APSApplication Form / APS Investment: TRUST
Dated:
Part 1 – Account Details
Account Name*
Firm Reference / (e.g. your firm’s identifier for this account)
Investment Entity* / Trust / (e.g. Individual, Joint, Company or Trust)
Product Type* / GIA / (e.g. GIA, ISA, SIPP or Offshore Bond)
Part 2 – Trust Details
Name of Trust *
Nature of Trust *
Official ID Number / The tax or charity number if applicable
Date of Establishment / Tax Domicile
Source of Funds
Address
Address line 1*
Address line 2
Town/City*
Country / Post Code *
Part 3 – Individual Details
Please include details for at least:
- One Signatory; and
- One Trustee.
Authorised Signatory/Trustee/Beneficiary
Authorised signatory? / Trustee? / Beneficiary?
Name *
Position *
Date of Birth * / Town of Birth*
Country of Nationality * / Country of Birth*
Identification Number type / Identification Number*
Telephone (Home) / Telephone (Contact)*
E-mail Address *
Permanent Residential Address (‘PO Box’ or ‘Care of’ addresses not acceptable)
Address line 1*
Address line 2 *
Town/City *
Country * / Post Code *
Part 3 – Individual Details (continued)
Authorised Signatory/Trustee/Beneficiary
Authorised signatory? / Trustee? / Beneficiary?
Name *
Position *
Date of Birth * / Town of Birth*
Country of Nationality * / Country of Birth*
Identification Number type / Identification Number*
Telephone (Home) / Telephone (Contact)*
E-mail Address *
Permanent Residential Address (‘PO Box’ or ‘Care of’ addresses not acceptable)
Address line 1 *
Address line 2 *
Town/City *
Country * / Post Code *
Authorised Signatory/Trustee/Beneficiary
Authorised signatory? / Trustee? / Beneficiary?
Name *
Position *
Date of Birth * / Town of Birth *
Country of Nationality * / Country of Birth *
Identification Number type / Identification Number *
Telephone (Home) / Telephone (Contact) *
E-mail Address *
Permanent Residential Address (‘PO Box’ or ‘Care of’ addresses not acceptable)
Address line 1 *
Address line 2 *
Town/City *
Country * / Post Code *
Part 4 – Corporate Details
Corporate Trustee
Company Name *
Company type* / Registration No.*
Date of Incorporation / Country of Incorporation
Source of Funds
Registered Office Address
Address line 1*
Address line 2
Town/City*
Country / Post Code *
Mailing Address (if different to the Registered Office Address)
Address line 1
Address line 2
Town/City
Country / Post Code
Corporate Trustee
Company Name *
Company type* / Registration No.*
Date of Incorporation / Country of Incorporation
Source of Funds
Registered Office Address
Address line 1*
Address line 2
Town/City*
Country / Post Code *
Mailing Address (if different to the Registered Office Address)
Address line 1
Address line 2
Town/City*
Country / Post Code
Part 5Directors and Shareholders Details
If there is a corporate trustee we require details for at least one Director. If there are any shareholders that own 25% or more of the company, please also include their details.
Director/Significant Shareholder
Significant Shareholder? / Director?
Name *
Position *
Date of Birth * / Town of Birth *
Country of Nationality * / Country of Birth *
Identification Number type / Identification Number *
Telephone (Home) / Telephone (Contact) *
E-mail Address *
Permanent Residential Address (‘PO Box’ or ‘Care of’ addresses not acceptable)
Address line 1 *
Address line 2
Town/City *
Country * / Post Code *
Director/Significant Shareholder
Significant Shareholder? / Director?
Name *
Position *
Date of Birth * / Town of Birth *
Country of Nationality * / Country of Birth *
Identification Number type / Identification Number *
Telephone (Home) / Telephone (Contact) *
E-mail Address *
Permanent Residential Address (‘PO Box’ or ‘Care of’ addresses not acceptable)
Address line 1 *
Address line 2
Town/City *
Country * / Post Code *
Director/Significant Shareholder
Significant Shareholder? / Director?
Name *
Position *
Date of Birth * / Town of Birth *
Country of Nationality * / Country of Birth *
Identification Number type / Identification Number *
Telephone (Home) / Telephone (Contact) *
E-mail Address *
Part 5 – Directors and Shareholders Details(continued)
Permanent Residential Address (‘PO Box’ or ‘Care of’ addresses not acceptable)
Address line 1 *
Address line 2
Town/City *
Country / Post Code *
Part 6 – My Financial Adviser
Adviser Firm Name*
Adviser Name*
Please confirm the appointment of your Financial Adviser as your agent in relation to APS, in the box.
The Adviser Firm named above is authorised by me to act as my agent and on my behalf to give Praemium International Limited instructions in relation to my APS Account. This authority includes acting, generally, in relation to the safe custody of a) money invested by me through using APS from time to time; and b) the investments acquired with my money; and specifically, giving instructions to buy, hold and sell investments through APS.
Part 7 – Bank Account Details
Please complete your account details for income and redemption payments. We will not make any payments into any account which is not in the investors name.
Bank* / Account No.*
Account name* / Sort Code*
IBAN No¹ / BIC. No¹
¹IBAN and BIC No. fields must be completed if account is outside of the United Kingdom.
Part 8 – Investment Selection
Initial Investment Amount* / £
Regular Monthly Withdrawal Amount / £
The funds will be purchased at the below weightings after the Initial Adviser Charge has been taken and 2% (7% if you are taking a regular withdrawal) of the remaining balance has been retained in the Cash Account. The exact amount purchased will be shown on your contract note.
ISIN / Fund Manager / Fund Name / Weighting
IE00B1W6DR00 / Dimensional Fund Advisors / Dimensional Emerging Markets Targeted Value Fund GBP / %
IE00B2PC0484 / Dimensional Fund Advisors / Dimensional Global Core Equity Fund GBP / %
IE00B2PC0930 / Dimensional Fund Advisors / Dimensional Global Targeted Value Fund GBP / %
GB0033772624 / Dimensional Fund Advisors / Dimensional Emerging Markets Core Equity Fund GBP / %
GB00B735N017 / Dimensional Fund Advisors / Dimensional Global Short Dated Bond Fund GBP (Gross) / %
Reinvest Income?
Where to send the money
Electronic transfers should be made to Praemium International Limited’s Client Account, details below, quoting the Account Name entered in Part 1.
Account name / PIL DPS Client Account
Account number / 91816748
Sort code / 402533
IBAN number / GB23MIDL40253391816748
BIC number / MIDLGB22
Part 9 – Fees Payable
Please confirm in the box below that we may deduct from your Portfolio such amounts as may be payable to your Adviserand ourselves at such rates and frequencies as are detailed in the applicable scale(s) of charges from time to time.
Please deduct applicable fees and costs directly from my/our Portfolio (using available cash balances where practicable).
I understand that in addition to my allocated share of all dealing charges and expenses, fees will be payable to my Financial Adviser and the Custodian at such rates and frequencies as are detailed in the applicable scale(s) of charges from time to time. (All fees are stated exclusive of any applicable GST or VAT.)
Adviser Fees
Annual Adviser Fee / %
Initial Adviser Fee – Lump Sum / %
Initial Adviser Fee – Regular / %
Custody Fees
Annual Custody Fee: the rate at which the annual custody fee is charged depends on the value of your APS Account. It is applied on a tiered basis as set out below.
Tier / Annual Custody Fee
the first £500,000 / 0.35%
from £500,000 to £1 million / 0.30%
from £1 million to £5 million / 0.20%
above £5 million / 0.15%
Part 10– Declarations & Signature
You have received with this Application Form our (Praemium International Limited’s) current Custody Terms (the "Terms") which set out the legal terms of the relationship between you and Praemium International Limited. You need not sign the Terms but it is an important document and you should read it carefully.
Our agreement with you comprises this Application Form, the Terms and any other ancillary forms and documents accompanying them (all as modified from time to time). Our agreement with you takes effect when you sign this Application Form.
You will also have a separate agreement with the Financial Adviser you appoint to advise and administer your APS Account (the “Adviser Firm”) and who is identified in Part 6 of this Form. We will act on your Adviser Firm’s instructions and provide global custody and execution services to you in relation to your APS Account. We may use one or more sub-custodians when providing such global custody and execution services.
Please note that:
- we will provide execution-only services in relation to your APS Account only on instructions given by your Financial Adviser. We will not generally provide execution-only services on your instructions.
- we will not provide any advisory or discretionary services to you or to anyone else. We accept no responsibility for the investment advice or decisions in relation to transactions made.
- it is your Financial Adviser’s responsibility to ensure that the assets and weightings selected for your APS Account are suitable for you. We accept no responsibility for performing these functions.
- we will not monitor your relationship with your Financial Adviser. We accept no responsibility for their compliance with any limits you have agreed with them, good practice, law or regulation with regard to the advice, investment or other activities they undertake on your behalf.
- the Terms may be varied by us as set out in the clause headed "Amendments" of the Terms. You will be informed in advance of any changes in writing.
By signing this Set-up Form you confirm that:
- you have received, read and understood this Application Form, the Terms and other ancillary documents;
- you have appointed your Financial Adviser as your agent with authority to give instructions to us on your behalf in connection with your APS Account;
- you understand that each Investment Manager may instruct us in relation to your Portfolio without further reference to you;
- your Financial Adviser may instruct us to execute transactions by means of the Praemium Platform and we may rely on instructions given by them without further reference to you;
- you warrant that the information you have provided is accurate and true and you will promptly notify us of any changes;
- you will indemnify us unconditionally and irrevocably against all loss, damages, liability and/or costs, of whatsoever nature, suffered or incurred by us as a result of us relying on any information provided by you which is later proven to be untrue and / or misleading;
- the signatures shown on this Set-up Form are to be regarded as specimen signatures representative of your signature(s);
- you have elected for the Exchange of Information in relation to the EU Savings Directive as referred to in the Custody Terms;
- you are bound by the Custody Terms and make the representations and give the warranties contained in those terms;
- you have received a personal recommendation in relation to assets and weightings from the Financial Adviser;
- all reports, statements and valuations relating to your Portfolio may be sent to your Financial Adviser;
- you have read and understand the Anti-Money Laundering requirements set out in the Custody Terms. You understand that the Custodian may need to use credit reference/information agencies in order to satisfy their statutory anti-money laundering obligations. These agencies may keep a record of such enquiries; and
- the information provided on this Form is correct and complete to the best of your knowledge.
I undertake to ratify everything that the Financial Adviser may do or purport to do under or because of this Declaration.
This Declaration is a deed and has been executed as a deed. This Declaration is governed by and will be interpreted in accordance with Jersey law and I submit to the jurisdiction of the Jersey Courts. Nothing in this clause limits your right to take any legal action or proceeding in any other court.
Executed and delivered as a deed
Part 10– Declarations & Signature (continued)
Primary Client
Name*
Signature*
Date*
Witness
Name*
Signature*
Date*
Address Line 1*
Address Line 2
Address Line 3
Town/City* / Post Code*
AdditionalClient
Name*
Signature*
Date*
Witness
Name*
Signature*
Date*
Address Line 1*
Address Line 2
Address Line 3
Town/City* / Post Code*
Part 11 - Adviser Declarations and Signature
By signing below the Financial Adviser confirms that:
- the information provided on this Application Form is correct and complete to the best of its knowledge;
- the Investor named in Part 2 of the Investment Form (the "Investor") is the Adviser’s client;
- the Adviser has made the relevant suitability assessment and given a personal recommendation to the Investor in relation their APS Account;
- the Adviser has the Investors' authority for acting as their agent;
- the introduced customer has an established relationship with the Adviser;
- the Adviser has identified and verified the identity of the underlying customer/introduced customer (and any beneficial owners and controllers) and recorded the evidence of identity according to procedures established and maintained by us;
- customer due diligence procedures and record keeping procedures are in line with the Money Laundering Order or are consistent with the standards established in the Financial Action Task Force’s Forty Recommendations;
- the Adviser consents to the custodian relying on its performance of these procedures;
- the Adviser agrees to provide other relevant customer due diligence information and copies of documentation establishing evidence of identity of the underlying customer/introduced customer (and any beneficial owners and controllers) upon request and without delay; and
- the Adviser will notify the relevant person of material changes to the information provided in this certificate.
Account Name*
Primary Investor Name*
Additional Investor Name*
Adviser Firm* / Firm’s FSA No.
Adviser Name*
Signature* / Date*
Attachments Checklist:
I attach a duly completed Application Form with the Declaration in Part 10 signed by the Adviser Firm’s client, the Investor.
The funds for the investment will be transmitted electronically on / quoting the Account Name entered in Part 1
and are expected to be available for investment on / .
This Application Form must be mailed to: Praemium International Limited, 3rd Floor East Salisbury House 1-9 Union Street St Helier Jersey JE2 3RF
Praemium International Limited:T: +44(0)1534 765 450 F: +44(0)1534 765 459
E:W:
Registered Office Address: 3rd Floor East, Salisbury House, 1-9 Union Street, St. Helier, Jersey JE2 3RF
Company Registration No. 107624 (Jersey) Praemium International Limited is regulated by the Jersey Financial Services Commission under reference IB0271
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