Application for a Certificate in relation to an Unclassified Fund

ThisCIF/UCF application 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.

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 this CIF/UCF application form.”

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

Section A – The Application

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

Section A.5:For the purpose of the completion of this form the following definitions will apply:

Single Class Fund:A fund with one class of redeemable units where the assets are held as a single pool.

Multi-class Fund:A fund with more than one class of redeemable units and where the assets are held as a single pool.

Umbrella Fund:A fund with more than one class of redeemable units and where the assets are held separately for each class.

Section B – Details of the Applicant

This Section is to be completed ONCE by each Applicant and all questions are to be completed save that to the extent that answers havealready been provided as part of a separate application in accordance with the Financial Services (Jersey) Law 1998, as amended and remain unchangedthen please state "As previously advised on [date]" byway of response.

Section B.1:The Commission requires that each holder of a certificate (“Certificate Holder”) nominates only one person as general contact for allcorrespondence relating to all certificates under the Lawgranted to the Certificate Holder.

Section B.10:A "Principal Person" is defined in Article 1 of the Law.

Section B.11:A "Key Person" is defined in Article 1 of the Law.

The Commission requires Principal Persons and Key Persons applying for the first time, or those needing to update their information (e.g. adding additional appointments), to do so by completing an electronic Personal Questionnaire (PQ) via itsWeb Portal.

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The Commission will no longer accept paper-based PQ or Additional Appointment forms. If you are accessing the Web Portal for the first time you will be required to register before proceeding.

Section C – Details of the AIF (alternative investment fund)

This Section is to be completed in each case where the Applicant is an AIF which intends to:

•be marketed in a Member State of the European Union (“EU”) or other European Economic Area (“EEA”) State to which Directive 2011/61/EU of the European Parliament and of the Council of 8 June 2011 on Alternative Investment Fund Managers (the “Directive”) applies; and

•avail itself of the exemption from the application of the Alternative Investment Funds (Jersey) Regulations 2012 (the “AIF Regulations”) afforded to a Certified Fund under Article 2 of the Alternative Investment Funds (Jersey) Order 2013 (the “Order”) PROVIDED THAT the Commission has granted its prior permission, in writing, for such AIF to be marketed in any Member State of the EU or other EEA State to which the Directive applies.

Section D - The Declaration

To be completed by all applicants.

Item (ii), which refers to Section B, should be crossed through only if ALL the required information has previously been given.

Section E - Details of the Fund

This section must be completed ONCE for each fund.

Section F - Details of the Fund

This section must be completed ONCE for each fund. If the fund is an umbrella fund, multiclass or a Protected Cell Company (“PCC”), photocopies should be taken and aseparate sheet should be completed in respect of each constituent part of the fund. Alternatively, please provide a schedule with the required information.

Payment of Fees

For this CIF/UCFapplication form 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 Financial Services Commission (Jersey) Law 1998, as amended and Article 7(12) of 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

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Section ADetails of the Application

A.1Full Legal Name of Fund:

A.2Full Legal Name of Applicant:

A.3Function(s) to be performed by the Applicant for the Fund named above:(Please tick appropriate box(es))

Company Issuing Units / Trustee / General Partner

A.4Is the Applicant already a holder of a certificate/permit or waiting to be granted a certificate/permit in relation to either an Unclassified or Recognized Fund under the Law?

/ Yes
/ No
If yes, the date on which the previous application form was signed (dd/mm/yyyy): / //
Please state the name of the fund for which the previous application was made:

A.5Please specify if this application is in connection with an umbrella,multi-class fund or PCC: (see notes)

Umbrella: / Multi-class: / PCC:
The number of constituent parts of the Fund:
The number of constituent parts that this application relates to:

Section BDetails of the Applicant

To the extent that answers have already been provided as part of a separate application inaccordance with the Financial Services (Jersey) Law 1998, as amended and remain unchanged then pleasestate "As previously advised on [date]" by way of response.

B.1Certificate contact name and address for Applicant in relation to any certificates 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.4(a) Country of Incorporation of Applicant:

(b)Date of Incorporation of Applicant:
(c)Company Registration Number:

B.5(a) Ultimate Beneficial Owner of Applicant:

(b)Legal structure of ultimate Beneficial Owner
(including partnership/trust etc.)
(c)Country of formation of ultimate Beneficial Owner
(d)Does the Fund 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.6(a) First accounting date for audited financial statements:

/ //
(b)Subsequent accounting date for audited financial statements:
(where different) / //
(c)What accounting standards will be adopted by the Applicant?

B.7Auditor of Applicant:

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

B.8(a) Does the Applicant use, or propose to use a business or tradingname different from that given in the answer to A.2?

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

B.9(a) Is the Applicant 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.10Principal Person information, please indicate clearly who from the list of Principal Persons is the Managing Director(see notes). If the Applicant is a PCC, please indicate who the directors are, and of each cell of the PCC. For regulatory purposes, the Commission prefers that the directors of the PCC and the PCs are the same.

Full Name / Capacity in which you act / Jersey
Resident / Electronic PQ alreadysubmitted? / %
Beneficial Ownership
Please chooseDirector - AlternateDirector - ExecutiveDirector - InfluentialDirector - ManagingDirector - Non-ExecutiveShareholder ControllerSpan of Control / Yes/NoYesNo / Yes/NoYesNo
Please chooseDirector - AlternateDirector - ExecutiveDirector - InfluentialDirector - ManagingDirector - Non-ExecutiveShareholder ControllerSpan of Control / Yes/NoYesNo / Yes/NoYesNo
Please chooseDirector - AlternateDirector - ExecutiveDirector - InfluentialDirector - ManagingDirector - Non-ExecutiveShareholder ControllerSpan of Control / Yes/NoYesNo / Yes/NoYesNo
Please chooseDirector - AlternateDirector - ExecutiveDirector - InfluentialDirector - ManagingDirector - Non-ExecutiveShareholder ControllerSpan of Control / Yes/NoYesNo / Yes/NoYesNo
Please chooseDirector - AlternateDirector - ExecutiveDirector - InfluentialDirector - ManagingDirector - Non-ExecutiveShareholder ControllerSpan of Control / Yes/NoYesNo / Yes/NoYesNo
Please chooseDirector - AlternateDirector - ExecutiveDirector - InfluentialDirector - ManagingDirector - Non-ExecutiveShareholder ControllerSpan of Control / Yes/NoYesNo / Yes/NoYesNo

B.11Key Person Information of the Fund, if there is a change of the Key Persons of the Trustee or the General Partner, please advise separately.

Please state the name of the Fund’s Compliance Officer:
Please state the e-mail address of the Compliance Officer:
PQ already submitted? / Yes
/ No
Please state the name of the Fund’s 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 Fund’s Money Laundering Compliance Officer:
Please state the e-mail address of the Money Laundering Compliance Officer:
PQ already submitted? / Yes
/ No

B.12Where the Fund is currently an unregulated fund within the meaning of the Collective Investment Funds (Unregulated Funds) (Jersey) Order 2008, please confirm that, subject to the grant of a certificate under the Law to the Applicant by the Commission, that the list of unregulated funds may be updated by removal of reference to the Fund.

/ Yes

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Section CDetails of the Alternative Investment Fund (the “AIF”)

C.1For information purposes only, please indicate the EU Member State(s) and/or other EEA State(s) in which the Applicant intends to market subject to the Commission’s prior approval.

(Please refer to the Commission’s Website for the list of EU/EEA States with which the Commission has signed the required bilateral cooperation agreement.)

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Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Liechtenstein
Lithuania
Luxembourg
Malta
Norway
Poland
Portugal
Romania
Slovak Republic
Slovenia
Spain
Sweden
The Netherlands
United Kingdom
Any of the above

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C.2(a) Will the Applicant be relying upon any transitional arrangement(s) adopted by any EU Member State and/or other EEA State to which the Directive applies and under which the Fund is marketed (“Transitional Arrangements”) which would operate to exclude the Applicant from the scope of Jersey’s AIFMD regime up until the expiry of the first of any such Transitional Arrangements?

/ Yes / No
(b)If so, please confirm on what date will the first of any such Transitional Arrangements expire? / //

C.3Please statethe full name and registered office of the Alternative Investment Fund Manager (the “AIFM”) (within the meaning of the Directive).

Name of AIFM:
Registered office:

C.4For the purpose of compliance with the Codes of Practice for Alternative Investment Funds and AIF Services Business (the “AIF Codes”), will the Applicant be subject to the sub-threshold provisions, the private placement rules or full compliance for passporting purposes?

Sub-Threshold Provisions: / Private Placement Rules: / Full Compliance:
The requirements of any EU Member State or other EEA State to which the Directive applies should be considered separately by the Applicant and, to the extent applicable, complied with in addition to the requirements of the AIF Codes.

C.5Where the Applicant has appointed an AIFM which is authorised or registered in an EU Member State and/or other EEA State, please state the full name and registered office of the depositary appointed.

Name of Depository:
Registered office:

C.6In respect of a depositary referred to in C.5which is established in Jersey, please tick the relevant box to indicate whether the services to be provided by such depositary shall be performed:

In full compliance with Article 21 of the Directive:
In accordance with Article 36 of the Directive:
In accordance with Article 21 and Recital 34 of the Directive (a private equity/real estate depositary for closed-ended funds):

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Section DDeclaration (see notes)

The Applicant is required to notify the Commission immediately of:

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

(b)any significant changes in the information provided in this application which occur after the date of submission of the application and prior to the Applicant receiving notification of the 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 C above,

(iv)Section D attached,

(v)Section(s) E 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 are aware that before the Commission processes this application form all Principal Persons and Key Persons will need to complete a Personal Questionnaire via the Commission’s Web Portal.

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

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

Please Note:

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

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Section EDetails of the Fund (see notes)

E.1Full Legal Name of the Fund

Where the Fund is a scheme or arrangement with more than one legal vehicle, please complete the scheme name above and provide the full legal name of each constituent part of the Fund below.

E.2Legal Form of Fund (Please tick the appropriate box):

Closed Ended Unit Trust / Closed Ended Investment Company
Open Ended Unit Trust / Open Ended Investment Company
Limited Partnership / Closed Ended Protected Cell Investment Company
Other (please specify below) / Open Ended Protected Cell Investment Company
Life Assurance Linked Contract

E.3(a) Country of Formation of Fund:

(b)Date of Formation of Fund:
(c)Registration Number of Fund:
(if applicable)

E.4If application is in respect of an umbrella or multi-class fund, please specify:

Umbrella / Multi-class / Number of Constituent Parts

E.5Will the Fund be compliant with the Codes of Practice under the Law?If not, please advise the areas of non-compliance.

/ Yes
/ No

E.6Which type of investor will the Fund be marketed to? (Please tick the relevant box(es))

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

E.7Is the Fund any of the following: (Please tick appropriate box(es))?

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

E.8(a)Is the Fund to be licensed/authorised for promotion elsewhere?

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

E.9Is any constituent part of the Fund to be listed?

/ Yes
/ No
If yes, please provide details as to where the Fund is to be listed.
If the Fund is planning to list within one year of an offer being made, please provide details.

E.10(a) Year end of fund:

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

E.11Name and Address of Auditor to the Fund:

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

E.12Name and Address of Statistics Officer to the Fund:

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

E.13Name and Address of Alternate Statistics Officer to the Fund (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.

E.14Do the Manager and Custodian/Trustee have the same ultimate holding company?

/ Yes
/ No

E.15Is the Fund involved in activities directly or indirectly that will fall within the Commission’s Sound Business Practice Policy?

(If yes, please provide full details)

/ Yes
/ No

E.16Is the Fund connected to a higher risk jurisdiction[1]?

(If yes, please provide full details)

/ Yes
/ No

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Section FDetails of the Fund (see notes)

Please note: This section should be completed for all funds. In respect of an umbrella, PCC ormulti-class fund, please photocopy this section as many times as needed and complete one pagefor each constituent part of the Fund.

F.1Full Legal Name of the Fund

F.2Name of constituent part (applicable only for umbrella funds, PCC or multi-class funds)

(Please tick the appropriate box)
Sub-Fund / PC / Share Class

F.2.1Is the constituent part to be open or closed ended?

F.3Investment 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:

F.4Primary investment objective: (Choose one only)

01 Capital Growth / 02 Income / 03 Both

F.5Minimum investment amount required:

F.6Base Currency:

F.7Which type of investor will the Fund 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)
Professional / Eligible
(as defined in the Jersey Eligible Investor Fund Guide).

F.8Is the Fund any of the following:(Please tick appropriate box(es))

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

F.9Has application been made and subsequently been REFUSED for authorisation in relation to the Fund/Constituent Part 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):

F.10Please list all Jersey fund service providers that provide their services to the Fund.

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

Important: Please Note -

If this section is completed in respect of an additional constituent part of an already existing fund theDeclaration after this page must be completed.

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Declaration

The Applicant is required to notify the Commission immediately of: