Crown Sigma UCITS plc

Transcription

1 Crown Sigma UCITS plc LGT Crown Listed Private Equity (the Sub-Fund ) Share Application Form and Subscription Agreement This share application form (the Application Form ), when completed, should be forwarded to: Crown Sigma UCITS plc (the Company ) c/o RBC Investor & Treasury Services Ireland Limited (the Administrator ) Attention: Crown Sigma UCITS plc Georges Quay House, 43 Townsend Street, Dublin 2, Ireland. Phone: (for Queries only) Fax: [email protected] (for Queries only) Unless the context otherwise requires and except as varied or otherwise specified in this Application Form and/or subscription agreement (the Subscription Agreement ), defined words and expressions used in this Application Form and/or Subscription Agreement shall bear the same meaning as in the prospectus of the Company dated 04 December 2015 and the supplement to the prospectus in respect of LGT Crown Listed Private Equity dated 04 December 2015 as amended or supplemented or substituted from time to time (the Prospectus ). Subscription Applications Applications should be made only by written application using this Application Form and Subscription Agreement. Application Forms and Subscription Agreements, duly completed, should be sent to the Administrator (for the account of the Company), at the address shown above. The Company reserves the right to reject any application in whole or in part, in which event the application monies or any balance thereof will be posted to the applicant without interest at his own risk. A properly completed and signed copy of any application must be submitted to the Administrator by fax to In the case of initial applications submitted by electronic means or by fax the original Application Form should be sent without delay to the Administrator. Redemption proceeds will not be processed until the Administrator is in receipt of the original application form and appropriate anti-money-laundering documentation. Please also note that although provided above for general communication purposes, dealing requests

2 cannot be accepted by phone or . Please note that the subscriber must contact the Administrator if an official subscription confirmation (the "Subscription Confirmation") is not forthcoming within 2 Business Days after the Application Form and Subscription Agreement may be expected to have been received by the Administrator, or if the Subscription Confirmation received contains information that differs from the Application Form and Subscription Agreement submitted. Neither the Company nor Administrator can be held liable for applications for subscription not processed in a timely manner if the subscriber does not immediately make contact with the Administrator regarding applications for subscription that are not confirmed within 2 Business Days; and neither the Company nor the Administrator can take responsibility for subscription applications that are not appropriately transmitted, sent or acknowledged. It is important to note that for all subscription instructions submitted to the Administrator, the responsibility for ensuring that the application for subscription has been received by the Administrator for the requested Dealing Day remains with the subscriber. Irrespective of any return receipt message, fax acknowledgement, etc. the subscriber must contact the Administrator for clarification if he does not receive a Subscription Confirmation. It remains the responsibility of the subscriber to ensure that the trade requested has been received and processed correctly. This should include checking the Subscription Confirmation for errors and contacting the Administrator immediately and no later than the subscription having been fully processed, if there is an error contained in the Subscription Confirmation received. In the event that the subscriber does not so contact the Administrator, any unacknowledged subscription application may have no validity and any acknowledgement which the subscriber believes differs from the instruction submitted shall be final and conclusive. Please note that the subscriber must ensure that they have the most up-to-date contact details for the Administrator as these may change from time to time. Subscription Payments EURO (EUR) Payments in full for the amount subscribed in relation to the Euro denominated Classes shall be made in Euro by bank wire transfer as follows: Important: The sending bank must issue an MT103 message to FETALULL. Failure to issue an MT103 message can result in your subscription proceeds arriving late (missing internal cut-off times) and the Company and Administrator do not accept any responsibility for subscription requests that miss the requested dealing date due to late settlement or a missing MT103 message. Intermediary Bank: Bank of America Dublin** SWIFT: BOFAIE3X** Beneficiary Bank: RBC Investor Services Bank SA Luxembourg SWIFT: FETALULL Beneficiary: CROWN SIGMA UCITS PLC - COLLECTION AC IBAN number: LU Ref: Investor name **NOTE for EUR Payments: In order to benefit as much as possible from local clearing, it is recommended that you route your payment via one of the following of our Bank of America EUR correspondent banks: Code Swift BOFAGB22 BOFAFRPP BOFADEFX BOFAIT2X Bank Name Bank of America London Bank of America Paris Bank of America Frankfurt Bank of America Milan 2

3 BOFAES2X BOFABE3X BOFAIE3X BOFANLNX Bank of America Madrid Bank of America Antwerp Bank of America Dublin Bank of America Amsterdam US DOLLAR (USD) Payments in full for the amount subscribed in relation to the US Dollar denominated Classes shall be made in US Dollar by bank wire transfer as follows: Important: The sending bank must issue an MT103 message to FETALULL. Failure to issue an MT103 message can result in your subscription proceeds arriving late (missing internal cut-off times) and the Company and Administrator do not accept any responsibility for subscription requests that miss the requested dealing date due to late settlement or a missing MT103 message. Intermediary Bank: SWIFT: Beneficiary Bank: SWIFT: Beneficiary account: IBAN number: Ref: Bank of America New York BOFAUS3N RBC Investor Services Bank SA Luxembourg FETALULL CROWN SIGMA UCITS PLC - COLLECTION AC LU Investor name In order to facilitate prompt and accurate crediting of subscription payments, subscribers must notify the Administrator, prior to remitting payment, of the details of the subscription payment, indicating (I) the name of the subscriber, (II) the Euro/US Dollar amount subscribed, (III) the subscriber's full registered (as well as mailing) address (including a telex or fax number if available), (IV) the name and address of the financial institution remitting the subscription payment and (V) the approximate date as of which the payment is being wired to the Company's account. (Separate notification is not required if the subscriber's subscription application is received by the Administrator prior to the payment date). Subscribers should also instruct the remitting bank to include the subscriber's name when remitting subscription payment to the Company's account. Notifications will be sent to subscribers showing the details of each transaction within 30 Business Days of the relevant Valuation Day. 3

4 SUBSCRIPTION AGREEMENT 200 To: Crown Sigma UCITS plc (the Company ) c/o RBC Investor & Treasury Services Ireland Limited (the Administrator ) Attention: Crown Sigma UCITS plc Georges Quay House, 43 Townsend Street, Dublin 2, Ireland. Telephone: (for Queries only) Fax: [email protected] (for Queries only) Applications should be made only by written application using this Application Form and Subscription Agreement. Application Forms and Subscription Agreements, duly completed, should be sent to the Administrator (for the account of the Company), at the address shown above. The Company reserves the right to reject any application in whole or in part, in which event the application monies or any balance thereof will be posted to the applicant without interest at his own cost and risk. A properly completed and signed copy of any application must be submitted to the Administrator by fax. In the case of initial applications submitted by electronic means or by fax, the Original Application Form should be sent without delay to the Administrator. Redemption proceeds will not be processed until the Administrator is in receipt of the original application form and appropriate anti-money-laundering documentation.. Please also note that although provided above for general communication purposes, dealing requests cannot be accepted by phone or . The Dealing day is the first Business Day of each week or such other Business Days as the Directors may, determine and notify in advance to Shareholders. The Dealing Deadline for subscriptions is 1.00pm (Irish time) two Business Days preceding the relevant Dealing Day and for redemptions is 1:00pm (Irish time) five Business Days preceding the relevant Dealing Day or such other time for the relevant Dealing Day as may be determined by Directors and notified in advance to Shareholders provided always that the Dealing Deadline is no later than the Valuation Point. If you are in doubt about the contents of this Subscription Agreement, you should consult your stockbroker, accountant, solicitor or other independent professional adviser. Ladies and Gentlemen, The undersigned investor (the "Investor") acknowledges having received and reviewed the Memorandum and Articles of Association of the Company (the "Articles"). The Investor acknowledges that the terms of the offering of the class of: (a) (b) (c) Class A (EUR) of the LGT Crown Listed Private Equity of participating shares; Class B (EUR) of the LGT Crown Listed Private Equity of participating shares; and Class O (EUR) of the LGT Crown Listed Private Equity of participating shares; with each participating share having no par value in the Company (the Shares ) are as stated in this Subscription Agreement, the Articles and the Prospectus. 4

5 The Investor hereby agrees with the Company as follows: (1) Subscription (a) Subscription Amount The Investor hereby irrevocably subscribes for a subscription amount as set out below. (b) Subscription Subject to Acceptance The Investor understands that this subscription is not binding on the Company until it is accepted by the Company, which may reject this subscription in whole or in part in its sole discretion for any reason whatsoever. The Investor agrees that unless and until its subscription is rejected or accepted by the Company, the Investor shall not be entitled to cancel, terminate, or revoke its subscription. If the Company rejects this subscription, this Subscription Agreement and all related documents executed by the Investor in connection herewith shall be cancelled and returned to the Investor. (c) Other Subscription Agreements The Company has entered into or expects to enter into separate but substantially identical subscription agreements (the "Other Subscription Agreements" and, together with this Subscription Agreement, the "Subscription Agreements") with other Investors (the "Other Investors"), providing, among other things, for the agreement of the Other Investors to subscribe for and purchase Shares. This Subscription Agreement and the other Subscription Agreements are separate agreements, and the sales of Shares to the Investor and the Other Investors are to be separate sales. (d) Electronic Dealing The Investor is required to make an initial subscription using an original Application Form and Subscription Agreement and all anti-money laundering requirements must be satisfied. However the Investor may elect to make subsequent subscriptions or redeem or convert their shares using an electronic dealing platform or electronic dealing facilities as agreed between the Company, the Administrator and the Investor. Investors who wish to use this service will be required to accept the terms and conditions of use of the service. In the event that the Investor elects to use this electronic dealing service, the Investor will be required to set up an account on the electronic platform by inputting all of the information required and any changes to this standing information must be notified to the Administrator in original form in writing. Investors who wish to use this electronic dealing service should tick the following box, in which case the Administrator will send the appropriate contact details for the electronic dealing service provider to the Investor: (2) Rights and Obligations of Investor If and to the extent the Investor's subscription has been accepted by the Company, the Investor shall upon issue of the Shares, be entitled to all of the rights, and shall be bound by all of the obligations, of a shareholder under the Articles in respect of the Shares subscribed. Amounts due in respect of subscriptions received by the Administrator may be transferred to the account of the Company at least two Business Day prior to the Dealing Day. The reason for this transfer is to ensure that all subscription money received is transferred to the Company to ensure that the Company can enter into investments without incurring the cost of bridging finance loans in connection with such investments. 5

6 The effect of the transfer is that subscription monies received by the Administrator shall not be held in escrow. Instead, subscription monies received by the Administrator will be transferred to the account of the Company prior to the issue of confirmation of number, Sub-Fund and class of Shares attributable to each Investor. If the Company becomes insolvent or unable to pay its debts as they fall due after funds are transferred by the Investor, but prior to receipt by the Investor of confirmation of issue of Shares, the subscription monies deposited into the subscription account may not be recoverable by the Investor, who may thereafter be considered an unsecured creditor. By signing the Subscription Agreement, the Investor consents to the transfer of subscription monies to the account of the Company prior to the issuance of a confirmation from the Administrator. The Investor acknowledges that no interest is earned on early subscription settlement. (3) Subscription Representations The Investor represents and warrants that: (a) Authorization of Purchase etc. It has the full power and authority to execute and deliver this Subscription Agreement, and to subscribe for and purchase the Shares hereunder and is authorized to pay all amounts it has committed to pay to the Company in the manner contemplated herein and in the Articles. The Investor's purchase of the Shares and its execution and delivery of this Subscription Agreement have been authorized by all necessary action on its behalf and this Subscription Agreement is and upon acceptance of this Subscription Agreement by the Company, shall be, its legal, valid and binding obligations, enforceable against the Investor in accordance with its terms. The individual signing this Subscription Agreement on behalf of the Investor has been duly authorized by the Investor to do so. (b) Compliance with Laws and Other Instruments The execution and delivery of this Subscription Agreement, the consummation of the transactions contemplated herein, and the performance of the Investor's obligations hereunder and under the Articles (including, without limitation, the acquisition of the Shares), will not conflict with, or result in any violation of or default under: (i) any provision of any charter, by-laws, trust agreement, partnership agreement or other governing instrument applicable to the Investor, (ii) any material agreement or other instrument to which the Investor is a party or by which the Investor or any of its properties are bound, or (iii) any permit, franchise, judgment, decree, laws, statute, order, rule or regulation in the jurisdiction under the laws of which the Investor is organized, in any jurisdiction in which the Investor conducts business, and/or in any other jurisdiction, the laws of which apply to the Investor and/or any of its business or properties. (c) Proper Investment Based on the Investor's own independent review and such professional advice as it has deemed appropriate under the circumstances, the Investor's acquisition of the Shares (i) is fully consistent with its financial needs, objectives and conditions, (ii) complies and is fully consistent with all investment policies, guidelines and restrictions applicable to it, and (iii) is a fit, proper and suitable investment for it notwithstanding the clear and substantial risks inherent in investing in or holding the Shares. 6

7 (d) Non-U.S. Person Status The Investor (i) is not a U.S. person, as defined in Regulation S under the United States Securities Act of 1933, as amended ("Regulation S"), (ii) is not acquiring Shares for the account or benefit of any U.S. person, and (iii) is acquiring Shares in an offshore transaction in accordance with Regulation S. If the Investor is organized as an entity for passive investments outside the United States, less than 10% of its beneficial interests are directly or indirectly owned by U.S. persons. (e) Investment Company Act and ERISA The Investor is not an Investment Company registered under the Investment Company Act or exempt from the registration requirements of the Investment Company Act by virtue of an exception or an exemption from such registration requirements, including without limitation Section 3(c)(1) and Section 3(c)(7) of the Investment Company Act. The Investor is not purchasing the Shares with funds that constitute assets of any employee benefit plan, within the meaning of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"). (f) Non-U.S. Listing The Investor is not an individual or entity listed on the United States Department of Treasury's Office of Foreign Assets Control ( OFAC ) website and is not directly or indirectly affiliated with, any country, territory, individual or entity named on an OFAC list or prohibited by any OFAC sanctions programmes. (g) Derivation of Subscription Monies The Investor represents that the monies to be used in subscribing for Shares in the Company are not directly or indirectly derived from activities that may contravene United States federal or state, or international, laws and regulations, including anti-money laundering laws and regulations. (h) USA Patriot Act 2001 The Investor is not a senior political figure and is not an immediate family member of or closely associated with a senior political figure (as those terms are used in the USA Patriot Act 2001). The Investor is not a foreign shell bank and does not transact with foreign shell banks (as that term is used in the USA Patriot Act 2001). (i) Transmission of Personal Data The Investor consents to the transmission by the Administrator of personal data (provided by the Investor to the Administrator) to third parties situated in countries which are outside of the European Economic Area and to third parties situated in countries which do not have data protection legislation in place which is equivalent to that in place within the European Economic Area. Information in relation to the Investor will be held, used, disclosed and processed for the purposes of (a) managing and administering the Investor's holdings in the Company and any related account on an ongoing basis; (b) for any other specific purposes where the Investor has 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 to third parties including the Investor's financial adviser (where appropriate), regulatory bodies, auditors, technology providers or to the Company 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; 7

8 (f) or for other legitimate business interests of the Company. The Investor hereby acknowledges that their right of access to and the right to amend and rectify their personal data, as provided herein. The Investor understands that the Company is a data controller and will hold any personal information provided by them in confidence and in accordance with the Data Protection Act 1988 as amended by the Data Protection (Amendment) Act The Investor consents to the Company and the Investment Manager sending information about other investment services to them by letter, telephone or other reasonable means of communication. The Investor understands that we have a right not to receive such information. If you do not wish to receive marketing material please tick the box below. and services. Please do not send me/us* any further information on other products (j) Access to Information The Investor has been provided an opportunity to ask questions of, and has received satisfactory answers thereto from, the Company and its representatives regarding the terms and conditions of the offering of Shares and other matters pertaining to this investment, and the Investor has obtained all additional information it requested from the Company and its representatives to verify the accuracy of all information furnished to it regarding the offering of Shares. (l) Correspondence by (4) Investor Awareness The Investor consents to the transmission of information and correspondence relating to the Company by the Administrator and by the Company to it by to the address specified by it in the section of this Subscription Agreement headed Registration Details. The Investor further represents and warrants that it is aware of the following: (a) (b) (c) (d) (e) No governmental agency has passed upon the Shares or made any finding or determination as to the fairness of an investment in the Company. The purchase of Shares involves a high degree of risk, including the possibility of a loss of the entire investment. The liquidation of any investment in the Company shall be subject to the limitations on repurchases as set out in the Prospectus and the Articles. Restrictions exist on the transferability of the Shares. The foregoing representations and warranties contained in Section (3) and this Section (4) shall survive the acquisition of the Shares by the Investor. 8

9 (5) Subscriptions by banks, brokers or other parties purchasing Shares for theirs clients If the Investor is a bank, broker or other party purchasing Shares for its clients, the Investor represents and warrants with respect to the Shares subscribed for or hereby and all other Shares subsequently acquired by the Investor: (a) (b) That each such client could make the representation in Sections 3 and 4 above hereof. That it will not distribute the Shares in the United States or transfer or deliver any of the Shares, or any part thereof or any interest therein to a U.S. person. (6) Representations, Warranties and Agreements of the Company To induce the Investor to subscribe for Shares, the Company represents, warrants and agrees with the Investor as follows: (a) Formation The Company is an umbrella type investment company with variable capital and segregated liability between sub-funds incorporated with limited liability and validly existing under the laws of Ireland, and has all requisite corporate power and authority to issue and sell the Shares and otherwise to carry on its business as now conducted and as proposed to be conducted as described in the Articles. (b) Authorization of Agreements, etc. The execution, delivery and performance by the Company of this Subscription Agreement have been duly authorized by all necessary action on behalf of the Company. This Subscription Agreement is the legal, valid and binding obligation of the Company, enforceable against the Company in accordance with its terms, except as the enforceability hereof may be limited by applicable bankruptcy, insolvency, reorganization or other similar laws affecting the enforcement of creditors' rights generally or by general principles of equity (regardless of whether such enforcement is considered in a proceeding in equity or at law). (c) Compliance with Laws and Other Instruments The execution and delivery by the Company of this Subscription Agreement and the consummation of the transactions contemplated hereby, will not conflict with or result in any violation of or default under (i) any provision of the Articles, (ii) any provision of any agreement or instrument to which the Company is a party or by which it or any of its properties are bound, or (iii) any other material permit, franchise, judgment, decree, statute, order, rule or regulation applicable to the Company. (d) Litigation etc. There is no action, proceeding or investigation pending or, to the knowledge of the Company, threatened against the Company that questions the validity of this Subscription Agreement or the Articles. (7) Investor Identification Requirements (a) The Administrator and the Company reserve the right to request such information as is necessary to verify the identity of the Investor (the Investor Identification Requirements ). The Investor shall promptly on demand provide such information and execute and deliver such documents as the Company or the Administrator may request to verify the accuracy of the Investor s representations and warranties herein or to comply with Irish anti-money laundering legislation or any other law or regulation to which the Company or the Administrator may be subject. 9

10 (b) In the event of delay or failure by the Investor to produce any information required for verification purposes, the Company or the Administrator may refuse to accept the application and the subscription monies relating thereto or may refuse to process a redemption request until proper information has been provided. (c) The Investor represents that the Shares are to be purchased with funds that are from legitimate sources in connection with its regular business activities and which do not constitute the proceeds of criminal conduct and the investment is not designed to conceal such proceeds so as to avoid prosecution for an offence or otherwise. The Investor hereby declares that the Shares are not being acquired and will not be held in violation of any applicable laws. (d) The Investor agrees further that the Administrator and the Company shall be held harmless and indemnified against any loss, claim, cost, damage or expense arising as a result of a failure to process any application or redemption if such information as has been required by the Company or the Administrator has not been provided by the Investor or which the Company or the Administrator may suffer as a result of any violations of law committed by the Investor. (8) Further Agreements At the request of the Company, the Investor will furnish promptly such further information, and execute and deliver such documents, as may be required in the determination of the Company to comply with any applicable laws or regulations. (9) Amendments and Waivers This Subscription Agreement may be amended and the observance of any provision hereof may be waived (either generally or in a particular instance and either retroactively or prospectively) only with the written consent of the Investor and the Company. (10) Survival of Representations and Warranties All representations and warranties contained herein or made in writing by the Investor or by or on behalf of the Company in connection with the transactions contemplated by this Subscription Agreement shall survive the execution and delivery of this Subscription Agreement, the Investor's admission as a Shareholder of the Company, and investigation at any time made by or on behalf of the Company or the Investor, and the issue and sale of Shares to the Investor. (11) Successors and Assigns This Subscription Agreement shall be binding upon and inure to the benefit of and be enforceable by the respective successors and permitted assigns of the parties hereto. (12) Confidentiality The Investor agrees that in no event the Investor will duplicate or furnish copies of the Articles, the Prospectus or this Subscription Agreement to persons other than its investment and tax advisers, accountants or legal counsel. (13) Notices All notices, requests, demands and other communications hereunder shall be in writing and shall be deemed to have been duly given to any party when delivered by hand, when delivered by fax or telex and confirmed, or when mailed, first-class postage prepaid, (a) if to the Investor, at the address or fax number set forth in the schedule hereto, or to such other address or fax number as the Investor shall have furnished to the Company in writing, and (b) if to the Company, to c/o RBC Investor & Treasury Services Ireland Limited (fax number ), or to such other address or addresses, or fax number or numbers, as the Company shall have furnished to 10

11 the Investor in writing. (14) Governing Law This Subscription Agreement shall be governed by and construed in accordance with the laws of Ireland and each of the parties hereto hereby irrevocably submits to the non-exclusive jurisdiction of the Irish courts. (15) Descriptive Headings The descriptive headings in this Subscription Agreement are for convenience of reference only and shall not be deemed to alter or affect the meaning or interpretation of any provision of this Subscription Agreement. (16) Entire Agreement This Subscription Agreement contains the entire agreement of the parties with respect to the subject matter of this Subscription Agreement, and there are no representations, covenants or other agreements except as stated or referred to herein and therein. (17) Counterparts This Subscription Agreement may be executed in one or more counterparts, each of which shall be deemed an original and all of which taken together shall constitute one and the same instrument. (18) EU Savings Directive Council Directive 2003/48/EC of 3 June 2003 (the EU Savings Directive ), which deals with the taxation of savings income in the form of interest payments, seeks to ensure that an individual who is resident in a member state of the European Union (an EU Member State ) and who receives savings income from another EU Member State, is taxed in the EU Member State 1 in which the Investor is resident for tax purposes. In this regard the Company is obliged to establish the identity and residence of such individuals. 1 Also applicable to residents of USA, Switzerland, Andorra, Liechtenstein, Monaco, San Marino, Jersey, Guernsey, Isle of Man, Anguilla, Montserrat, British Virgin Islands, Turks and Caicos Islands, Cayman Islands, Netherlands Antilles, and Aruba. Accordingly any reference to EU Member State should be deemed to include these additional countries. 11

12 REGISTRATION DETAILS TYPE OF INVESTOR please tick as appropriate Corporation or Private Company investing on own behalf Corporation listed on an approved Stock Exchange Pension / Benefit Plan Trust Charities and Foundations LGT Group entity investing on behalf of its clients (with a separate written agreement and not receiving any retrocession payments) Governmental University or College or Education Regulated Financial entity investing on own behalf Regulated Financial entity investing on behalf of private / individual investors Regulated Financial entity investing on behalf of non-private investors Non-Regulated Financial entity investing on own behalf Non-Regulated Financial entity investing on behalf of private / individual investors Non-Regulated Financial entity investing on behalf of non-private investors Financial entity investing on behalf of its clients and mandates (based on a separate written agreement and not receiving any retrocession payments) Limited Liability Corporation (USA) Limited Partnership (USA) Investor is subject to ERISA = YES or NO 2 ADDITIONAL CONFIRMATIONS The investment ownership or underlying beneficial ownership of this investment includes one or more Politically Exposed Persons (PEP s) = YES or NO 2 Please refer to page 9, paragraph (f) of this Agreement. 12

13 INSTITUTIONAL AND CORPORATE INVESTORS Please note that private individuals are not permitted to subscribe on their own behalf. Please note that the appropriate section of Appendix: Important Investor Identification requirements must be completed or your application risks being rejected. Investor Name: Country & Date of Incorporation: Main Business activity: Tax Country and Tax Identification Number: Main Business activity: Tick as appropriate: Investing on own behalf or on behalf of others CORRESPONDENCE / CONTACT DETAILS (to be completed by all Investors) Registered (home) Address: Mailing Address (if different): Contact Details: Main Contact Name: Phone: Fax: Copy Correspondence: Should you wish the Administrator to issue duplicate Shareholder correspondence (including dealing confirms and statements) in addition to the fax number given above, please enter the below details: Copy Contact Name: Phone: Fax: Please note that by providing contact address and / or fax numbers, you are electing to receive dealing confirmations and account statements via and / or fax to these contact details and copies will not be issued by post (regular mail) unless you request this in writing. 13

14 Subscription Amount: Class A (EUR): EUR Class B (EUR): Class O (EUR): EUR EUR The Investor notes that interest is not earned on early subscription settlement. Source of Subscription Settlement and Future Return Payments 3 Please provide below full banking details for the bank account from which the appropriate subscription settlement is being received. Settlement can only be accepted by telegraphic transfer from a bank account in the Investor s own name and a detailed written explanation is required for approval if this is not the case. The below account details provided will be maintained on file as the redemption account of record for this investment and future payments back to the relevant Investor(s) will be returned to this account unless a written request for change has been received and approved. Interest is not earned on early subscription settlement. Full Bank Name: Full Bank Address: Sort Code / Swift / ABA Number: Bank Account Full Name: Bank Account Number/ IBAN: Specified U.S. Person Please tick either (a) or (b) below and complete as appropriate. a) The Investor is a Specified U.S. Person and the Investor s U.S. Federal Taxpayer Identifying number (U.S. TIN) is as follows: U.S. TIN: b) The Investor is not a Specified U.S. Person 3 Please note that completion of this section is prerequisite for the acceptance of this Agreement by the Administrator. Should the relevant account details be altered in future, the investor should immediately notify the Administrator of such change. 14

15 Declaration of Tax Residency 4 Please indicate the Investor s place of tax residence (if resident in more than one country please detail all countries of tax residence and associated tax identification numbers). Country of Tax Residency Tax ID Number Investor s FATCA Classification 5 The Company aims to comply at all times with the U.S. FATCA provisions. This compliance is achieved by adopting one of the statuses envisaged by the FATCA provisions. The Company has currently opted for the status of certified non-reporting collective investment vehicle. The possibility that the Company will change or relinquish this status in future cannot be ruled out, however. Investors or potential investors who have questions about the Company's current FATCA status are advised to contact their relationship manager. As the Company aims to be FATCA-compliant, it will only accept FATCA-compliant entities as investors. As such, there is a restriction on distribution to individuals. Taking into account that restriction, permitted investors within the meaning of the FATCA provisions are the following: 1. exempt beneficial owners; 2. active non-financial foreign entities (active NFFEs); and 3. financial institutions that are not non-participating financial institutions. Should the Company be required to pay withholding tax, disclose information or incur any other losses because an investor is not FATCA-compliant, the Company reserves the right, without prejudice to any other rights, to claim damages against the investor in question. Please tick one of the below categories, and provide the Investor s GIIN I. Irish Financial Institution or a Partner Jurisdiction Financial Institution II. III. Registered Deemed Compliant Foreign Financial Institution Participating Foreign Financial Institution Please provide the Investor s Global Intermediary Identification number (GIIN): If the Investor is a Financial Institution but unable to provide a GIIN, please tick one of the below reasons: I. Partner Jurisdiction Financial Institution and has not yet obtained a GIIN 4 Declaration of tax residency is requested in the context of the OECD Common Reporting Standard ( CRS ), an initiative to implement automatic exchange of financial account information on a global basis. 5 We are obliged under Section 891E of the Taxes Consolidation Act 1997 (as amended) and regulations made pursuant to that section to collect certain information about each investor s tax arrangements. Please note that in certain circumstances we may be obliged to share this information with relevant tax authorities. Unless otherwise stated, all terms identified in italics are as defined in the Agreement between the Government of Ireland and the Government of the United States of America to Improve International Tax Compliance and to Implement FATCA, a copy of which is available on the Irish Revenue Commissioners website at or at If any of the information below about the Investor s tax residence or FATCA classification changes in the future, please ensure that we are advised of these changes promptly. If you have any questions about how to complete this form, please contact your tax advisor. 15

16 II. The Investor 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: III. Exempt Beneficial Owner IV. Certified Deemed Compliant Foreign Financial Institution (including a deemed compliant Financial Institution under Annex II of the Agreement) V. Non-Participating Foreign Financial Institution VI. Excepted Foreign Financial Institution VII. U.S. person but not a Specified U.S. person Non-Financial Institutions: If the Investor is not a Financial Institution, please confirm the Investor s FATCA status below: I. The Investor is an Active Non-Financial Foreign Entity or II. The Investor is a Passive Non-Financial Foreign Entity (If the Investor is a Passive Non- Financial Foreign Entity, please provide details of any Controlling Persons in the below box (whose percentage of ownership is 25% or greater) which are U.S. citizens or resident in the U.S. for tax purposes. The term Controlling Persons is to be interpreted in a manner consistent with the recommendations of the Financial Action Task Force. Full Name Date of Birth Full Residential Address Details of Controlling Person s Beneficial Ownership Tax Reference number III. The Investor is an Excepted Non-Financial Foreign Entity or IV. The Investor is a U.S. person but not a Specified U.S. person 16

17 Entity Self-Certification for CRS 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 Residence Tax ID Number 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 above 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 I. Financial Institution under CRS (other than (II) below II. 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 **) Non-Financial Institutions under CRS: If the Entity is a Non-Financial Institution, please tick one of the below categories I. 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 II. Active Non-Financial Entity a Government Entity or Central Bank III. IV. Active Non-Financial Entity an International Organisation Active Non-Financial Entity other than (I)-(III) (for example a start-up NFE or a non-profit NFE) V. 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 Person s: 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. 17

18 Declaration of Residence Outside Ireland 1, 2 Subscribers 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. (See heading Irish Taxation ). Subscribers must complete (a) or (b) below. 3 (A) 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 Irish Resident or Irish Ordinary Resident; and Should I/we/the company* become Irish Resident I/we* will so inform the Company, in writing, accordingly. OR (B) Declaration as intermediary 4 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 Irish Resident nor Irish Ordinary Resident. 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* hold Shares becomes Irish Resident. * Delete as appropriate Fund and Sub-Fund name (to which investment is being made): Name and address of subscriber: Signature of applicant or authorised signatory: 18

19 IMPORTANT NOTES 1 If the subscriber is an Exempt Irish Shareholder, it should contact the Administrator who will provide it with the appropriate declaration which must be made to confirm its status. 2 Non-resident declarations are subject to inspection by the Irish Revenue Commissioners and it is a criminal offence to make a false declaration. 3 To be valid, the application form (incorporating the declaration required by the Irish Revenue Commissioners) must be signed by the Subscriber. Where there is more than one Subscriber, each person must sign. If the Subscriber is a company, it must be signed by the company secretary or another authorised officer. 4 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. Authorised Signatories The Company and Administrator are authorised to act on the written instructions of any person listed below until further notice. For corporate entities, a certified authorised signatory list should also be attached. Name Signature Date: Company Seal / Stamp (if applicable): 19

20 SIGNATURE PAGES ALL INVESTORS MUST COMPLETE THIS SECTION. The undersigned hereby represents that: 1. the undersigned has carefully read and is familiar with this Application Form, Subscription Agreement and the Prospectus; 2. the information contained herein is complete and accurate and may be relied upon; and 3. the undersigned agrees that the execution of this signature page constitutes the execution and receipt of this Application Form and Subscription Agreement. IN WITNESS WHEREOF, the undersigned has executed this Application Form and Subscription Agreement on the date specified below. Signature block corporate Investors Authorised Signatories SIGNATURE PAGES The Company or Administrator are authorised to act on the instructions, communications and requests and to deal with instruments purporting to be made, drawn, accepted, endorsed or given by mail or fax from any person listed on a certified authorised signatory list or a certified excerpt of the commercial register of the corporate Investor. Signatures Name: Authorised Signatory Name: Authorised Signatory For and on behalf of: (name of Investor) Date Company seal/stamp (if applicable) 20

21 Appendix: Important Investor Identification requirements It is very important to note that the appropriate investor identification documents must be received as part of your completed Application Form and Subscription Agreement. Failure to fully satisfy the Company s and the Administrator s investor identification requirements can result in your subscription being delayed to a later Subscription Day and can even result in your application being rejected. The Company and the Administrator reserve the right to change the following requirements from time to time in order to keep up to date with changing regulations and best practices. INDEX Regulated Financial Institutions (designated jurisdictions), please complete Section 1 Corporate entities, please complete Section 2 Trusts, please turn to Section 3 Limited Partnerships, please turn to Section 4 LLC, please turn to Section 5 Pensions / Foundations / Charities, please turn to Section 6 & 7 21

22 SECTION 1: REGULATED FINANCIAL INSTITUTIONS We define a Regulated Financial Institution as an individual or other entity, which is regulated in respect of banking or investment services in an EU Member State or in a jurisdiction, which is designated under Section 31 of the Criminal Justice Act (Money Laundering and Terrorist Financing) Act, 2010 as having AML requirements equivalent to those imposed by the 3 rd Money Laundering Directive (2005/60/EC). We require copies of correspondence confirming your registration with an appropriate regulatory body. In addition to EU member states, at the time of writing designated jurisdiction included: Australia, Brazil, Canada, Hong Kong, Iceland, India, Japan, Liechtenstein, Mexico, Norway, Singapore, South Africa, Switzerland, and the United States of America. Also accepted are Jersey, Guernsey and the Isle of Man and the French overseas territories of Mayotte, New Caledonia, French Polynesia, Saint Pierre and Miquelon and Wallis and Futuna and the Dutch overseas territories of Netherlands Aruba, Curacao, Sint Maarten, Bonaire, Sint Eustatius and Saba. Name of Regulated Financial Institution Name under which investment made (if different) Regulated by Regulator s Address & Country Please confirm whether any one person owns/control 10% or more of the investment and if yes, provide below details: (a) If a Legal Entity, the entity's full name and registered address, and names of any natural persons ultimately owning/controlling 25% or more; (b) If a Natural Person, the individual's full name, date of birth, nationality and source of funds. IMPORTANT DECLARATION: We the above named Regulated Financial Institution; hereby declare that we are licensed by the above regulatory authority under the laws of the jurisdiction stated. We are thereby subject to regulations and / or guidelines which, to the best of our knowledge and understanding, meet or exceed the standards set out under 3 rd EU Money Laundering Directive (Directive 2005/60/EC) or equivalent laws applicable under our jurisdiction. We declare that we have anti-money laundering / client identification policies, procedures and internal controls in place and that these procedures ensure that the identity of all underlying beneficial owners of any investments made in the above applicant names have been established and verified in full. We confirm that all relevant client identification documentation will be retained on file for a minimum of five years after the end of the underlying investor s relationship with a fund and that these documents will be made available to the administrator or appropriate authorities upon request. We acknowledge that this declaration is being relied upon with regard to measures to be applied in accordance with the relevant AML legislation and that this declaration shall apply to all investments made under the above applicant names, to all funds (not only the above mentioned fund) administered by BNP Paribas Fund Administration Services (Ireland) Limited. SIGNATURE PRINT NAME TITLE Company Seal / Stamp (if applicable): 22

23 SECTION 2: CORPORATIONS Corporate entities that are making investments on their own behalf should return the following documentation. The Administrator may also, without limitation, require additional information and / or documentation relating to the Corporation or its Directors or underlying beneficiaries. Subscriptions are not accepted from Corporations whose ultimate ownership is held in bearer share format. Certified copy of Certificate of Incorporation Certified copy of Memorandum & Articles of Associations (or equivalent) A Full list of all Directors. Please ensure to include full name, date of birth and residential address for each Director. Certified copies of Passport or Driving Licence photo identification and Bank Statement or Utility Bill address verification for at least two or the Corporation s Directors. All Directors must provide this documentation if the Corporation is not domiciled in one of the designated jurisdictions listed above. Full list of all who have signing authority on the account (a fully updated Authorised Signatory list should be included). Confirmation as to whether any one person owns/controls 10% or more of the investment and if yes, provide below details If a Legal Entity, the entity's full name and registered address, and names of any natural persons ultimately owning/controlling 25% or more. If a Natural Person, the individual's full name, date of birth, nationality and source of funds. Source of Wealth 6 : 6 Source of Wealth - means confirmation or a description of the activities that generated the net worth of the investor (that is, the activities that produced the investor's funds, assets and property). 23

24 SECTION 3: TRUSTS Unless the Trustee or the administrators of the Trust qualify as a regulated Financial Institution and can complete the attached Regulated Entity / Designated Body Declaration, we require: Confirmation and identification documents (as per individual requirements above) of all ultimate beneficiaries of the Trust those persons who receive financial benefit from the Trust. A certified / notarised true copy of the Trust Deed. Confirmation as to the nature, scope and jurisdiction of the Trust. A full authorised signatory list detailing all those who have power to sign on the account. Confirmation and identification documents (as per individual requirements above) of the actual settlors and controlling persons Source of Wealth 7 : SECTION 4: Limited Partnership (LP) Certified copy of Partnership Agreement Confirmation of General Partner and listing of any directors, if appropriate. Where an individual, verify the identity of General Partner in accordance with the Private Investor identification / Corporate requirements above, as appropriate. Confirmation of all partners that own more than 25% of the capital, profit or voting rights and listing of any directors, if appropriate. Verification documents ought to be submitted for all persons that own more than 25% of the capital, profit or voting rights in accordance with the Private Investor identification / Corporate requirements above. Authorised signatory list. Source of Wealth 7 : SECTION 5: Limited Liability Company (LLC) Certified copy of Operating Agreement Confirmation of Managing Member and listing of any directors, if appropriate. Where an individual, verify the identity of Managing Member in accordance with 24

25 the Private Investor identification / Corporate requirements above, as appropriate. Confirmation of all persons that own / control more than 25% of the capital, profit or voting rights Verification documents ought to be submitted for all persons that own / control more than 25% of the capital, profit or voting rights in accordance with the Private Investor identification / Corporate requirements above. Authorised signatory list. Source of Wealth 7 : SECTION 6: PENSIONS A certified / notarised copy of the Pension's Offering Memorandum (or equivalent documents). A certified / notarised copy of approval / registration from the appropriate jurisdictional Tax Authority (if applicable). Confirmation as to the parties who administer the pension. A full list of names, addresses, occupations and date of births for the Trustees, Governors and Board Members. Verification documents ought to be sought in accordance with the Private Investor identification / Corporate requirements above. A full authorised signatory list detailing all those who have power to sign on the account. If this is an Individual or Family Pension Scheme, we require full disclosure and verification of all potential beneficiaries of the Pension Scheme. For all beneficiaries aged 18 years and over this should be by way of certified / notarised Passport Copies to verify the beneficiary's identity and certified / notarised Utility Bill Copies to verify the beneficiary's address. If this is a Corporate / Employee Pension Scheme, we require confirmation as to the entrance criteria for the scheme (who is allowed enter the scheme). Confirmation of status with regard to the [United States] Employee Retirement Income Security Act, as amended ('ERISA'). Source of Wealth 7 : SECTION 7: CHARITIES / FOUNDATIONS A certified / notarised copy of the Memorandum and Articles of Association (or equivalent documents). A certified / notarised copy of approval from the appropriate jurisdictional Tax Authority. Confirmation as to the nature, purpose and scope of the Charity / Foundation. Confirmation as to the main sources of income for the Charity / Foundation and full details as to the underlying beneficiaries of the Charity / Foundation. A full list of names, addresses, occupations and date of births for the Trustees, Governors and Board Members. Verification documents ought to be sought in accordance with the Private Investor identification / Corporate requirements above 25

26 A full authorised signatory list detailing all those who have power to sign on the account. Source of Wealth 7 : Contact details for assistance We would ask you to note that the above list of requisite documents is not exhaustive; for certain jurisdictions equivalent documents may be accepted. If your entity type has not been mentioned above, or we can be of any assistance in ensuring that you return the appropriate documents, please do not hesitate in contacting the Investor Services Department. 26

27 Crown Sigma UCITS plc LGT Crown Listed Private Equity (the Sub-Fund ) Redemption Request Form This redemption request form (the Redemption Request Form ), when completed, should be forwarded to: Crown Sigma UCITS plc (the Company ) c/o RBC Investor & Treasury Services Ireland Limited (the Administrator ) Attention: Crown Sigma UCITS plc Georges Quay House, 43 Townsend Street, Dublin 2, Ireland. Telephone: (for Queries only) Fax: [email protected] (for Queries only) Unless the context otherwise requires and except as varied or otherwise specified in this Redemption Request Form, defined words and expressions used in this Redemption Request Form shall bear the same meaning as in the prospectus of Company dated 04 December 2015 and the supplement to the prospectus in respect of LGT Crown Listed Private Equity dated 04 December 2015as amended or supplemented or substituted from time to time (the Prospectus ). Completed Redemption Request Forms must be returned to the Administrator by fax (if possible) and mailed to the above details. Please note that although provided above for general communication purposes, redemption requests can not be accepted by phone or . The original Redemption Request Form must be sent to the Administrator if there is a change of payment details. The Dealing day is the first Business Day of each week or such other Business Days as the Directors may, determine and notify in advance to Shareholders. The Dealing Deadline for redemptions is 1:00pm (Irish time) five Business Days preceding the relevant Dealing Day or such other time for the relevant Dealing Day as may be determined by Directors and notified in advance to Shareholders provided always that the Dealing Deadline is no later than the Valuation Point. Redemption requests will be processed in accordance with the Prospectus and the redeeming investor must contact the Administrator if the redeeming investor has not received an official redemption confirmation (the "Redemption Confirmation") within 2 Business Days of when the Redemption Request Form may be expected to have been received by the Administrator. Neither the Company nor the Administrator can be held liable for redemption requests not processed in a timely manner if the redeeming investor does not immediately make contact with the Administrator regarding redemption requests that are not confirmed within 2 Business Days; and neither the Company nor the Administrator can take responsibility for redemption requests that are not appropriately transmitted, sent or acknowledged. 27

28 It is important to note that for any redemption request submitted to the Administrator, the responsibility for ensuring that the redemption request has been received by the Administrator for the requested Dealing Day remains with the redeeming investor. Irrespective of any return receipt message, fax acknowledgement, etc. the redeeming investor must contact the Administrator for clarification if the redeeming investor does not receive a Redemption Confirmation. It remains the responsibility of the redeeming investor to ensure that the redemption request has been received and processed correctly. This should include checking the Redemption Confirmation for errors and contacting the Administrator immediately and no later than the redemption request having been fully processed, if there is an error contained in the Redemption Confirmation received. In the event that the redeeming investor does not so contact the Administrator, any unacknowledged redemption request may have no validity and any acknowledgement which the redeeming investor believes differs from the instruction submitted shall be final and conclusive. Please note that the redeeming investor must ensure that they have the most up-to-date contact details for the Administrator as these may change from time to time. Dear Ladies and Gentlemen, I/We being holder(s) of LGT Crown Listed Private Equity, Class A (EUR), Class B (EUR), Class O (EUR) Shares hereby request redemption of the following amount on the next Redemption Day under the terms and conditions set forth in the Prospectus. Delivery of this Redemption Request Form may be by fax provided that the fax is signed and signed original is mailed to the Administrator promptly thereafter. I/We represent and warrant that I/we am/are the sole record holder and beneficial owner of the LGT Crown Listed Private Equity, Class A (EUR), Class B (EUR), Class O (EUR) free and clear of any and all liens, pledges, restrictions, options, rights of first refusal, encumbrances, charges, proxies, powers of attorney, agreements or claims of any kind whatsoever and I/we have the legal right, power and authority to redeem the Shares. Class to be redeemed Cash Value Shares Total Holding Class A (EUR) Class B (EUR) Class O (EUR) You should mark Total Holding should you wish your entire holding to be redeemed. Please ensure that you specify the correct holder and account ID from which the holding is to be redeemed. Holder ID Account ID and Description Shareholder Name(s): 28

29 Registered Address: The Shareholder(s) hereby request that the redemption proceeds are released in accordance with the Prospectus to the following bank account. All future payments for this holder ID shall be made to the same bank account unless the Shareholder(s) notifies the Administrator in writing to advise them otherwise. Please note that it is our policy not to make any third party payments. The bank account details quoted below must be in the name of the registered Shareholder(s) that appears on our register. Payments can only be made in the Sub-Fund s base currency by telegraphic transfer and not by cheque. The intermediary details requested below are important. Please check with your bank if you are unsure regarding any of the information that is requested herein. Bank account Name: Bank account Number: Full Beneficiary Bank Name, Address and Sort Code / Swift / ABA Number Full Intermediary Bank Name, Address and Sort Code / SWIFT / ABA Number In the case of joint holders, all must sign. A corporation should complete the Redemption Request Form under seal or under the hand of at least two duly authorised officials who should state their capacity. Signature: Signature: Print Name : Print Name : 29

30 Crown Sigma UCITS plc LGT Crown Listed Private Equity (the Sub-Fund ) Share Conversion Request Form This share conversion request form (the Share Conversion Request Form ), when completed, should be forwarded to: Crown Sigma UCITS plc (the Company ) c/o RBC Investor & Treasury Services Ireland Limited (the Administrator ) Attention: Crown Sigma UCITS plc Georges Quay House, 43 Townsend Street, Dublin 2, Ireland. Telephone: (for Queries only) Fax: [email protected] (for Queries only) Unless the context otherwise requires and except as varied or otherwise specified in this Share Conversion Request Form, defined words and expressions used in this Share Conversion Request Form shall bear the same meaning as in the prospectus of Company dated 04 December 2015 and the supplement to the prospectus in respect of LGT Crown Listed Private Equity dated 04 December 2015 as amended or supplemented or substituted from time to time (the Prospectus ). Ladies and Gentlemen, Conversion requests must be made only by written application using this Share Conversion Request Form. Share Conversion Request Form duly completed, must be sent to the Administrator (for the account of the Company), at the address shown above. The Company reserves the right to reject any request for conversion in whole or in part. A properly completed and signed copy of any Share Conversion Request Form may be submitted to the Administrator by fax in advance of submitting the original, in order to expedite processing of the application. The signed original, however, should be sent without delay to the Administrator. Conversion requests will be processed in accordance with the Prospectus and the Shareholder must contact the Administrator if the Shareholder has not received an official conversion confirmation (the "Conversion Confirmation") within 2 Business Days of when the Share Conversion Request Form may be expected to have been received by the Administrator. Neither the Company nor the Administrator can be held liable for conversion requests not processed in a timely manner if the Shareholder does not immediately make contact with the Administrator regarding conversion requests that are not confirmed within 2 Business Days; and neither the Company nor the Administrator can take responsibility for 30

31 conversion requests that are not appropriately transmitted, sent or acknowledged. It is important to note that for any conversion request submitted to the Administrator, the responsibility for ensuring that the conversion request has been received by the Administrator for the requested Dealing Day remains with the Shareholder. Irrespective of any return receipt message, fax acknowledgement, etc. the Shareholder must contact the Administrator for clarification if the Shareholder does not receive a Conversion Confirmation. It remains the responsibility of the Shareholder to ensure that the conversion request has been received and processed correctly. This should include checking the Conversion Confirmation for errors and contacting the Administrator immediately and no later than the conversion request having been fully processed, if there is an error contained in the Conversion Confirmation received. In the event that the Shareholder does not so contact the Administrator, any unacknowledged conversion request may have no validity and any acknowledgement which the Shareholder believes differs from the instruction submitted shall be final and conclusive. Please note that the Shareholder must ensure that they have the most up-to-date contact details for the Administrator as these may change from time to time. The Dealing day is the first Business Day of each week or such other Business Days as the Directors may, determine and notify in advance to Shareholders. The Dealing Deadline for subscriptions is 1.00pm (Irish time) two Business Days preceding the relevant Dealing Day and for redemptions is 1:00pm (Irish time) five Business Days preceding the relevant Dealing Day or such other time for the relevant Dealing Day as may be determined by Directors and notified in advance to Shareholders provided always that the Dealing Deadline is no later than the Valuation Point. If you are in doubt about the contents of this Subscription Agreement, you should consult your stockbroker, accountant, solicitor or other independent professional adviser. The undersigned investor (the "Investor") acknowledges having received and reviewed the Memorandum and Articles of Association of the Company (the "Articles") and the Prospectus. The Investor acknowledges that the terms of the offering of the class of (a) (b) (c) Class A (EUR) of the LGT Crown Listed Private Equity of participating shares; Class B (EUR) of the LGT Crown Listed Private Equity of participating shares; Class O (EUR) of the LGT Crown Listed Private Equity of participating shares; with each participating share having no par value in the Company (the Shares ) are as stated in this Share Conversion Request Form, the Articles and the Prospectus. I/We being holder(s) of LGT Crown Listed Private Equity, Class A (EUR), Class B (EUR), Class O (EUR) Shares hereby request to convert the following amount of Shares on the next Redemption Day under the terms and conditions set forth in the Prospectus. Delivery of this Share Conversion Request Form may be by fax provided that the fax is signed and signed original is mailed to the Administrator promptly thereafter. I/We represent and warrant that I/we am/are the sole record holder and beneficial owner of the LGT Crown Listed Private Equity, Class A (EUR), Class B (EUR), Class O (EUR) free and clear of any and all liens, pledges, restrictions, options, rights of first refusal, encumbrances, charges, proxies, powers of attorney, agreements or claims of any kind whatsoever and I/we have the legal right, power and authority to apply for a conversion of the Shares. 31

32 Original Class New Class # Shares of Original Class to be Converted Total Holding You should mark Total Holding should you wish your entire holding to be converted. Please ensure that you specify the correct holder and account ID from which the holding is to be converted. Holder ID Account ID and Description Shareholder Name(s): Registered Address: In the case of joint holders, all must sign. A corporation should complete this Share Conversion Request Form under seal or under the hand of at least two duly authorised officials who should state their capacity. Signature: Signature: Print Name : Print Name : 32