B3BRDC38 GBP5,000 GBP1,000 APP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 1

2 Application Form Sub-Funds and share classes ISIN Minimum Investment Subsequent Investment Subscription Amount Number of Shares CGWM Select Opportunity Fund A GBP (Accumulation) IE00B3BRDQ73 GBP5,000 GBP1,000 CGWM Select Global Diversity Fund A USD (Accumulation) IE00B3BRDM36 USD5,000 USD1,000 A USD (Distribution) IE00B3BRDL29 USD5,000 USD1,000 A EUR Hedged (Accumulation) IE00BSJCDW50 USD5,000 USD1,000 A SGD Hedged (Distribution) IE00B54L8R61 USD5,000 USD1,000 T USD (Accumulation) IE00BSJCDR08 USD5,000 USD1,000 T GBP Hedged (Accumulation) IE00BSJCDS15 USD5,000 USD1,000 T EUR Hedged (Accumulation) IE00BSJCDT22 USD5,000 USD1,000 T SGD Hedged (Accumulation) IE00BSJCDV44 USD5,000 USD1,000 CGWM Select Global Affinity Fund A USD (Accumulation) IE00B3BRDJ07 USD5,000 USD1,000 A USD (Distribution) IE00B3BRDH82 USD5,000 USD1,000 A EUR Hedged (Accumulation) IE00BSJCJL65 USD5,000 USD1,000 A SGD Hedged (Distribution) IE00B7R58130 USD5,000 USD1,000 T USD (Accumulation) IE00BSJCJG13 USD5,000 USD1,000 T GBP Hedged (Accumulation) IE00BSJCJH20 USD5,000 USD1,000 T EUR Hedged (Accumulation) IE00BSJCJJ44 USD5,000 USD1,000 T SGD Hedged (Accumulation) IE00BSJCJK58 USD5,000 USD1,000 CGWM Select Global Opportunity Fund A USD (Accumulation) IE00B3BRDK12 USD5,000 USD1,000 A GBP Hedged (Accumulation) IE00BSJCJC74 USD5,000 USD1,000 A EUR Hedged (Accumulation) IE00BSJCJD81 USD5,000 USD1,000 A SGD Hedged (Accumulation) IE00B7V99524 USD5,000 USD1,000 T USD (Accumulation) IE00BSJCJ725 USD5,000 USD1,000 T GBP Hedged (Accumulation) IE00BSJCJ832 USD5,000 USD1,000 T EUR Hedged (Accumulation) IE00BSJCJ949 USD5,000 USD1,000 T SGD Hedged (Accumulation) IE00BSJCJB67 USD5,000 USD1,000 AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 2

3 Sub-Funds and share classes ISIN Minimum Investment Subsequent Investment Subscription Amount Number of Shares CGWM Select Bond Fund A GBP (Accumulation) IE00BYNFQ459 GBP5,000 GBP1,000 A EUR Hedged (Accumulation) IE00BYNFQ566 GBP5,000 GBP1,000 A USD Hedged (Accumulation) IE00BYNFQ673 GBP5,000 GBP1,000 A GBP (Distribution) IE00BGLP1Z72 GBP5,000 GBP1,000 A EUR Hedged (Distribution) IE00BGLP2096 GBP5,000 GBP1,000 A USD Hedged (Distribution) IE00BGLP2104 GBP5,000 GBP1,000 CGWM GPS Optimized Portfolio 4 Fund D GBP (Distribution) IE00B99BF239 GBP 50,000 GBP1,000 CGWM GPS Optimized Portfolio 5 Fund D GBP (Distribution) IE00B99BF676 GBP 50,000 GBP1,000 CGWM Global Equity Fund - Settlement is required within 3 Business Days of the relevant Dealing Day A USD (Accumulation) IE00BDF17P27 USD5,000 USD1,000 A SGD Hedged (Accumulation) IE00BDF17Q34 USD5,000 USD1,000 T USD (Accumulation) IE00BDF17W93 USD5,000 USD1,000 T GBP Hedged (Accumulation) IE00BDF17X01 USD5,000 USD1,000 T EUR Hedged (Accumulation) IE00BDF17Y18 USD5,000 USD1,000 T SGD Hedged (Accumulation) IE00BDF17Z25 USD5,000 USD1,000 Please note The minimum and subsequent investments are set out above or are the equivalent in USD, SGD or EUR With regards to the CGWM GPS Optimized Portfolio Funds, the D GBP (Distribution) shares are only available to retail investors who receive advice from and pay a separate fee to financial intermediary/advisor. If payment is not being made in the Fund s base currency, then please note that foreign exchange will be arranged by the Administrator of the Fund in accordance with the procedures employed by the Administrator for foreign exchange transactions. 2. Details of applicant(s) Unit Holder 1 Mr/Mrs/Miss/Ms/title: First name/family name/company name: Unit Holder 2 Mr/Mrs/Miss/Ms/title: First name/family name/company name: Address inc street/town/country/postcode: Address inc street/town/country/postcode: Telephone: Fax: Telephone: Fax: Mailing address (if different from the address of the first named holder): If more than two applicants add an additional page with their details and tick here: AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 3

4 3. Bank details for payment of subscription If subscriptions are not being paid in the Fund s base currency, then please note that foreign exchange will be arranged by the Administrator of the fund in accordance with the procedures employed by the Administrator for foreign exchange transactions. Subscriptions should be made by TT or BACS as follows: Sterling (GBP) Payments: Intermediary Bank: Barclays Bank PLC, London SWIFT: BARCGB22 Beneficiary Bank: The Northern Trust International Banking Corporation, New Jersey IBAN: GB64BARC Beneficiary: Canaccord Genuity Investment Funds Plc Reference: Contract number/shareholder account number US Dollar (USD) Payments: Beneficiary Bank: The Northern Trust International Banking Corporation, New Jersey SWIFT: CNORUS33 Fedwire ABA: CHIPS ABA: 0112 Beneficiary: Canaccord Genuity Investment Funds Plc Reference: Contract number/shareholder account number Euro (EUR) Payments: Intermediary Bank: Barclays Bank PLC, London SWIFT: BARCGB22 Beneficiary Bank: The Northern Trust International Banking Corporation, New Jersey SWIFT: CNORUS33 Beneficiary: Canaccord Genuity Investment Funds Plc Reference: Contract number/shareholder account number Singapore Dollar (SGD) Payments: Intermediary Bank: DBS Bank Ltd., Singapore SWIFT: DBSSSGSG Beneficiary Bank: The Northern Trust International Banking Corporation, New Jersey Account Number: SWIFT: CNORUS33 Beneficiary: Canaccord Genuity Investment Funds Plc Reference: Contract number/shareholder account number When sending payment by TT, please quote: Applicant s name Bank Bank account number Fund name Confirmation note number (if one has been issued) AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 4

5 4. Dividend information and redemption payment Please tick the preferred dividend option: Cash Reinvestment Pay proceeds to: Name of bank: Account name: Account number: Sort code: Address: Postcode: Please note that the Company will automatically re-invest any distribution entitlements in further shares of the same class: 1. Unless distributions are in excess of US$100, 50 or 100 or currency equivalent, and instructions in writing to the contrary are received from the Shareholder at least 21 days prior to the relevant distribution date; 2. If distributions are less than US$100, 50 or 100 or currency equivalent in value; 3. In all cases where the Shareholder s anti-money laundering documentation is incomplete or has not been completed to the satisfaction of the Administrator. Please note bank charges may be deducted. Please see the main prospectus for further details. No third party payments will be undertaken. If the section is not completed, redemption will be paid in favour of the registered shareholder or in favour of the joint registered shareholders as appropriate, and sent to the registered address of the first named shareholder or to the mailing address. The present instruction shall apply to the relevant Fund and shall be valid until cancelled by me/us in writing. Joint applicants acknowledge that they are also bound by these instructions. A telegraphic transfer fee of 20/ 30/US$37.50 or currency equivalent will be applied to dividends or redemptions paid in this way. 5. Detail of Agent/Nominee/Intermediary This section only needs to be completed where there is an agent/nominee or intermediary. Where there is no such agent this section does not need to be completed. Total front end fee: % Commission to pay to agent: % Name: Contact: Telephone: Fax: Address: Postcode: Note: Any Intermediary recorded above hereby confirms that they are complying with all necessary laws and regulations in entering or soliciting a third party to enter into this contract. In addition to verifying the source of funds, Intermediaries are obliged to verify the identity of any investor introduced by the Intermediary. Intermediaries falling into this category should supply the information detailed in the relevant section of the Money Laundering Verification Form. Unless this information is supplied, the Shares will not be registered by the Administrator. Dealing procedure All application, redemption, transfer requests and instructions in relation to the Shares in the relevant funds must be received before the times specified in the relevant supplement of the Prospectus for each fund. Applications, redemptions and transfer request received after that time will generally be deemed to have been received for the next Dealing Day. No redemption payment will be made until the original application form has been received from the investor and the Administrator is satisfied that all of the necessary anti-money laundering checks have been completed in full. By ticking here, I hereby consent to the provision of contract notes, statements and other reports, by secured and encrypted electronic transmission, which may be issued from time to time by the administrator in respect of my holdings in the Fund. AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 5

6 Section 2 Declaration of Residence Outside of The Republic of Ireland Applicants resident outside Ireland are required by the Irish Revenue Commissioners to make the following declaration which is in a format authorised by them, in order to receive payment without deduction of tax. It is important to note that this declaration, if it is then still correct, shall apply in respect of any subsequent acquisitions of shares. Terms used in this declaration are defined in the Prospectus. Declaration on own behalf I/we* declare that I am/we are* applying for the shares on my own/our own behalf/on behalf of a company* and that I am/we are/the company* is entitled to the shares in respect of which this declaration is made and that I am/we are/the company is* not currently resident or ordinarily resident in Ireland, and should I/we/the company* become resident in Ireland I will/we will* so inform you, in writing, accordingly. *Delete as appropriate (mandatory) Declaration as Intermediary I/we* declare that I am/we are* applying for shares on behalf of persons: who will be beneficially entitled to the shares; and, who, to the best of my/our* knowledge and belief, are neither resident nor ordinarily resident in Ireland. I/we* also declare that: unless I/we* specifically notify you to the contrary at the time of application, all applications for shares made by me/us* from the date of this application will be made on behalf of such persons; and, I/we* will inform you in writing if I/we* become aware that any person, on whose behalf I/we* holds shares, becomes resident in Ireland. *Delete as appropriate (mandatory) Signature and declaration I / We declare that the information contained in this form and any attached documentation is true and accurate to the best of my/our* knowledge and belief. (*delete as applicable) Date: Signed: Signatory capacity if applicable: (i.e. Director/Manager) In the case of joint holders, ALL holders must complete this declaration. Important notes 1. Non-resident declarations are subject to inspection by the Irish Revenue Commissioners and it is a criminal offence to make a false declaration. 2. To be valid, the application form (incorporating the declaration required by the Irish Revenue Commissioners) must be signed by the applicant. Where there is more than one applicant, each person must sign. If the applicant is a company, it must be signed by the company secretary or another authorised officer. 3. If the application form (incorporating the declaration required by the Irish Revenue Commissioners) is signed under power of attorney, a copy of the power of attorney must be furnished in support of the signature. AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 6

7 Section 3 Declaration of Residence Within The Republic of Ireland¹ Declaration referred to in section 739D(6) Taxes Consolidation Act, 1997 I declare that the information contained in this declaration is true and correct. I also declare that I am applying for the shares on behalf of the applicant named below who is entitled to the shares in respect of which this declaration is made and is a person referred to in Section 739D (6) of the Taxes Consolidation Act, 1997, being a person who is: (please tick as appropriate). A pension scheme A company carrying on life business within the meaning of section 706 TCA 1997 An investment undertaking A special investment scheme A unit trust to which section 731(5) (a) TCA 1997 applies; A charity being a person referred to in section 739D(6)(f)(i) TCA 1997; A qualifying management company A specified company 1. See definitions at the end of the form Entitled to exemption from income tax and capital gains tax by virtue of sections 784A(2), and 787I of the TCA 1997, (see further requirements for Qualifying Fund Manager below) A credit union to which Section 2 of the Credit Union Act, 1997 applies. Additional requirement where the declaration is completed on behalf of a pension scheme, a company carrying on life business within the meaning of section 706 TCA 1997, an investment undertaking, a special investment scheme, a unit trust to which section 731(5) (a) TCA applies, a qualifying management company or a credit union to which Section 2 of the Credit Union Act 1997 applies. I undertake that, in the event that the shares cease to be assets of the *pension scheme/company carrying on life business within the meaning of section 706 TCA 1997/investment undertaking/special investment scheme/unit trust to which section 731(5) (a) TCA applies/qualifying management company/credit union to which Section 2 of the Credit Union Act 1997 applies, including a case where the shares are transferred to another such entity, I will, by written notice, bring this fact to the attention of the investment undertaking accordingly. (*Delete as appropriate). Return of Values (Investment Undertakings) Regulations 2013 The Company must collect additional information in order to satisfy Return of Values (Investment Undertakings) Regulations 2013 (S.I.245 of 2013). Therefore any individual, company or any unincorporated body of persons which are an Irish resident must provide the following additional information and documentation: Tax Identification Number (TIN)/PPS Number: Any one of the following additional documents are required to verify the TIN or PPS Number (either a copy or the original is sufficient) P60 P45 P21 Balancing Statement Pay Slip (where employer is identified by name or tax number) Drug Payment Scheme Card European Health Insurance Card Tax Assessment Tax Return Form PAYE Notice of Tax Credits Child Benefit Award Letter/Book Pension Book Social Services Card Public Services Card In addition, any printed documentation issued by the Revenue Commissioners or by the Department of Social Protection which contain your name, address and tax reference number will also be acceptable. In the case of joint account holders, the additional documentation is required for each applicant. AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 7

8 Your personal information will be handled by the Administrator or it s duly appointed delegates as Data Processor for the Company in accordance with the Data Protection Acts 1988 to Your information provided herein will be processed for the purposes of complying with the Return of Values (Investment Undertakings) Regulations 2013 and this may include disclosure to the Irish Revenue Commissioners. Please see the table below for a list of exempted unit holders: Unit Holders The following resident entities from which the investment undertaking (IU) has obtained a duly completed resident entity declaration: Pension Schemes Companies carrying on a Life Assurance business Another investment undertaking Special investment schemes Unit trusts to which section 731(5) applies Charities Certain IFSC companies ARFs; AMRFs PRSA providers Credit Unions Companies, where the IU is a money market fund NAMA The National Pensions Reserve Fund Section 110 Companies Unit holders where the IU, immediately before a chargeable event, holds a non-resident declaration made by the person who made the investment; or where the IU has put in place equivalent measures with the written approval of the authorised Revenue officer. A Unit holder who holds units which are held in a recognised clearing system. Taxes Consolidation Act 1997 ref s.739d(6)(a) s.739d(6)(b) s.739d(6)(c) s.739d(6)(d) s.739d(6)(e) s.739d(6)(f) s.739d(6)(g) s.739d(6)(h) s.739d(6)(i) s.739d(6)(j) s.739d(6)(k) s.739d(6)(ka) s.739d(6)(l) s.739d(6)(m) s.739d(7); s.739d(7b) s.739b(1)(d)(i)(iii) s.739g(3) Additional requirements where the declaration is completed on behalf of a Charity I also declare that at the time of making this declaration, the shares in respect of which this declaration is made are held for charitable purposes only; and Form part of the assets of a body of persons or trust related by the Revenue Commissioners as a body or trust established for charitable purposes only, or are, according to the rules or regulations established by statute, charter, decree, deed of trust or will, held for charitable purposes only and are so treated by the Revenue Commissioners; I undertake that, in the event that the person referred to in paragraph (7) (d) of Schedule 2B TCA 1997 ceases to be a person referred to in Section 739D(6)(f)(i) TCA 1997, I will by written notice, bring this fact to the attention of the investment undertaking accordingly. Additional requirements where the declaration is completed by a Qualifying Fund Manager I also declare that at the time this declaration is made, the shares in respect of which this declaration is made; Are assets of an *approved retirement fund/an approved minimum retirement fund; and Are managed by the declarant for the individual named below who is beneficially entitled to the shares. I undertake that, if the shares cease to be assets of the *approved retirement fund/the approved minimum retirement fund, including a case where the shares are transferred to another such fund, I will, by written notice, bring this fact to the attention of the investment undertaking accordingly. (*Delete as appropriate). Additional requirements where the declaration is completed by an Intermediary I/we* declare that I am/we are* applying for shares/units on behalf of persons who to the best of my/our* knowledge and belief, have beneficial entitlement to each of the units in respect of which this declaration is made; and is a person referred to in section 739D(6) TCA I/we* also declare that unless I/we* specifically notify you to the contrary at the time of application, all applications for shares/units made by me/us* from the date of this application will be made on behalf of persons referred to in section 739D(6) TCA 1997; and I/we* will inform you in writing if I/we* become aware that any person ceases to be a person referred to in section 739D(6) TCA * Delete as appropriate AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 8

9 Name of Applicant: ²Irish Tax Reference Number of Applicant: ³Authorised Signatory: (Declarant) (Mr/Ms/etc.): Capacity in which declaration is made: Date: Important notes 1. This is a form authorised by the Revenue Commissioners which may be subject to inspection. It is an offence to make a false declaration. 2. Tax reference number in relation to a person, has the meaning assigned to it by Section 885 TCA 1997 in relation to a specified person within the meaning of that section. In the case of a charity, quote the Charity Exemption Number (CHY) as issued by the Revenue. In the case of a qualifying fund manager, quote the tax reference number of the beneficial owner of the shares. 3. In the case of (i) an exempt pension scheme, the administrator must sign the declaration (ii) a retirement annuity contract to which Section 784 or 785 applies, the person carrying on the business of granting annuities must sign the declaration (iii) a trust scheme, the trustees must sign the declaration. In the case of a charity, the declaration must be signed by the trustees or other authorised officer of a body of persons or trust established for charitable purposes only within the meaning of Sections 207 and 208 TCA In the case of a company, the declaration must be signed by the company secretary or other authorised officer. In the case of a unit trust it must be signed by the trustees. In any other case, it must be signed by an authorised officer of the entity concerned or a person who holds a power of attorney from the entity. If the latter, a copy of the power of attorney should be furnished in support of this declaration. AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 9

10 Section 4 (i) Entity Self-Certification for FATCA and CRS Instructions for completion We are obliged under Section 891E, Section 891F and Section 891G of the Taxes Consolidation Act 1997 (as amended) and regulations made pursuant to those sections to collect certain information about each investor s tax arrangements. Please complete the sections below as directed and provide any additional information that is requested. Please note that in certain circumstances we may be legally obliged to share this information, and other financial information with respect to an investor s interests in the Fund with relevant tax authorities.this form is intended to request information only where such request is not prohibited by Irish law. If you have any questions about this form or defining the investor s tax residency status, please refer to the OECD CRS Portal or speak to a tax adviser. For further information on FATCA or CRS please refer to Irish Revenue website at or the following link: in the case of CRS only. If any of the information below about the investor s tax residence or FATCA/CRS classification changes in the future, please ensure that we are advised of these changes promptly. (Mandatory fields are marked with an *) Investors that are individuals should not complete this form and should complete the form entitled Individual Self-Certification for FATCA and CRS. Section 1: Investor Identification Investor Name *: Country of Incorporation or Organisation: (the Entity ) Current Registered Address*: Number: Street: City, Town, State, Province or Country: Postal/ZIP Code: Country: Mailing Address (if different from above) Number: Street: City, Town, State, Province or Country: Postal Code: Country: Section 2: FATCA Declaration Specified U.S. Person: Please tick either (a), (b) or (c) below and complete as appropriate. a. The Entity is a Specified US Person and the Entity s US Federal Taxpayer Identifying number (US TIN) is as follows: U.S. TIN: b. The Entity is not a Specified US Person (please also complete Sections 3, 4 and 5) c. The Entity is a US person but not a Specified U.S. Person (please also complete Sections 3, 4 and 5) AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 10

11 Section 3: Entity s FATCA Classification* (the information provided in this section is for FATCA, please note your classification may differ from your CRS classification in Section 5): 3.1 Financial Institutions under FATCA: If the Entity is a Financial Institution, please tick one of the below categories and provide the Entity s GIIN at Irish Financial Institution or a Partner Jurisdiction Financial Institution 2. Registered Deemed Compliant Foreign Financial Institution 3. Participating Foreign Financial Institution 3.2 Please provide the Entity s Global Intermediary Identification number (GIIN) 3.3 If the Entity is a Financial Institution but unable to provide a GIIN, please tick one of the below reasons: 1. The Entity has not yet obtained a GIIN but is sponsored by another entity which does have a GIIN Please provide the sponsor s name and sponsor s GIIN : Sponsor s Name: Sponsor s GIIN: 2. Exempt Beneficial Owner 3. Certified Deemed Compliant Foreign Financial Institution (including a deemed compliant Financial Institution under Annex II of the Agreement) 4. Non-Participating Foreign Financial Institution 5. Excepted Foreign Financial Institution 3.4 Non-Financial Institutions under FATCA: If the Entity is not a Financial Institution, please tick one of the below categories 1. Active Non-Financial Foreign Entity 2. Passive Non-Financial Foreign Entity (If this box is ticked, please include self-certification forms for each of your Controlling Persons) 3. Excepted Non-Financial Foreign Entity Section 4: CRS Declaration of Tax Residency (please note that you may choose more than one country)* Please indicate the Entity s country of tax residence for CRS purposes, (if resident in more than one country please detail all countries of tax residence and associated tax identification numbers ( TIN )). NOTE: Provision of a Tax ID number (TIN) is required unless you are tax resident in a Jurisdiction that does not issue a (TIN). If the Entity is not tax resident in any jurisdiction (e.g., because it is fiscally transparent), please indicate that below and provide its place of effective management or country in which its principal office is located. Country of Tax Residency Tax ID Number AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 11

12 Section 5: Entity s CRS Classification*(The information provided in this section is for CRS. Please note an Entity's CRS classification may differ from its FATCA classification in Section 3): For more information please see the CRS Standard and associated commentary Financial Institutions under CRS: If the Entity is a Financial Institution, please tick one of the below categories 1. Financial Institution under CRS(other than (II) below) 2. An Investment Entity located in a Non-Participating Jurisdiction and managed by another Financial Institution (If this box is ticked, please indicate the name of any Controlling Person(s) of the Entity and complete a separate individual self-certification forms for each of your Controlling Persons **) 5.2 Non Financial Institutions under CRS: If the Entity is a Non Financial Institution, please tick one of the below categories 1. Active Non-Financial Entity a corporation the stock of which is regularly traded on an established securities market or a corporation which is a related entity of such a corporation 2. Active Non-Financial Entity a Government Entity or Central Bank 3. Active Non-Financial Entity an International Organisation 4. Active Non-Financial Entity other than (I)-(III) (for example a start-up NFE or a non-profit NFE) 5. Passive Non-Financial Entity (If this box is ticked, please complete a separate Individual Self-Certification Form for each of your Controlling Person(s) ) **Controlling Persons: NB: Please note that each Controlling Person must complete a Separate Individual Self-Certification form. If there are no natural person(s) who exercise control of the Entity then the Controlling Person will be the natural person(s) who hold the position of senior managing official of the Entity. For further information on Identification requirements under CRS for Controlling Persons, see the Commentary to Section VIII of the CRS Standard. Section 6: Declarations and Undertakings I/We declare (as an authorised signatory of the Entity) that the information provided in this form is, to the best of my/our knowledge and belief, accurate and complete. I acknowledge that the information contained in this form and information regarding the Account Holder may be reported to the tax authorities of the country in which this account(s) is/are maintained and exchanged with tax authorities of another country or countries in which the Account Holder may be tax resident where those countries (or tax authorities in those countries) have entered into Agreements to exchange financial account information. I/We undertake to advise the recipient promptly and provide an updated Self-Certification where any change in circumstance occurs which causes any of the information contained in this form to be incorrect. Authorised Signature(s)*: Print Name(s)*: Capacity in which declaration is made*: Date: (dd/mm/yyyy):* AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 12

13 Section 4 (ii) Individual (Controlling Person s) Self-Certification for FATCA and CRS Instructions for completion We are obliged under Section 891E, Section 891F and Section 891G of the Taxes Consolidation Act 1997 (as amended) and regulations made pursuant to those sections to collect certain information about each investor s tax arrangements. Please complete the sections below as directed and provide any additional information that is requested. Please note that in certain circumstances we may be legally obliged to share this information, and other financial information with respect to an investor s interests in the Fund with relevant tax authorities.this form is intended to request information only where such request is not prohibited by Irish law. If you have any questions about this form or defining the investor s tax residency status, please refer to the OECD CRS Portal or speak to a tax adviser. For further information on FATCA or CRS please refer to Irish Revenue website at or the following link to the OECD CRS Information Portal at in the case of CRS only. If any of the information below about the investor s tax residence or FATCA/CRS classification changes in the future, please advise of these changes promptly. Please note that where there are joint or multiple account holders each investor is required to complete a separate Self-Certification form. Sections 1, 2, 3 and 5 must be completed by all investors. Section 4 should only be completed by any individual who is a Controlling Person of an entity investor which is a Passive Non-Financial Entity. For further guidance see (Mandatory fields are marked with an *) Section 1: Investor Identification Investor Name*: Current Residential Address*: Number: Street: City, Town, State, Province or Country: Postal/ZIP Code: Country: Mailing Address (if different from above) Number: Street: City, Town, State, Province or Country: Postal/ZIP Code: Country: Place Of Birth* Town or City of Birth*: Country of Birth*: Date of Birth*: Section 2: FATCA Declaration of U.S. Citizenship or U.S. Residence for Tax purposes*: Please tick either (a) or (b) and complete as appropriate. 1. I confirm that [I am]/[the investor is] a U.S. citizen and/or resident in the U.S. for tax purposes and [my]/[its] U.S. federal taxpayer identifying number (US TIN) is as follows OR 2. I confirm that [I am not]/[the investor is not] a U.S. citizen or resident in the U.S. for tax purposes. AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 13

14 Section 3: CRS Declaration of Tax Residency (please note you may chose more than one country)* Please indicate your/ the investor s country of tax residence (if resident in more than one country please detail all countries of tax residence and associated taxpayer identification numbers ( TIN ). Please see the CRS Portal for more information on Tax Residency. Country of Tax Residency Tax ID Number NOTE: Provision of a Tax ID number (TIN) is required unless you are tax resident in a Jurisdiction that does not issue a TIN. Section 4 Type of Controlling Person (ONLY to be completed by any individual who is a Controlling Person of an entity investor which is a Passive Non-Financial Entity or an Investment Entity located in a Non-Participating Jurisdiction and managed by another Financial Institution) For joint or multiple Controlling Persons please complete a separate Self-Certification form for each Controlling Person Please Confirm what type of Controlling Person applicable under CRS that applies to you/the investor by ticking the appropriate box. Please Tick Entity Name Controlling Person of a legal person control by ownership Controlling Person of a legal person control by other means Controlling Person of a legal person senior managing official Controlling Person of a trust - settlor Controlling Person of a trust trustee Controlling Person of a trust protector Controlling Person of a trust beneficiary Controlling Person of a trust other Controlling Person of a legal arrangement (non-trust) settlor-equivalent Controlling Person of a legal arrangement (non-trust) trustee-equivalent Controlling Person of a legal arrangement (non-trust) protector-equivalent Controlling Person of a legal arrangement (non-trust) beneficiary-equivalent Controlling Person of a legal arrangement (non-trust) other-equivalent AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 14

15 Section 5: Declaration and Undertakings: I declare that the information provided in this form is, to the best of my knowledge and belief, accurate and complete. I acknowledge that the information contained in this form and information regarding the Account Holder may be reported to the tax authorities of the country in which this account(s) is/are maintained and exchanged with tax authorities of another country or countries in which the Account Holder may be tax resident where those countries (or tax authorities in those countries) have entered into Agreements to exchange financial account information. I undertake to advise the recipient promptly and provide an updated Self-Certification form where any change in circumstances occurs which causes any of the information contained in this form to be incorrect. Authorised Signature*: Print Name*: Date: (dd/mm/yyyy)*: Capacity*: AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 15

16 Section 5 Money Laundering Requirements and EU Savings Directive Anti-Money Laundering verification requirements In accordance with The Criminal Justice (Money Laundering and Terrorist Financing) Acts, 2010 and Guide to completing this form. Part I This section must be completed by all applicants and transferees Part II This section is to be completed by any applicant which is a Recognised Regulated Entity: eg a bank, provider of financial services or nominee company investing on its own behalf and if regulated for compliance with applicable Anti Money Laundering regulations in a Prescribed Country¹ Part III This section is only applicable to individual & joint account investors investing directly into the Fund, i.e. not through an intermediary. Part IV This section is applicable to Intermediaries, Financial Agents and Nominees acting on behalf of third parties. Part V This section is to be completed if an unregulated Nominee Company is acting as intermediary or nominee for investors and the Nominee Company is owned by a Relevant Third Party. Part VI To be completed by any Politically Exposed Person(s) investing into the Fund. Part VII This section is applicable to other investors investing directly into the Fund. In the case of joint account holders, the additional documentation is required for each applicant. Please note that in all cases this is an indicative list only and the Administrator or Fund may, at its absolute discretion request further due diligence documentation/information to satisfy applicable procedural and regulatory requirements. PART I ALL Full name(s) and full current permanent address/registered office of applicants(s)/transferee(s): Mr/Mrs/Miss/Ms/Company Name: Address/Registered Office: Date of Birth* (if applicable): Country of Birth/Registration: Full name where applicable of any beneficial owner of investor who owns more than 25% of company / Partnership / LLC / CIS / Trust / Public body: 1: 3: 2: 4: DECLARATION - I/We declare that the information contained in this form, including the section entitled Representations and Warranties at pages 14 to 15, and any attached documentation is true and accurate to the best of my/our knowledge and belief. Date: Signed: Signatory capacity if applicable: (i.e. Director/Manager) In the case of joint holders, ALL holders must complete this declaration. * Must be over 18 years of age. ¹ Prescribed Countries as set out in The Criminal Justice (Money Laundering and Terrorist Financing) Act Statutory Instrument 347 of 2012: Australia, Austria, Belgium, Brazil, Bulgaria, Canada, Channel Islands, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hong Kong, Hungary, Iceland, India, Ireland, Isle of Man, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Mexico, Netherlands, Norway, Poland, Portugal, Romania, Singapore, Slovakia, Slovenia, South Africa, South Korea, Spain, Sweden, Switzerland, United Kingdom, United States, The Dutch overseas territories of Netherlands Aruba, Curacao, Sint Maarten, Bonaire, Sint Eustatius and Saba. The French overseas territories of Mayotte, New Caledonia, French Polynesia, Saint Pierre and Miquelon and Wallis & Futuna. AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 16

17 PART II Recognised Regulated Entities Please tick the following, if appropriate: I/We are a Recognised Regulated Entity (as previously defined) acting on its own account. Yes If the answer is Yes, please supply the name of the regulated entity and also the name of your regulator: If you are acting on behalf of a third party see Part IV PART III Individuals and Joint Account Holders If you, as applicant(s) or transferee(s) is/are an Individual(s) please supply the following documents. In the case of joint account holders, please supply the relevant documentation in respect of all holders. A copy photographic identity document and a copy non-photographic identity document dated within the last six months. Note: the Company or the Administrator may require further documentation to be provided upon written request. PART IV To be completed by Financial Agents, Nominees and Intermediaries As an intermediary/agent/nominee company authorised and regulated in a Prescribed Country¹, you must provide: 1. Standard reliance letter (a template can be obtained from the Administrator) 2. Relevant Third Party s Authorised Signatory List 3. Proof of regulatory status of Relevant Third Party PART V If Nominee Company is unregulated and is acting as intermediary or nominee for investors and the nominee company is owned by a Relevant Third Party If the Nominee Company is unregulated and is acting as intermediary or nominee for investors the following documents are required; 1. Standard reliance letter (a template can be obtained from the Administrator) 2. Documentation in accordance with the legal form of the Nominee Company 3. Proof of regulatory status of Relevant Third Party Relevant Third Party Note - A Relevant Third Party is a regulated entity in the Prescribed Countries¹: that is a credit institution, or that is a financial institution, or who is an external accountant or auditor and who is also a member of a designated accountancy body, or is a member of a designated accountancy body, auditor, tax adviser, legal professional or trust or company service provider subject to mandatory professional registration or mandatory professional supervision under the laws of the other Prescribed Country¹. ¹ Prescribed Countries as set out in The Criminal Justice (Money Laundering and Terrorist Financing) Act Statutory Instrument 347 of 2012: Australia, Austria, Belgium, Brazil, Bulgaria, Canada, Channel Islands, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hong Kong, Hungary, Iceland, India, Ireland, Isle of Man, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Mexico, Netherlands, Norway, Poland, Portugal, Romania, Singapore, Slovakia, Slovenia, South Africa, South Korea, Spain, Sweden, Switzerland, United Kingdom, United States, The Dutch overseas territories of Netherlands Aruba, Curacao, Sint Maarten, Bonaire, Sint Eustatius and Saba. The French overseas territories of Mayotte, New Caledonia, French Polynesia, Saint Pierre and Miquelon and Wallis & Futuna. AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 17

18 Part VI Politically Exposed Persons A Politically Exposed Person is defined as an individual who is or was at any time in the preceding 18 months entrusted with a prominent public function or immediate family members of such persons or persons known to be close professional associates of such persons. Please confirm whether you are a Politically Exposed Person (PEP) Yes No If the answer is yes, please provide the following documentation: 1. Certified Copy Photographic Identity Document eg Passport or Driver s Licence and 2. Two Certified Copies of Proof of Residential Address Verification eg utility bill/bank statement dated within the last six months 3. Source of Funds please confirm the source from which you are settling your subscription: Earnings from Employment/Self Employment Investment Income Lump Sum Retirement Sale of Property Inheritance of Gift Matured Investment Court Award Other please specify below Other 4. Source of Wealth - Please provide a brief description of your source of wealth (source of total accumulated net worth) Note: Certified documents means that there is an original signature on the document from a suitable person confirming the documents are a true copy of the original, and they will need to sign and date it, printing their name, occupation, address, telephone number and address. Suitable persons include any of the following; police officer, practicing solicitors, embassy consular staff, financial institutions, medical professions, notaries public. The person certifying the documents should be independent of the investor. PART VII OTHER INVESTORS (Standard Customer Due Diligence) If you, as applicant or transferee, fall under one of the investor categories outlined below please provide documents evidencing the requested information. Please note that in all cases this is an indicative list only and the Administrator or Fund may, at its absolute discretion request further due diligence documentation/information to satisfy applicable procedural and regulatory requirements. Listed Company For a Listed Company in a Prescribed Country Proof of Listing on a Recognised Exchange 2 in a Prescribed Country. Otherwise see 1-10 below. 1. Proof of listing. 2. Full name. 3. Registered number. 4. Registered office address. 5. Principal business address. 6. Details of Directors including name, residential address and date of birth. 7. Details of any beneficial owners who are natural persons, who own more than 25% of the share capital, profit or voting rights or otherwise exercise control over the management of the company. 8. Confirmation as to whether the company is investing on its own behalf or on behalf of underlying investors and (as applicable) identify any Beneficial Owner. 9. Verification of identity from: Search of the relevant company registry; and/or Copy of Certificate of incorporation or equivalent; and/or Copy of Memorandum and Articles of Association or equivalent; and/or Copy of latest audited financial statements. 2 A Recognised Exchange is regulated under MiFid or deemed to have equivalent transparent rules. AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 18

19 Wholly Owned Subsidiary of a Listed Company 1. Full name. 2. Registered number. 3. Registered office address. 4. Principal business address 5. Details of Directors of the company including name, residential address and date of birth. 6. Detail of any Beneficial Owner beneficially entitled to more than 25% of the share capital, profit or voting rights or otherwise exercise control over the management of the entity. 7. Confirmations as to whether the company is investing on its own behalf or on behalf of underlying investors and (as applicable) provide identity detail for any Beneficial Owner. Where the Beneficial Owner is a corporate entity, the Administrator requires details of ultimate beneficial owners (this can be demonstrated through an organisation chart signed by an authorised signatory or shareholder register or other company documentation etc). 8. Verification of identity from: Search of the relevant company registry; or Copy of Certificate of incorporation or equivalent; or Copy of Memorandum and Articles of Association or equivalent; or Copy of latest audited financial statements. Private and Unlisted Company 1. Full name. 2. Registered number. 3. Registered office address. 4. Principal business address. 5. Details of Directors including name, residential address and date of birth. 6. Documentation to verify the identity of two directors or one director and one authorised signatory in accordance with Part III above (Individuals and Joint Account Holders) as the same requirements apply. 7. Detail of any beneficial owners who are natural persons, own more than 25% of the share capital, profit or voting rights or otherwise exercise control over the management of the company. Where the Beneficial Owner is a corporate entity, the Administrator requires details of ultimate beneficial owners (this can be demonstrated through an organisation chart signed by an authorised signatory or shareholder register or other company documentation etc). 8. Verification of identity from: Search of the relevant company registry; and/or Copy of Certificate of incorporation or equivalent; and/or Copy of Memorandum and Articles of Association or equivalent; and/or Copy of audited financial statements. Note: the Company or the Administrator may require further documentation to be provided upon written request. Partnership 1. Full name. 2. Registered office address. 3. Principal business address. 4. Details of all partners (where not a Partnership Fund); including name, residential address and date of birth. 5. If a Partnership Fund, verify (by providing documentation as per entity type) names of General Partner and partners who own more than 25% of the partnership capital, profit or voting rights or otherwise exercise control over the management of the Partnership Fund and listing of directors, if appropriate. Where the beneficial owner is a corporate entity, the Administrator requires details of ultimate beneficial owners (this can be demonstrated through an organisation chart signed by an authorised signatory or shareholder register or other company documentation etc). 6. Verification of identity of General Partner, or two partners, or one partner and one authorised signatory (in accordance with Part III above Individuals and Joint Account Holders - as the same requirements apply). 7. Constitutional Document (e.g. Partnership Agreement). Note: the Company or the Administrator may require further documentation to be provided upon written request. AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 19

20 Limited Liability Company (LLC) 1. Full name. 2. Registered office address. 3. Principal business address. 4. Details of Managing Member including name, residential address and date of birth. 5. Verification of identity of two Managing Members or one Managing Member and one authorised signatory (in accordance with Part III above). 6. Verify (by providing documentation as per entity type) members who own more than 25% of the share capital, profit or voting rights or otherwise exercise control over the management of the LLC. Where the beneficial owner is a corporate entity, the Administrator requires details of ultimate beneficial owners (this can be demonstrated through an organisation chart signed by an authorised signatory or shareholder register or other company documentation etc). 7. Constitutional Document (e.g. Certificate of formation). 8. Operating agreement. Collective Investment Scheme 1. Full name of CIS. 2. Registered address of CIS. 3. Prospectus or equivalent. 4. Name and address of scheme promoter. 5. Name and address of scheme administrator. 6. Name and address of entity carrying out anti-money laundering checks upon the scheme investors and confirmation that entity is regulated for AML purposes. 7. Verify (by providing documentation as per entity type) any investors who own more than 25% of the share capital. Trust, Foundation or similar entity 1. Full name of trust. 2. Registered address of trust. 3. Legal form of the trust, foundation or similar entity. 4. Trust deed or equivalent or confirmation of the entity to an appropriate register. 5. Nature / purpose of the Trust etc. 6. Details of all trustees including name, residential address and date of birth. 7. Verification of identity of two trustees or one trustee and one authorised signatory (in accordance with Part III above). 8. Details of settler including name, residential address and date of birth. 9. Verify (by providing documentation as per entity type) any beneficial owners who own at least 25% of the share capital or voting rights or otherwise exercises control over the trust. Where the beneficial owner is a corporate entity, the Administrator requires details of ultimate beneficial owners (this can be demonstrated through an organisation chart signed by an authorised signatory or shareholder register or other company documentation etc). 10. Details of protector (as appropriate) including name, residential address and date of birth. Pension Scheme For an employee sponsored pension scheme in the EU proof of registration from the relevant tax authorities. Otherwise items 1-6 below. 1. Full name. 2. Registered office address. 3. Confirmation of registration (as appropriate) from the relevant tax authorities or pension s board or items 4 and 5 below. 4. Verification of identity of two Trustees/Directors/Governors/Board Members or one Trustee/Director/Governor/Board Member and one authorised signatory (in accordance with Part III above Individuals and Joint Account Holders as the same requirements apply). 5. Constitutional/Formation Document (e.g. Trust Deed). AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 20

21 Charity Extract from the relevant Charities Register e.g. UK Charities Commission or 1-9 below. 1. Full name. 2. Nature/purpose including the nature of the funding. 3. Registered office address. 4. Principal business address. 5. Details of Trustees/Directors/Governors/Board Members or equivalent including name, residential address and date of birth. 6. Verification of identity of two Trustees/Directors/Governors/Board Members or one Trustee/Director/Governor/Board Member and one authorised signatory (in accordance with Part III above Individuals and Joint Account Holders - as the same requirements apply). 7. Details of beneficiaries (where ascertainable). 8. Constitutional/Formation Document. Club or Society 1. Full name. 2. Registered office address. 3. Nature/Purpose including the nature of funding. 4. Confirmation of the legal status. 5. Constitutional/Formation Document (e.g. Trust Deed) and / or copy of audited financial statements (if available). 6. Details of officers. 7. Verification of identity of two officers of the Club/Society or one officer and one authorised signatory (in accordance with Part III above Individuals and Joint Account Holders - as the same requirements apply). Note: the Company or the Administrator may require further documentation to be provided upon written request. Public Body For a Public Body in a Prescribed Country background from a reliable source (e.g. internet search) and Authorised Signatory List. Otherwise see 1-9 below. 1. Full name. 2. Nature and status. 3. Registered office address. 4. Name of the home state authority and nature of its relationship with public body. 5. Ownership of the entity. 6. Details of main public body officials including name, residential address and date of birth. 7. Verify (by providing documentation as per entity type) all persons who own or control over 25% of the entity s share capital, profit or voting rights or otherwise exercises control over the management of the entity. Where the beneficial owner is a corporate entity, the Administrator requires details of ultimate beneficial owners (this can be demonstrated through an organisation chart signed by an authorised signatory or shareholder register or other company documentation etc). 8. Appropriate background information on the entity (e.g. via internet search). School, College or University 1. Full name. 2. Registered office address. 3. Verification of identity from relevant registers and/or from obtaining appropriate background information (e.g. via internet search). 4. Verification of identity of two officials or one official and one authorised signatory in accordance with Part III above - Individuals and Joint Account Holders - as the same requirements apply or 5 and 6 below. 5. Confirmation of ownership of the entity. In particular, confirmation of public ownership or independent ownership. 6. Details of main officials including name, residential address and date of birth. AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 21

22 Section 6 Representations and Warranties 1. I/We confirm that I am/we are 18 years of age or over. 2. I/We, having received and considered a copy of the current KIID, Prospectus, any relevant supplements thereto and the most recent annual and/ or semi-annual report of the Company, hereby confirm and declare that this application is based solely on the information contained in such documentation and is made pursuant to the terms of this Application Form. 3. I/We agree that the issue and allotment to me/us of the Shares is subject to the provisions of the KIID, Prospectus and the relevant Supplements thereto, that subscription for Shares will be governed and construed in accordance with Irish law and I/we confirm that by subscribing for Shares, I/ we are not relying on any information or representation other than such as may be contained in the Prospectus, the relevant Supplements and the most recent annual or semi annual report (if available) thereto. 4. I/We agree to notify the Company or the Administrator immediately if I/we become aware that any of the representations is no longer accurate and complete in all respects and agree immediately to take such action as the Company may direct, including where appropriate, the redemption of my/ our holding in its entirety. I/We agree to indemnify each of the Administrator and the Company and agree to keep each of them indemnified against any loss of any nature whatsoever arising to any of them as a result of any breach of any of the representations, warranties or declarations given by me/us in this Application Form. 5. I/We have such knowledge and experience in business and financial matters or have obtained advice from a professional adviser such that I am/we are capable of evaluating the merits, and the risks, of an investment by me/us in the Company. 6. I/We understand that the tax disclosure set forth in the Prospectus and the relevant Supplements thereto is of a general nature and may not cover the jurisdiction in which I am /we are subject to taxation and that the tax consequences of my/our purchase of Shares depend on my/our individual circumstances. 7. I/We acknowledge the right of the Company at any time to require the mandatory redemption of Shares as provided in the Prospectus and in the relevant Supplements thereto. 8. I am/we are not subscribing for Shares on behalf of one or more (i) employee benefit plans ( ERISA Plans ) subject to Title I of United States Employee Retirement Income Security Act of 1974, as amended ( ERISA ), (ii) retirement plans covering only self-employed individuals and individual retirement accounts or otherwise defined as a plan in Section 4975(e)(1) of the United States Internal Revenue Code of 1986, as amended (collectively Qualified Plans ), or (iii) entities deemed to hold the assets of an ERISA Plan or Qualified Plan. 9. I/We, if not a natural person, am/are duly organised, validly existing and in good standing under the laws of the jurisdiction in which I am/we are organised and I/we have the power and authority to enter into and perform my/our obligations under this Application Form. 10. I am/we are able to bear the economic risk of an investment in the Shares, including, without limitation, the risk of loss of all or a part of my/ our investment and the potential difficulties in selling or transferring my/our Shares for an indefinite period of time. I/we do not have an overall commitment to investments which are not readily marketable that is disproportionate to my/our net worth, and my/our investment in the Shares will not cause such overall commitment to be excessive. 11. The Administrator and the Company are each hereby authorised and instructed to accept and execute any instructions in respect of the Shares to which this application relates given by me/us in written form or by facsimile. If the instructions are given by me/us by facsimile I/we undertake to confirm them in writing immediately. I/We hereby agree to indemnify each of the Administrator and the Company (on its own behalf and as agent of the Fund) and agree to keep each of them indemnified against any loss of any nature whatsoever arising to any of them as a result of any of them acting upon facsimile instructions. 12. The Administrator and the Company may rely conclusively upon and shall incur no liability in respect of any action taken upon any notice, consent, request, instruction or other instrument believed in good faith to be genuine or to be signed by properly authorised persons. 13. I/We acknowledge that due to anti-money laundering requirements operating within their jurisdiction the Administrator and the Company (as the case may be) may require further identification of the applicant(s) before the application can be processed and the Administrator and the Company shall be held harmless and indemnified against any loss arising as a result of a failure to process the application if such information has been required by the parties referred to and has not been provided by me/us or has been provided in incomplete form. 14. I/We request that the Shares issued pursuant to this application are registered in the name(s) and address set out above. 15. I/We hereby accept such lesser number of Shares, if any, than may be specified above in respect of which this application may be accepted. 16. (In respect of joint applicants only) we direct that on the death of one of us the Shares for which we hereby apply be held in the name of and to the order of the survivor or survivors of us or the executor or administrator of the last of such survivor or survivors. 17. I/We consent to personal information obtained in relation to me/us being handled by the Administrator, the Company, the Custodian, the Investment Manager and the Sub-Investment Manager and their delegates, agents or affiliates in accordance with the Data Protection Acts 1988 to Information in relation to me/us will be held, used, disclosed and processed for the purposes of (a) managing and administering my/our holdings in the Fund and any related account on an ongoing basis; (b) for any other specific purposes where I/we have given specific consent to do so; (c) to carry out statistical analysis and market research (d) to comply with any applicable legal or regulatory obligations including legal obligations under company law and anti-money laundering legislation; (e) for disclosure and transfer whether in Ireland or elsewhere (including companies situated in countries outside of the European Economic Area which may not have the same data protection laws as in Ireland) to third parties including my/our financial adviser (where appropriate), regulatory bodies, auditors, technology providers or to the Fund and its delegates and its or their duly appointed agents and any of their respective related, associated or affiliated companies for the purposes specified above; (f) or for other legitimate business interests of the Company. I/we hereby acknowledge my/our right of access to and the right to amend and rectify my/our personal data, as provided herein. I/we understand that the Company is a data controller and will hold any personal information provided by me/us in confidence and in accordance with the Data Protection Act AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 22

23 1988 as amended by the Data Protection (Amendment) Act I/we consent to the recording of telephone calls that I/we make to and receive from the Administrator, the Company, the Custodian, the Investment Manager or the Sub-Investment Manager and their delegates or duly appointed agents and any of their respective related, associated or affiliated companies for record keeping, security and/or training purposes. I/we consent to the Company, the Investment Manager or the Sub-Investment Manager sending information about other investment services to me/us by letter, telephone or other reasonable means of communication. I/we understand that we have a right not to receive such information. 18. I/We hereby authorise the Company and the Administrator to retain all documentation provided by me/us in relation to my/our investment in the Company for such period of time as may be required by Irish law, but for not less than five years after the period of investment has ended. 19. I/We confirm that I/we am/are not a U.S. Person as defined in the Prospectus and I/we am/are outside the United States and am/are not acquiring Shares on behalf of, or for the benefit of, a U.S. Person nor do I/we intend to sell or transfer any Shares which I/we may purchase to any person who is a U.S. Person. 20. I/We acknowledge that the Company intends to take such steps as may be required to satisfy any obligations imposed by either (i) the Foreign Account Tax Compliance Act ( FATCA ) and Common Reporting Standards ( CRS ) regulations or (ii) any provisions imposed under Irish law arising from the inter-governmental agreement between the Government of the United States of America and the Government of Ireland ( IGA ) so as to ensure compliance or deemed compliance (as the case may be) with the FATCA and CRS regulations or the IGA from 1 July I/We agree to provide to the Company, the Investment Manager, the Administrator and/or the Distributor the necessary FATCA and CRS declarations, confirmations and/or classifications at such times as each of them may request and furthermore provide any supporting certificates or documents as each of them may reasonably require in connection with this investment by reason of the FATCA and CRS regulations or the IGA, as described above, or otherwise. Should any information furnished to any of them become inaccurate or incomplete in any way, I/we hereby agree to notify the Company, the Investment Manager, the Administrator and/or the Distributor immediately of any such change and further agree to immediately take such action as the Company, the Investment Manager, the Administrator and/or the Distributor may direct, including where appropriate, redemption of our Shares in respect of which such confirmations have become incomplete or inaccurate where requested to do so by the Company, the Investment Manager, the Administrator and/or the Distributor (as applicable). If relevant, I/we agree to notify the Company and the Administrator of any change to my/our tax residency status. I/we hereby also agree to indemnify and keep indemnified the Company, the Investment Manager, the Administrator and/or the Distributor against any loss, liability, cost or expense (including without limitation legal fees, taxes and penalties) which may result directly or indirectly as a result of a failure to meet our obligations pursuant to this section or failure to provide such information which has been requested by the Company, the Investment Manager, the Administrator and/or the Distributor and has not been provided by me/us, and from any misrepresentation or breach of any warranty, condition, covenant or agreement set forth herein or in any document delivered by me/us to the Company, the Investment Manager, the Administrator and/or the Distributor. I/We further acknowledge that a failure to comply with the foregoing obligations or failure to provide the necessary information required may result in the compulsory redemption of our entire holding in the Company, and that the Company and the Custodian are authorised to hold back from redemption proceeds or other distributions to me/us such amount as is sufficient after the deduction of any redemption charges to discharge any such liability and I/we shall indemnify and keep indemnified the Company and the Custodian against any loss suffered by them or other Shareholders in the Company in connection with any obligation or liability to so deduct, withhold or account. 22 I/We acknowledge that the Company may temporarily borrow an amount equal to the subscription, subject to the Fund s borrowing limits, and invest the amount borrowed in accordance with the investment objective and policies of the Fund. Once the required subscription monies have been received, the Company will use this to repay the borrowings. In the event of failure by me/us to settle the subscription monies on a timely basis, the Company reserves the right to charge me/us for any interest or other costs incurred by the Company as a result of this borrowing; the Company also reserves the right to reverse any allotment of Shares. If I/we fail to reimburse the Company for those charges, the Company will have the right to sell all or part of my/our holdings of Shares in the Fund and I/we shall be liable for any related charges and/or loss suffered by the Company in the event that the redemption proceeds are less than the amount originally subscribed. 23 I/We acknowledge and agree that payment of redemption proceeds in respect of a particular Fund is subject to receipt by the Administrator of original subscription documents and compliance with all anti-money laundering procedures and that notwithstanding this, as a redeeming Shareholder, I/we will cease to be a Shareholder, with regard to the redeemed Shares, and will be unsecured creditors of the particular Fund, from the relevant Dealing Day. In such circumstances, any sums payable by way of dividend to me/us shall remain an asset of the Fund until such time as the Administrator has verified my/our identity to its satisfaction, following which such dividend will be paid. I/We further acknowledge that pending dividends and redemptions, including blocked redemptions, will, pending payment to the relevant Shareholder, be held in the umbrella cash subscriptions, dividends and redemptions account ( Umbrella Cash Account ) in the name of the Company. I/we acknowledge and agree that such amounts will constitute a debt due to me/us from the relevant Fund, as and from the relevant Dealing Day, and will not be held on trust for me/us pending payment of any dividend and/or redemption proceeds. 24 I/We acknowledge that subscription monies received in respect of a Fund in advance of the issue of Shares will be held in the Umbrella Cash Account in the name of the Company and will be treated as an asset of the relevant Fund. I/We further acknowledge that as an investor I/we will be unsecured creditors of the relevant Fund with respect to the amount subscribed and held by the Company until Shares are issued on the Dealing Day and, as such, I/we will not benefit from any appreciation in the Net Asset Value of the relevant Fund or any other Shareholder rights (including dividend entitlement) until such time as Shares are issued on the relevant Dealing Day. I/We further acknowledge that in the event of an insolvency of the Fund or the Company, there is no guarantee that the Fund or Company will have sufficient funds to pay unsecured creditors in full. I/We further acknowledge that in the event of the insolvency of another Fund of the Company (the Insolvent Fund), recovery of any amounts held in the Umbrella Cash Account to which another Fund is entitled (the Entitled Fund), but which may have transferred to the Insolvent Fund as a result of the operation of the Umbrella Cash Account, will be subject to the principles of Irish insolvency law and the terms of the operational procedures for the Umbrella Cash Account and, consequently, there may be delays in effecting and/or disputes as to the recovery of such amounts, and the Insolvent Fund may have insufficient funds to repay amounts due to the Entitled Fund. If you do not wish to receive marketing material please tick the box below. Please do not send me/us* any further information on other products and services. AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 23

24 Definitions Intermediary An Intermediary means a person who carries on a business which consists of, or includes, the receipt of payments from an investment undertaking resident in Ireland on behalf of other persons; holds units in an investment undertaking on behalf of other persons. Residence (1) Individual An individual will be regarded as being resident in Ireland (the State ) for a tax year if s/he: 1. spends 183 days or more in the State in that tax year; or 2. has a combined presence of 280 days in the State, taking into account the number of days spent in the State in that tax year together with the number of days spent in the State in the preceding. Presence in a tax year by an individual of not more than 30 days in the State will not be reckoned for the purpose of applying the two-year test. Presence in the State for a day means the personal presence of an individual at the end of the day (midnight). (2) Company A company which has its central management and control in Ireland (the State ) is resident in the State irrespective of where it is incorporated. A company which does not have its central management and control in Ireland but which is incorporated in the State is resident in the State except where: the company or a related company carries on a trade in the State, and either the company is ultimately controlled by persons resident in EU Member States or countries with which the Republic of Ireland has a double taxation treaty, or the company or a related company are quoted companies on a recognised Stock Exchange in the EU or in a tax treaty country; or the company is regarded as not resident in the State under a double taxation treaty between the Republic of Ireland and another country. It should be noted that the determination of a company s residence for tax purposes can be complex in certain cases and declarants are referred to the specific legislative provisions which are contained in section 23A Taxes Consolidation Act, Ordinary Residence The term ordinary residence as distinct from residence relates to a person s normal pattern of life and denotes residence in a place with some degree of continuity. An individual who has been resident in Ireland (the State ) for three consecutive tax years becomes ordinarily resident with effect from the commencement of the fourth tax year. An individual who has been ordinarily resident in the State ceases to be ordinarily resident at the end of the third consecutive tax year in which s/he is not resident. Thus, an individual who is resident and ordinarily resident in the State in 2013 and departs from the State in that year will remain ordinarily resident up to the end of the tax year in The Company is structured as an open-ended umbrella fund with segregated liability between sub-funds. The Company was incorporated with limited liability as an investment company with variable capital on 26 February 2003 under the laws of Ireland and is authorised by the Central Bank of Ireland (the Central Bank ) as an undertaking for collective investment in transferable securities pursuant to the European Communities (Undertakings for Collective Investment in Transferable Securities) Regulations, 2011 as amended. Such authorisation is not an endorsement or guarantee of the Company by the Central Bank nor is the Central Bank responsible for the contents of the Supplements and the Prospectus. The authorisation of the Company by the Central Bank shall not constitute a warranty as to the performance of the Company and the Central Bank shall not be liable for the performance or default of the Company. AAPP0087 Canaccord Genuity Investment Funds plc - Application Form June 2016 canaccordgenuity.com 24