Application for Registration Under Article 9 of the FINANCIAL SERVICES (JERSEY) LAW 1998

Application for Registration under Article 9 of the FINANCIAL SERVICES (JERSEY) LAW 1998, AS AMENDED (THE “LAW”) in respect of fund services business

This FSJ/FSB application form is to be completed in accordance with the requirements of the Law,and any associated Orders and Regulations. Please also read carefully the Commission’s Licensing Policy under the Law and associated guidance notes before completing this form.

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 FSJ/FSB 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.2Boxes should be ticked for all classes of Fund Services Business which are to be performed by the Applicant.

Section B – Details of the Applicant

This Section is to be completed by all Applicants.

If the Applicant is already the holder of, or has previouslymade application for, a Permit to be a functionary of a Recognized Fund or a Certificate Holder of an Unclassified Fund, the only questions of Section B which need to be completed are those for which the answers have changed since the previous application.

Section B.1The Commission requires that each Applicant nominates one person as general contact for all correspondence relating to the application under 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 anelectronicPersonalQuestionnaire(PQ)viaitsWeb 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 a Fund Services Business which intends to:

•market any AIF in any 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 being required to register as an AIF services business under Article 2(11) of the Law afforded to persons who carry on Fund Services Business where theFund Services Business includes the same functions as the AIF services business under Paragraph23(1)(a) of Schedule 2 to the LawPROVIDED THAT the Commission has granted its prior permission in writing for the relevant AIF to be marketed in any Member State of the EU or other EEA State to which the Directive applies.

For the avoidance of doubt, please note that completion of the AIFSB/EXEMPT notification form is not required in addition to completion (by the Applicant) of Section C of this FSJ/FSB application form (Details of the Alternative Investment Fund).

Section D–Managed Entities

Section D.1This question is to be completed by all Applicants, the remainder of the section may not be applicable.

Section E–Manager of a Managed Entity

All questions in this section are to be completed by an Applicant that proposes to undertake the role of acting as aManager of aManaged Entity.

Section F - Types of Funds

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

Section G - The Declaration

To be completed by all Applicants.

Payment of Fees

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

For details of fees payable, see the notice published on the Commission'sWebsite in accordancewith Article15 of the Financial Services Commission (Jersey) Law 1998, as amended and Articles 8(3) and 9(6)of the Financial Services (Jersey) Law 1998, as amended.

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

Completed FSJ/FSB applicationforms 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 (see notes)

A.1Full Legal Name of Applicant:

A.2Classes of Fund Services Business to be performed by the Applicant named above: (see notes)(Please tick appropriate box(es))

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Class / Description
U. / Manager
V. / Administrator
W. / Registrar
X. / Investment Manager
Y. / Investment Adviser
Z. / Distributor
ZA. / Subscription Agent
ZB. / Redemption Agent
ZC. / Premium Receiving Agent
Class / Description
ZD. / Policy Proceeds Paying Agent
ZE. / Purchase Agent
ZF. / Repurchase Agent
ZG. / Trustee
ZH. / Custodian
ZI. / Depository
ZJ. / Member of a Partnership
(except a Limited Partner)
ZK. / Manager of a Managed Entity

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A.3Is the Applicant already a holder of a certificate/permit or waiting to be a Functionary/Fund Service Provider to either an Unclassified or Recognized Fund under the Law?

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

Section BDetails of the Applicant (see notes)

B.1Address for Applicant in relation to registration under the Law: (See notes)

Name:
Address:
E-mail address:
Telephone:

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
(d)Is the Applicant connected to a higher risk jurisdiction[1]?
(If yes, please enter details below to include (if applicable) whether the Applicant intends to provide services to customers who are themselves connected with a higher risk jurisdiction or for whom structures are established which will engage in activities with such jurisdictions). / Yes
/ No

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)Please provide an up to date ownership structure chart attached to the end of this form, detailing any and all holding companies/entities, subsidiaries and the Applicant’s ultimate beneficial owners. Please annotate with detail regarding the country of incorporation, the percentage of ownership held, the activities undertaken by subsidiary companies and whether the entities are regulated and/or listed.

B.6(a)First accounting year end date of Applicant.

/ //
(b)Subsequent accounting year end date of Applicant:
(where different) / //
(c)What accounting standards will be adopted by the Applicant?

B.7Auditor of Applicant:

Name:
Address:
E-mail address:
Telephone:

B.8(a)Does the Applicant 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.9(a)Is the Applicant a member of, has it applied for, or does it intend 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.10Has the Applicant received consent under the Control of Housing and Work (Jersey) Law 2012 (which came into force on 1 July 2013, replacing the Regulation of Undertakings and Development (Jersey) Law 1973)?

/ Yes
/ No

B.11Are shares in the Applicant subject to any options, charges, lien or other encumbrances? (If yes, please provide details)

/ Yes
/ No

B.12Principal Person information, please indicate clearly who from the list of Principal Persons is the Managing Director. A “Principal Person” is defined in Article 1 of the Law.

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

B.13Key Persons

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

B.14(a) Please confirm that Professional Indemnity Insurance (“PII”) is in place in accordance with the Fund Services Business Codes of Practice. Please provide details of level of PII, level of excess and details of any limitations in cover. Alternatively, if self-insured, please provide full details.

(b)If the Applicant is to apply full codes, please provide a copy of the relevant insurance documentation.

B.15Is the Applicant subject to any internal audit or review?

/ Yes
/ No
If yes, please give details:

B.16Does the Applicant have any other licence, membership, recognition, exemption, authorisation or registration conferred by any body (including investment exchanges and clearing houses) whether in Jersey or elsewhere?

/ Yes
/ No
If yes, please provide details:

Note:If answering “Yes” to any of the following questions, Applicants should provide details on a separate sheet.

B.17Has the Applicant, including all current principal persons, at any time been refused or had revoked any other licence, membership, recognition, exemption, authorisation or registration by any body, or having made an application decided not to proceed with it?

/ Yes
/ No

B.18Has the Applicant at any time in the previous ten years been criticised, censured, disciplined, suspended, expelled, fined or been subject of any disciplinary action by any regulatory body in Jersey or by any relevant supervisory authority or any Professional Body?

/ Yes
/ No

B.19Is the Applicant aware that its affairs, at any time in the previous ten years, have been investigated (including whether or not yet completed) by any regulatory body in Jersey or by any relevant supervisory authority or government or its agencies or any Professional Body?

/ Yes
/ No

B.20Have any of the Applicant’s books and records (including customer books and records) been requisitioned or seized at any time in the previous ten years by a relevant supervisory authority or any government or its agencies?

/ Yes
/ No

B.21Has the Applicant been engaged in any civil proceedings or arbitration at any time in the previous ten years in which a debt was adjudged due from, or judgement given against, the Applicant in relation to any financial services business conducted by them?

/ Yes
/ No

B.22Has any settlement of £10,000 or greater been entered into at any time in the previous three years, whether or not on an ex-gratia basis, to avoid or bring to an end legal action being brought against the Applicant or to avoid adverse publicity for the Applicant, in relation to any financial services business conducted by them?

/ Yes
/ No
If yes, please provide details of number and value of “settlements” made:

B.23Has the Applicant at any time been convicted of any offence involving fraud, or other dishonesty, or an offence under legislation (whether or not in Jersey) relating to companies (including insider dealing), financial services business, insolvency, customer credit or consumer protection?

/ Yes
/ No

B.24Is the Applicant involved in any pending proceedings or regulatory actions that are of a type that could in due course fall within any of the categories of proceedings or actions in B.20 and B.21 above?

/ Yes
/ No

B.25Has the Applicant reviewed the Commission’s Licensing Policy and the Codes of Practice for Fund Services Business?

/ Yes
/ No
If yes, please provide details of any areas of non-compliance:

B.26Has the Applicant outsourced or delegated, or does it intend to outsource or delegate, any material parts of its activities?

/ Yes
/ No
If yes, please provide details below:
Description of activity / To whom? / Is there an Agreement in place? / Compliance with the Outsourcing and Delegation Policy?
Yes/NoYesNo / Yes/NoYesNo
Yes/NoYesNo / Yes/NoYesNo
Yes/NoYesNo / Yes/NoYesNo
Yes/NoYesNo / Yes/NoYesNo
Yes/NoYesNo / Yes/NoYesNo
Yes/NoYesNo / Yes/NoYesNo
Yes/NoYesNo / Yes/NoYesNo
Yes/NoYesNo / Yes/NoYesNo

B.27Please confirm how the Applicant intends to meet the financial resources requirements as defined in the Codes of Practice for Fund Services Business.

B.28If the Applicant is a managed entity applying high level codes, please provide a declaration from or a confirmation on behalf of the directors/the board of the Fund Services Business that the directors have considered the matter and formed the opinion that the company will maintain and be able to demonstrate the existence of adequate financial resources and adequate insurance, in accordance with Core Principle 5 of the Codes of Practice for Fund Services Business.

B.29If the Applicant will be applying full codes, please provide an ANLA calculation to cover the first three to five business years, and an analysis as to how the Applicant intends to comply with the codes.

(a)Paid Up Share Capital
(Please state the amount)
(b)Expenditure Requirements
(c)Will a subordinated loan in accordance with the Funds Services Business Codes of Practice be required? / Yes
/ No

B.30Please provide a copy of the latest audited accounts of the Applicant. Please also provide a copy of the Applicant’s business plan which should includethe following headings(This list is not exhaustive):

Purpose of FSB;

Classes of Business;

The Company and Rationale for Business;

A draft copy of the Applicant’sBusiness Risk Assessment (“BRA”) as per the requirement in the AML/CFT Handbook[2];

Confirmation that the Applicant has draft AML/CFT policies and procedures to ensure compliance with applicable statutory and regulatory obligations;

The Fund(s) and/or Prospective Funds;

Financial Resources including issued and paid up share capital;

Insurance including PII cover;

Fees and Financial Projections;

Expenses;

Operations, Outsourcing and Delegation arrangements;

Directors and Key Persons (with brief bios showing relevant qualifications and experience);

Compliance with FSB Codes, full matrix analysis or Principle 5 confirmation if managed entity acting only for Expert Funds or equivalent; and

Governance Arrangements.

Please note that the Business Plan must be signed by a proposed Principal Person of the Applicant on behalf of the Applicant.
If any of the above are not included please explain why.

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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 States with which the Commission has signed the required 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 of the AIF(s) and whether it is regulated under the CIF Law or COBO:

Name of AIF and Regulatory Status:

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.

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Section DManaged Entities (see notes)

D.1Has the Applicant entered into any agreement with another Jersey based financial services provider for provision of any of the following services? (Please tick services provided as appropriate)

/ Yes
/ No

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Directors
Administrative support
Compliance Officer
Compliance Support
MLRO/MLCO
Registered Office
Administrative Office
Maintenance of books and records (other than statutory records)
PII
Company Secretary
Procedures manual
Other (Please specify below or use a separate sheet if necessary)

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