If you wish to apply for Shares you must complete the Application Form in accordance with the instructions printed thereon and send it together with payment in full by cheque, bank draft or telegraphic transfer.
Applications sent by post should be addressed to INTERNATIONAL ADMINISTRATION (GUERNSEY)
LIMITED, P.O. BOX 282, REGENCY COURT, GLATEGNY ESPLANADE, ST. PETER PORT,
GUERNSEY, CHANNEL ISLANDS GY1 3RH and marked ATTN: EEA LIFE SETTLEMENTS FUND PCC LIMITED.
Applications sent by facsimile transmission should be sent to INTERNATIONAL ADMINISTRATION (GUERNSEY) LIMITED, FAX NO +44 (0) 1481 716868. Applications must arrive no later than the day specified in the relevant Appendices to the Offering Memorandum with cleared funds before the Subscription Day. Payment shall be made in the denominated currency of the Cell. Cheques and bank drafts should be made payable to EEA Life Settlements Fund Client Account and crossed “Not Negotiable”. Monies sent by telegraphic transfer should be sent to:
Remittance in USD
Northern Trust International Banking Corporation, New York (ABA: 026-001-122, SWIFT: CNORUS33) Account: Northern Trust (Guernsey) Limited (SWIFT code: BBCOGGSP)
Account no: 112318-20273
For further credit to: EEA Life Settlements Fund Client Account No. 102526300 By order of the [Applicant Name] for subscription of [Cell name]
Remittance in EURO
Société Generale, Paris (BIC: SOGEFRPP)
Account: Northern Trust (Guernsey) Limited (BIC: BBCOGGSP) IBAN: FR7630003069900010110805917
For further credit to: EEA Life Settlements Fund Client Account, IBAN: GB80BBCO40488402526300 By order of the [Applicant Name] for subscription of [Cell name]
Remittance in GBP
Northern Trust (Guernsey) Limited Sort code: 40-48-84 SWIFT: BBCOGGSP
Account : EEA Life Settlements Fund Client Account No: 02526300 By order of the [Applicant Name] for subscription of [Cell name]
For monies sent by telegraphic transfer, please instruct your bank to complete and return to the Administrator a letter of confirmation in the form of the sample letter attached.
If the monies remitted are not in the denominated currency of the Cell applied for, the applicants on signing the Application Form agree that the Administrator or Custodian may convert the remittances into the respective Cell currency at the prevailing market rate.
If the Application Form or associated cleared funds are not received as required, then the Application may be rejected or held over until the next Subscription Day, at the discretion of the Administrator. In the event that an application is rejected, application monies will be returned without interest by cheque through the post or telegraphic transfer at the risk and expense of the applicant. No applications may be withdrawn once received by the Administrator and any interest accruing upon monies received prior to the relevant Subscription Day will be for the account of the respective Cell.
MONEY LAUNDERING DECLARATIONS
The Criminal Justice (Proceeds of Crime) (Financial Services Business) (Bailiwick of Guernsey) Regulations, 2007 require the Company to establish the identity of the person by whom or on whose behalf an Application Form is lodged with payment. The applicant or agent lodging an Application Form shall be deemed to agree to provide the Company with such information and other evidence as the Company may require to satisfy the verification of identity requirements. Shares will not be allotted to the applicant until the verification of identity requirements has been complied with to the satisfaction of the Company. The documentation required to comply with such requirements will vary depending on the type of applicant, the nature of the relationship between the Company and the applicant, and whether the applicant is in a jurisdiction as set out in Appendix C to the Handbook for Financial Services Business on Countering Financial Crime and Terrorist Financing. In all cases, the applicants should provide the following documents on application.
INDIVIDUAL APPLICANTS:
The Company will require the following due diligence documents to accompany the Application Form:
a) A certified copy passport or national identity card which must contain the identity of the applicant, the number of the document, a clear photograph of the applicant, the signature of the applicant as well as the date and place of issue of the document and expiry date.
b) An original telephone, water, electricity or similar invoice addressed to the residential address(es) for review and return. The invoice should not be more than three months old. The Company will be pleased to return the original document if requested to do.
c) Should any other party retain signing authority over the investment (e.g. financial advisor) then due diligence documentation will also be required by the Company.
CORPORATE APPLICANTS OTHER THAN NOMINEE COMPANIES:
The Company will require the following due diligence documents to accompany the Application Form:
a) A certified copy of the applicant’s statutory documents. This will include the Certificate of Incorporation, Change of Name Certificate (if applicable), the Memorandum and Articles of Association and the authorised signatory list.
b) Due diligence documentation as for individual applicants will be taken on the beneficial owner and a maximum of four principal directors (or the authorised signatories if the Directors and signatories are not the same).
c) Where the applicant is a public company quoted on the stock exchange of the jurisdiction of the applicant then it will be sufficient to supply a copy of the latest set of audited annual accounts and the authorised signatory list.
CORPORATE APPLICANTS NOMINEE COMPANIES:
The Company will require the following due diligence documents to accompany the Application Form:
a) A certified copy of the applicant’s statutory documents. This will include the Certificate of Incorporation, Change of Name Certificate (if applicable), the Memorandum and Articles of Association and the authorised signatory list.
b) Due diligence documentation as above on the underlying beneficial investor.
EEA LIFE SETTLEMENTS FUND PCC LIMITED APPLICATION FORM
This application form should be completed and sent to International Administration (Guernsey) Limited, P.O. Box 282, Regency Court, Glategny Esplanade, St. Peter Port, Guernsey, Channel Islands GY1 3RH and marked Attn: EEA Life Settlements Fund PCC Limited or fax to +44 (0) 1481 716868
To: the Directors of EEA Life Settlements Fund PCC Limited
I/We, the applicant(s) named in Section 1 below, hereby offer irrevocably to subscribe in the Cells of the Company, as stated in Section 2 below on the terms of this application form and the latest Offering Memorandum and subject to the Memorandum and Articles of Association of the Company and subject to the laws of Guernsey.
Section 1 – investor(s)
Existing Shareholder(s) Yes No
Holder 1 Name
Occupation Previous names (if any)
Holder 2 Name
Occupation Previous names (if any)
Holder 3 Name
Occupation Previous names (if any)
Holder 4 Name
Occupation Previous names (if any)
Registered address:
Postcode:
Correspondence address (if different from above):
Postcode:
Section 2 – Deal Instruction
* The Sterling Classes will apply for distributor status (see supplement)
Section 3 - Distributions
Distributions may be made from time to time to the bank account you nominate below. Your distributions will be reinvested in Shares of the Cell to which you subscribe, unless you tick this box. Your instruction will remain valid unless you otherwise advise the Company in writing.
Section 4 – Bank Account Details
(account for receipt of distribution and redemption proceeds) Bank Name
Bank Address SWIFT Code
Account Name Account No.
Section 5 – Declaration
I/We enclose payment crossed “not negotiable” or I/We confirm that payment has been made by telegraphic transfer to the above account, for the sum set out above.
I/We understand that the completion of this Application Form accompanied by a cheque or bank draft or confirmation that monies have been remitted by telegraphic transfer constitutes a warranty that the cheque or bank draft will be honoured on first presentation and constitutes an acceptance of the other terms and conditions of application set out in the Offering Memorandum. I/We understand that no application will be accepted unless and until payment in full for the Shares has been made.
Signed in the order as in Section 1:-
Holder 1 Holder 2
Holder 3 Holder 4
Section 6 – Introducing agent Name of introducing
Applicant’s undertakings and consents
By completing and delivering an Application Form together with payment each applicant undertakes to the Company as follows:
(a) the applicant acknowledges the right of the Company to scale down applications and to reject applications in whole or in part. In such case application monies will be returned to applicants by cheque sent through the post at the applicant’s own risk;
(b) any application shall be irrevocable and any cheque or bank draft presented for payment will be honoured on first presentation;
(c) the application and any issue of Shares made on and subject to the terms and conditions of the latest Offering Memorandum, the Application Form and the Articles;
(d) the application for Shares is based solely upon the information in this document and no other information or representation has been relied upon;
(e) the applicant acknowledges a copy of the latest annual accounts, if any, has been made available to him before the application;
(f) the applicant agrees that if monies remitted are not in the denominated currency of the Cell applied for, the Administrator or the Custodian may convert the remittance into the relevant Cell currency at the prevailing market rate; and
(g) any monies returned will not include any interest, if any, earned while being held in a client account, and the applicant consents that the interest shall be for the benefit of the relevant Cell.
Personal information contained in the Application Form will be handled by the Administrator acting as Data Processor on behalf of the Company in accordance with Guernsey Data Protection Legislation.
The applicant hereby consents to the processing of his information and disclosure of his information to any relevant Guernsey or overseas agency, the Manager, the Investment Adviser and where necessary or in the Company's or Administrator's legitimate interests to any company in the Administrator's or Manager's group of companies or agents of the Administrator including companies situated in countries which may not have the same data protection laws as Guernsey.
PLEASE GIVE THIS LETTER TO YOUR FINANCIAL INSTITUTION AND HAVE THEM RETURN IT TO THE ADMINISTRATOR AT THE SAME TIME THAT THE SUBSCRIPTION MONEY IS WIRED.
SAMPLE LETTER
[to be placed on letterhead of the financial institution remitting payment]
Date
Via mail and facsimile: Fax 01481 716868 International Administration (Guernsey) Limited PO Box 282
Regency Court Glategny Esplanade St Peter Port
Guernsey, GY1 3RH Channel Islands
Dear Sirs RE:
1. Name of Remitting Financial Institution:
2. Address of Remitting Financial Institution:
3. Name of Customer:
4. Address of Customer:
5. We have remitted to your account at [Bank], Account Number [number] for [amount] by order of [subscriber] on [date].
The above information is given in strictest confidence for your own use only and without any guarantee, responsibility or liability on the part of this institution or its officials.
Yours faithfully Signed:
Full Name:
Position: