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

APPLICATION FOR A Certificate in relation to a ‘Company Issuing Units’ of an Unclassified Fund in relation to an incorporated cell (‘IC’) of an incorporated cell company (‘ICC’)

This form is to be completed in accordance with the requirements of the Collective Investment Funds (Jersey) Law 1988,as amended (the “Law”), and any associated Orders and Regulations.

Where the application is for an umbrella fund in the form of an incorporated cell company (“ICC”) thisapplication form is to be used. Please note each IC of an ICC will need to complete the whole of the IC certificate application form.

Where the application is solely for a fund in the form of an incorporated cell (“IC”) of an incorporated cell company (“ICC”) the CIF/UCF application form is to be used.

If more space is needed the answer should be written on a separate sheet of paper with the heading: “Continuation of answer to question_ of application form CIF/IC.”

Answers are to be written in black ink in BLOCK CAPITALS or typed.

Section A – Details of the Application

All questions in this section are to be completed by all applicants.

Section B – Details of the ICC

All questions in this section are to be completed by the ICC.

Section B.1:The Jersey Financial Services Commission(the “Commission”) requires that each holder of acertificate (“Certificate Holder”) nominates only one person as general contact for all correspondence relating to all certificates under the Law granted to the Certificate Holder.

Section B.11:A "Principal Person" is defined in Article 1 of the Law. PersonalQuestionnaires, Additional Appointments and Notification of Ceasing to Act Forms can be downloaded from the Commission's website(

Section C - The Declaration

To be completed by the ICC.

Section D - Details of the IC as Applicant

To be completed by all applicants, photocopies should be taken and a separate sheet should be completed in respect of each IC of the ICC.

SectionD.15:See the note above regarding Section B.11.

Payment of Fees

For the Application to be valid, the correct fee must accompany each form.

For details of fees payable, see the notice published on the Commission'swebsite in accordancewith Article 15 of the FinancialServices Commission (Jersey) Law1998, as amended and Article 7(12) of the Law and relevant Orders under the Law.

Please pay by cheque and make the cheque payable to the "Jersey Financial Services Commission" and crossed "A/C payee".

Completed Application Forms should be sent to:

The Senior Manager, Funds Authorisation
Jersey Financial Services Commission
PO Box 267,
14-18 Castle Street,
St Helier, Jersey, JE4 8TP

Data Protection (Jersey) Law 2005

Personal data provided to the Commission – a data controller as defined in the Data Protection (Jersey) Law 2005 – will be used by the Commission to discharge its statutory, administrative and operational functions. Further information may be found in the Commission’s Data Protection policy, copies of which are available on request from the Commission and which may also be found on

CIF/IC September 2012Page 1 of 13

Section ADetails of the Application

A.1Full Legal Name of ICC:

A.2Full Legal Name of IC:

A.3Please arrange for the details of each IC to be completed on a separate Section D of this form.

A.4Does the ICC have ICs that are already a holder of a certificate or waiting to be granted a certificate in relation to an Unclassified Fund under the Law.

/ Yes
/ No
If yes, please state the date on which the previous application form was signed: / //
Please state the name of the ICs for which the previous application was made:

A.5The number of ICs of the ICC:

The number of ICs that this application relates to:

Section BDetails of the ICC

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

Name:
Address:
E-mail address:
Telephone: / Facsimile:

B.2Is the registered office address different to answer B.1? (If yes, please enter details below)

/ Yes
/ No

B.3Is the principal place of business different to answer B.1?(If yes, please enter details below)

/ Yes
/ No

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

Name:
Address:
E-mail address:
Telephone: / Facsimile:

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

Name:
Address:
E-mail address:
Telephone: / Facsimile:

Please note: Quarterly fund statistics are required to be submitted to the Commission electronically. The named Statistics Officer will be responsible for this.

B.6(a)Date of Incorporation of ICC:

/ //
(b)Company Registration Number of ICC:

B.7(a)Ultimate Beneficial Owner of ICC:

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

B.8Accounting year end date of ICC:

/ //

Name and address of auditor to the ICC:

Name:
Address:

B.9(a)Does the ICC use, or propose to use a business or trading name different from that given in the answer to A.1?

/ Yes
/ No
(b)If yes, please state name:

B.10(a) Is the ICC a member, has applied, or intends to apply for membership of any self-regulatory organisation, professional body, investment exchange or clearing house in the UK or overseas?

/ Yes
/ No
(b)If yes, please give details
Organisation:
Membership No.: / Date: / //

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

Full Name / Capacity which makes you a Principal Person e.g. “Director, CEO” etc / Jersey
Resident / PQ already submitted to the Commission
on? / %
Beneficial Ownership
Yes/NoYesNo / //
Yes/NoYesNo / //
Yes/NoYesNo / //
Yes/NoYesNo / //
Yes/NoYesNo / //
Yes/NoYesNo / //
Please state the name of the Compliance Officer:
Please state the e-mail address of the Compliance Officer:
PQ already submitted? / Yes
/ No
Please state the name of the Money Laundering Reporting Officer:
Please state the e-mail address of the Money Laundering Reporting Officer:
PQ already submitted? / Yes
/ No
Please state the name of the Money Laundering Compliance Officer:
Please state the e-mail address of the Money Laundering Compliance Officer:
PQ already submitted? / Yes
/ No

B.12Has application been made and subsequently been REFUSED for authorisation in relation to the ICC and/or IC under the rules and laws of any regulatory body, or for the units to be admitted to the listing of any stock exchange or other principal market?

/ Yes
/ No

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(If yes, please enter details below):

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Section CDeclaration

The ICC is required to notify the Commissionimmediately of:

(a)any other information which it considers relevant to this application; and

(b)any significant changes in the information provided in this application which occur after the date of submission of the application and prior to the Applicant receiving notification of the Commission’s decision concerning the application.

(THE ATTENTION OF SIGNATORIES IS DRAWN TO ARTICLE 16 OF THE LAW)

We declare that the information given in:

(i)Section A above,

(ii)Section B above,

(iii)Section D attached is complete and correct to the best of our knowledge at the time of the application and that there are no other material facts of which the Commission should be aware.

We declare that all relevant PQs have been submitted or are enclosed with this application together with the relevant certificate fees.

For and on behalf of:
Signatures:
Names:
Positions:
Date: / // / //

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

Please Note:

If it is preferred that during the period when this application is being considered, any correspondencerelating only to this application should be addressed to someone other than the person named in B.1above, please give details below:

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Section DDetails of the IC (see notes) as Applicant

D.1Full Legal Name of the IC

D.2Full Legal Name of the ICC

D.3Legal Form of Fund (Please tick the appropriate box):

Closed Ended Investment Company / Open Ended Investment Company

D.4Is the IC an Expert Fund as defined in the Jersey Expert Fund Guide?

/ Yes
/ No

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

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

D.6Will the IC be compliant with the Codes of Practice under the Law?If not, please advise the areas of non-compliance.

/ Yes
/ No

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

Number of Constituent Parts

D.8(a)Is the IC or ICC to be licensed/authorised for promotion elsewhere?

/ Yes
/ No
(b)If so, where?

D.9(a)Is this IC of the ICC to be listed?

/ Yes
/ No
(b)If yes, please provide details as to where the IC is to be listed.

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

/ //
(b)First Accounting date if different / //
(c)When will annual reports be published? / //

D.11Name and Address of Auditor to the IC:

Name:
Address:
E-mail address:
Telephone: / Facsimile:

D.12Do the Manager and Custodian/Trustee have the same ultimate holding company?

/ Yes
/ No

D.13(a)Does the IC use, or propose to use a business or trading name different from that given in the answer to D.2?

/ Yes
/ No
(b)If yes, please state name:

D.14(a) Is the IC a member, has applied, or intends to apply for membership of any self-regulatory organisation, professional body, investment exchange or clearing house in the UK or overseas?

/ Yes
/ No
(b)If yes, please give details
Organisation:
Membership No.: / Date: / //

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

Full Name / Capacity which makes you a Principal Person e.g. “Director, CEO” etc / Jersey
Resident / PQ already submitted to the Commission
on? / %
Beneficial Ownership
Yes/NoYesNo / //
Yes/NoYesNo / //
Yes/NoYesNo / //
Yes/NoYesNo / //
Yes/NoYesNo / //
Yes/NoYesNo / //
If different from the ICC, please fill in the information below:
Please state the name of the Compliance Officer:
Please state the e-mail address of the Compliance Officer:
PQ already submitted? / Yes
/ No
Please state the name of the Money Laundering Reporting Officer:
Please state the e-mail address of the Money Laundering Reporting Officer:
PQ already submitted? / Yes
/ No
Please state the name of the Money Laundering Compliance Officer:
Please state the e-mail address of the Money Laundering Compliance Officer:
PQ already submitted? / Yes
/ No

D.16Investment Policy

Please refer closely to Appendix 1 (Codes for Investment Policy) and enter below the code and description that most closely matches the investment policy of the fund/constituent part:
Code:
Description:

D.17Primary investment objective: (Choose one only)

01 Capital Growth / 02 Income / 03 Both

D.18Minimum investment amount required:

D.19Base Currency:

D.20Which type of investor will the IC be marketed to? (Please tick the appropriate box(es))

General Public / High Net Worth
Sophisticated / Institutional
Single Investor / Expert (as defined in the Jersey Expert Fund Guide)

D.21Is the IC any of the following: (Please tick appropriate box(es))

Index Tracker / Feeder Fund
Split Capital / None of the above
Fund of Funds

D.22Has application been made and subsequently been REFUSED for authorisation in relation to the ICC and/or IC under the rules and laws of any regulatory body, or for the units to be admitted to the listing of any stock exchange or other principal market?

/ Yes
/ No
(If yes, please enter details below):

D.23Please list all Jersey fund service providers that provide their services to the IC.

Name of fund service provider / Class(es) of Fund Services Business

Important: Please Note -

The Declaration after this page must be completed.

Declaration

The IC is required to notify the Commission immediately of:

(c)any other information which it considers relevant to this application; and

(d)any significant changes in the information provided in this application which occur after the dateof submission of the application and prior to the IC receiving notification of the Commission’sdecision concerning the application.

(THE ATTENTION OF THE SIGNATORIES IS DRAWN TO ARTICLE 16 OF THE LAW)

We declare that the information given herein in Section D and the information given in Sections A and B signed by the ICC is complete and correct to the best of our knowledge atthe time of the application and there are no other material facts of which the Commission should be aware.

We also declare that all relevant PQs have been submitted or are enclosed with this application together with the relevant certificate fees.

For and on behalf of:
Signatures:
Names:
Positions:
Date: / // / //

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

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Appendix 1:Codes for Investment Policy

Code / Description
Equity
E01 / Equity-UK
E02 / Equity-Europe (Including UK)
E03 / Equity-Europe (Excluding UK)
E04 / Equity-US (North America)
E05 / Equity-Japan
E06 / Equity-Far East (Including Japan)
E07 / Equity-Far East (Excluding Japan)
E08 / Equity-Global Emerging Markets
E09 / Equity-Global Equity
E10 / Equity-Other
Bond
B01 / Bond-Global
B02 / Bond-UK Debt
B03 / Bond-US Debt
B04 / Bond-Europe
B05 / Bond-Other
Money Market
M01 / Money Market-Sterling
M02 / Money Market-US Dollar
M03 / Money Market-Euro
M04 / Money Market-Swiss
M05 / Money Market-Other
Specialist
S01 / Specialist-Venture Capital/Private Equity - Emerging Markets
S02 / Specialist-Venture Capital/Private Equity - Other
S03 / Specialist-Real Property
S04 / Specialist-Derivatives
S05 / Specialist-Traded Endowment Policies
S06 / Specialist-Hedge/Alternative Investment Funds
S07 / Specialist-Other
Mixed
X01 / Mixed-Mixed Equity and Bond

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