TCM (CAYMAN) Subscription Application

TCM GLOBAL INDEX FUND (CAYMAN), LTD. ("TCM" or the "FUND") for Non-US Investors

See also:
- Additional Shares Application (for existing investors)
- Withdrawals (for existing investors)
- TCM Exhibit A and Exhibit B Glossaries

US Investors complete THIS APPLICATION.

Email Address for Correspondence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

What is the investing entity? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Declaration of U.S. Citizenship or U.S. Residence for Tax purposes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

U.S. Persons {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

US Persons, Citizens and Residents should STOP and complete

this subscription application

Material published on this website is protected by copyright. You are expressly prohibited from electronically storing any material found here or republishing it by any means.

Subscription Details

This form duly completed is submitted to:

NAV FUND SERVICES (CAYMAN) LTD.
Transfer Agency Services
5th Floor Harbour Place, 103 South Church Street,
George Town, Grand Cayman KY1-1202, CAYMAN ISLANDS
Phone +1 345 946 5006
Fax +1 345 946 5007
Email: fundservices@navcayman.net

We the undersigned, having received and read a copy of the Confidential Offering Memorandum of the Fund dated January 2019 (the "Offering Memorandum") hereby apply for Participating Redeemable Non-Voting Shares of the Fund:

(insert US Dollar amount in figures) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

(insert US Dollar amount in words) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

and undertake to have settled therefor in full by telegraphic transfer, for value by:

Requested Subscription Date: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

The Shares in the Fund hereby subscribed for are herein referred to as the "Shares".

Please enter the bank account details from which you will wire investment, so Administrator can reconcile incoming wires with this subscription form. You can wait for approval of your application by Administrator before wiring investment:

Bank Account Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Bank Account Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Payment by wire transfer should be sent referencing the subscriber’s name to:

Banking Details:
Beneficiary Name:    TCM GLOBAL INDEX FUND (CAYMAN) LTD
USD account no:      187062-20010
Beneficiary Address: Stureplan 4c, vån. 4, 114 35 Stockholm, Sweden
Reference:           [Investor’s Name]

Bank name:           The Northern Trust International Banking Corporation
Bank address:        Harborside Financial Center,
                     3 Second Street, Suite 1401,
                     Jersey City, New Jersey 07311-3988, USA
Bank tel:            +1 (201) 793 4900
Bank fax:            +1 (201) 793 4961/62
SWIFT code:          CNORUS33
Fedwire ABA:         026001122
CHIPS ABA:           0112

I/We acknowledge that due to money laundering requirements operating within its jurisdiction and/or the requirements of the Money Laundering Regulations (as amended) of the Cayman Islands and the Guidance Notes issued pursuant thereto the Administrator may require further identification of the applicant(s) before the application can be processed and the Administrator shall be held harmless and indemnified against any loss arising as a result of a failure to process the application if such information has been requested by the Administrator and has not been provided by me/us.

I/We hereby agree to be bound by the Offering Memorandum and the Memorandum and Articles of Association of the Fund ("Articles of Association").

In consideration of the Administrator processing this Subscription Form and the Fund making a provisional allotment of Shares, I/we hereby agree to indemnify and hold harmless the Fund, the Administrator, the Directors of the Fund and the Investment Manager against any loss, costs or expenses incurred by it or them as a result of my/our failure to pay the required subscription monies for the application of Shares within the time required by the Administrator.

I/We confirm that I am/we are eighteen years of age or over (natural persons only).

I/We confirm that I/we am/are not a US investor and am/are not acquiring Shares on behalf of, nor for the benefit of, a US investor nor do I/we intend selling or transferring any Shares which I/we may purchase to any person who is a US investor.

I/We warrant that (a) I/we have the knowledge, expertise and experience in financial matters to evaluate the risks of investing in the Fund; (b) I am/we are aware of the risks inherent in investing in the Shares and the method by which the assets of the Fund are held and/or traded; and (c) I/we can bear the risk of loss of my/our entire investment.

I/We warrant that I am/we are able to acquire Shares without violating applicable laws.

I/We confirm that we are not/have not been subject to any legal proceedings, including, but not limited to, lawsuits or arbitration, involving any investments, including securities, commodities, or other investments

I/We hereby accept such lesser number of Shares, if any, than may be specified above in respect of which this application may be accepted.

I/We having received and considered a copy of the Offering Memorandum, hereby confirm that this application is based solely on the Offering Memorandum and any supplemental Memorandum current at the date of this Subscription Form, the material contracts therein and the Articles of Association, together (where applicable) with the most recent financial statements of the Fund.

I/We request that the Shares issued pursuant to this application be registered in the name(s) and address set out below.

I/We agree that I/we shall not take any action to present a petition or commence any case, proceeding, proposal or other action under any existing or future law of any jurisdiction, domestic or foreign, relating to bankruptcy, insolvency, reorganisation, arrangement in the nature of insolvency proceedings, adjustment, winding-up, liquidation, dissolution, composition or analogous relief with respect to the Fund or the debts of the Fund unless and until a debt is immediately due and payable by the Fund to me/us.

The Administrator is hereby authorised and instructed to accept and execute any instructions in respect of the Shares to which this application relates given by me/us in written form including by email to the email address listed above. If the instructions are given by me/us by facsimile, I/we undertake to confirm them in writing. I/We hereby agree to indemnify the Administrator and agree to keep it indemnified against any loss of any nature whatsoever arising to any of them as a result of it acting upon facsimile instructions. The Administrator may rely conclusively upon and shall incur no liability in respect of any action taken upon any notice, consent, request, instruction or other instrument believed in good faith to be genuine or to be signed by properly authorised persons.

I/We are fully empowered and have authority to make this investment whether the investment is on my/our own behalf or on the behalf of another person or institution.

I/We confirm that I/we have the right and authority to request a redemption of Shares and confirm that I/we will comply with the redemption procedures set out in the Offering Memorandum. All redemption instructions may be made in writing including by email to the email address listed above.

I/We agree that the issue and allotment to me/us of Shares is subject to the provisions of the Offering Memorandum and the Articles of Association, that subscription for Shares will be governed and construed in accordance with Cayman Islands law and I/we confirm that by subscribing for Shares, I/we are not relying on any information or representation other than such as may be contained in the Offering Memorandum.

I/We hereby agree to indemnify and keep indemnified the Fund and the Administrator against any loss arising to either of them as a result of any breach of any representation, warranty, covenant or confirmation by me/us in this Subscription Form or of my/our failure to disclose any relevant details or provide them with all information requested by either of them.

In the case of delay or failure to provide satisfactory information, the Administrator may take such action (including declining to accept an application) as it thinks fit.

I/We agree to notify the Administrator immediately if I/we become aware that any of these confirmations are no longer accurate and complete in all respects and agree immediately either to sell or to tender to the Administrator for redemption a sufficient number of Shares to allow the confirmation to be made.

I/We acknowledge and agree that pursuant to the Articles of Association, the Directors shall, if lawfully required to do so under the laws of any jurisdiction to which the Fund, or any service provider to the Fund is subject, be entitled to disclose any information regarding the affairs of the Fund including without limitation information contained in the Register of Members of the Fund and books of the Fund. The Directors, any person acting as a service provider to the Fund and any other person authorised by the Directors shall have the right to access all information belonging to the Fund.

I/We agree to provide the above confirmations to the Administrator at such times as the Administrator may request, and to provide on request such certifications, documents or other evidence as the Administrator may reasonably require to substantiate such representations.

(In respect of joint with rights of survivorship applicants only) We direct that on the death of one of us the Shares for which we hereby apply be held in the name of and to the order of the survivor or survivors of us or the executor or manager of such survivor or survivors.

"FATCA" means one or more of the following, as the context requires:

(a) sections 1471 to 1474 of the US Internal Revenue Code of 1986 and any associated legislation, regulations or guidance, commonly referred to as the US Foreign Account Tax Compliance Act, or similar legislation, regulations or guidance enacted in any other jurisdiction which seeks to implement equivalent tax reporting and/or withholding tax regimes;

(b) any intergovernmental agreement, treaty or any other arrangement between the Cayman Islands and any of the US or any other jurisdiction (including between any government bodies in each relevant jurisdiction), entered into to facilitate, implement, comply with or supplement the legislation, regulations or guidance described in paragraph (a); and

(c) any legislation, regulations or guidance implemented in the Cayman Islands to give effect to the matters outlined in the preceding paragraphs.

I/We agree to provide to the Fund or its agents, upon request, any documentation or other information that the Fund or its agents may require from time to time in connection with the Fund’s obligations under, and compliance with, applicable laws and regulations including, but not limited to FATCA. By executing this Agreement, I/We waive any provision under the laws and regulations of any jurisdiction that would, in the absence of such waiver, prevent or inhibit the Fund's compliance with applicable law as described in this paragraph including, but not limited to preventing (i) me/us from providing any requested information or documentation, or (ii) the disclosure by the Fund or its agents of the provided information or documentation to applicable governmental or regulatory authorities. I/We further acknowledge that the Fund and the Investment Manager may take such action as each of them considers necessary in relation to my/our holding and/or redemption proceeds to ensure that any withholding tax payable by the Fund, and any related costs, interest, penalties and other losses and liabilities suffered by the Fund, the Administrator, or any other investor, or any agent, delegate, employee, director, officer or affiliate of any of the foregoing persons, arising from my/our failure to provide any requested documentation or other information to the Fund, is economically borne by me/us.

I/We warrant that I am/we are aware and accept that the Fund has authority to redeem a portion of my/our Shares and to pay the proceeds to the Investment Manager as part of any Incentive Fee payable in accordance with the provisions of the Offering Memorandum.

I/We hereby appoint the Administrator or any representative thereof, with full power of substitution, as my/our proxy to attend any meeting (whether a general meeting, a class meeting or otherwise) of the Shareholders of the Fund and to vote and speak, at any such meeting at which such Shares could be voted, on my/our behalf and to represent the Shares in such manner as the Administrator in its absolute discretion deems fit.

This Subscription Form shall be governed by and construed in accordance with the laws of the Cayman Islands.

Tax and Legal Advice Disclaimer:
TCM and its affiliates do not provide tax, legal or accounting advice. This material has been prepared for subscription purposes only, and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. You should consult your own tax, legal and accounting advisors if you are unsure how to complete this form.

Individual Account Holder

Individual {binding ItemNumber}

Account Holder Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Place of Birth (city) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Country of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Country of Citizenship {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Occupation of Investor {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Expected Frequency of Transactions {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Mailing Address different from above? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Mailing Address

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Declaration of Tax Residency (other than U.S.)

I hereby confirm that I am, for tax purposes, resident in the following countries (provide the tax reference number type and number applicable in each country).

Country/countries of tax residency {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Tax reference number type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Tax reference number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

If applicable, please specify the reason for non-availability of a tax reference number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Individual Account Holder Identification and Self-Certification

Individual Declaration and Undertakings

I declare that the information provided in this form is, to the best of my knowledge and belief, accurate and complete. I undertake to advise the recipient promptly and provide an updated Self-Certification form within 30 days where any change in circumstances occurs which causes any of the information contained in this form to be inaccurate or incomplete. Where legally obliged to do so, I hereby consent to the recipient sharing this information with the relevant tax information authorities.

I acknowledge that it is an offence to make a self-certification that is false in a material particular.

Typing your name is equivalent to your handwritten signature. By typing my signature and sending it via the Internet, I acknowledge that I have read and understand all information provided during the application process; that I intend TCM and service providers to rely upon it; that I intend to be bound thereby; and that I understand and agree that my electronic signature is the equivalent of a manual written signature.

Signature (type Full Name) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Entity Identification and Self-Certification

Legal Entity Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date of Incorporation/Organization {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Country of Formation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Nature of the investor's business {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Expected Frequency of Transactions {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Current Residence or Registered Address

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Contact Details

Contact {binding ItemNumber}

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Mailing Address different from above? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Mailing Address

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ERISA Status

The undersigned is a corporation, partnership, trust or other entity, and 25% or more of the value of any class of equity interests of the undersigned is held by US employee benefit plans within the meaning of Title I of the Employee Retirement Income Security Act of 1974 (“ERISA”) (including plans maintained outside the United States subject to ERISA). {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

The undersigned certifies that it is a “defined benefit plan” (as defined in Section 3(35) of ERISA) which is not described in Section 4(b)(1), 4(b)(2) or 4(b)(4) of ERISA. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

The undersigned certifies that it is an involuntary, noncontributory defined benefit plan as defined in the Securities and Exchange Release Nos. 33-6188 and 33-6218. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IN CONNECTION WITH ERISA OR IRA INVESTORS, THE INVESTMENT MANAGER DOES NOT (I) ACT OR REPRESENT THAT IT IS ACTING, IN A FIDUCIARY CAPACITY TO SUCH INVESTORS AND DOES NOT (II) PROVIDE IMPARTIAL “INVESTMENT ADVICE” OR A RECOMMENDATION THAT AN INVESTMENT IN THE FUND IS SUITABLE, ADVISABLE OR APPROPRIATE FOR SUCH AN INVESTOR, WHETHER GENERALLY OR IN LIGHT OF SUCH INVESTORS PARTICULAR CIRCUMSTANCES. FURTHERMORE, THE INVESTMENT MANAGER HAS A FINANCIAL INTEREST IN MANAGING THE FUND AND ITS INTERESTS MAY CONFLICT WITH THE INTERESTS OF ERISA AND IRA INVESTORS. IN MAKING AN INVESTMENT DECISION, ERISA AND IRA INVESTORS MUST RELY ON THE RECOMMENDATION OF AN INDEPENDENT PLAN FIDUCIARY OR THEIR OWN EXAMINATION OF THE FUND, THE TERMS OF THE OFFERING AND THE RISKS ATTENDANT WITH AN INVESTMENT IN THE FUND.

Further Representations and Warranties by Investors Subject to ERISA:

(i) If the undersigned is a pension plan or retirement fund, no individual or employer participating directly or indirectly in the plan or the fund (collectively, the “Plan”), acting in his or its capacity as an individual or employer (recognizing that with respect to roll-over and similar accounts, the sole beneficiary may be acting in the capacity of Plan Investment Fiduciary, as defined below), can direct the investments of the Plan (or any pension plan participating in the Plan); the initial decision to invest assets of the Plan in the Fund has been made, and the decision to make subsequent investments of assets of the Plan in the Fund will be made, by a fiduciary of the Plan (unrelated to the Investment Manager) (the “Plan Investment Fiduciary”) acting in the exercise of its sole discretion to make such investment decisions, and such fiduciary has the authority and may, in its sole discretion, subsequently determine to withdraw such investment from the Fund and to invest such assets elsewhere; the decision to invest assets of the Plan in the Fund was not, and any subsequent decision to withdraw assets from the Fund will not be, made pursuant to the direction of any individual or individuals participating in the Plan, and no individual or individuals participating in the Plan will determine whether or how much of their assets will be invested in the Fund; neither the employer nor any other person associated with the Plan shall have, or attempt to exercise, the power to influence or control the appointment or removal of the Investment Manager, or any successor to any such person, the investment objectives, policies or restrictions of the Fund, and the investment or management decisions regarding the Fund; and neither the employer nor any other person associated with the Plan has made or will make any representation to individuals participating in the Plan that all or any specific portion of their contributions will be invested in the Fund. The undersigned acknowledges that it understands (and the Investment Manager agrees) that neither the Investment Manager nor any person acting on behalf of the Fund or the Investment Manager will have any direct contact with individuals as such participating in the Plan regarding investment of contributions to the Plan.

(ii) All of the types of investments to be made by the Fund as described in the Offering Memorandum are permitted under the terms of the Plan.

(iii) The undersigned is a named fiduciary, within the meaning of Section 402(a) of ERISA, of such Plan, and in accordance with Section 403 of ERISA, at least one signatory for the Plan hereunder is a “trustee” or “investment manager” of the Plan as defined in ERISA.

(iv) If the undersigned is an employee benefit plan or related partnership qualified under Section 401(a) or 501(a) of the Code, respectively, the person executing this Subscription Agreement on behalf of the undersigned represents that he or she and the Plan Investment Fiduciary have been informed of and understand the Fund’s investment objectives, policies and strategies and that the decision to invest in the Fund is consistent with the provisions of the Code, ERISA, and the governing documents of the Plan and that he or she has the authority to execute this Subscription Agreement on behalf of the undersigned.

(v) The undersigned and/or the Plan Investment Fiduciary will provide to the Investment Manager upon acceptance of this Subscription Agreement and from time-to-time thereafter upon reasonable notice a list of the parties in interest, as defined in ERISA Section 3(14), of the Plan.Insert and format text, links, and images here.

US FATCA Classification for Non-US Entities

Entity is a Registered Foreign Financial Institution (RFFI) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Are you able to provide your Global Intermediary Identification (GIIN) or do you have a Sponsored Entity GIIN? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RFFI category and FATCA GIIN

Do you applied for and received a "Deemed-Compliant" status from the IRS? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Model 1 or Model 2 Reporting FFI {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Global Intermediary Identification (GIIN) number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Entity is a Financial Institution but unable to provide a GIIN or has a Sponsored Entity GIIN {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Trustee Details

Trustee's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Trustee's GIIN {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Certified or Registered Deemed Compliant FFI

The classifications available for deemed-compliant status are extensive and complex. For your information, listed below is each available deemed-compliant classification and a short description of the classification. The deemed-compliant classifications are separated into two main sub-categories: (1) Registered Deemed-Compliant FFIs and (2) Certified Deemed-Compliant FFI. If you feel that one of these classifications may apply to your entity, please consult a professional tax advisor.

Entity is Certified Deemed Compliant FFI because: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Entity is Registered Deemed Compliant FFI because: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Non-Participating Foreign Financial Institution (NPFI)

FFI is: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Entity is not a Foreign Financial Institution {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Exempt Beneficial Owner

Exempt Beneficial Owners under the US IGA include Government entities, International Organizations, Central Bank, Broad Participation Retirement Funds, Narrow Participation Retirement Funds, Pension Funds of an Exempt Beneficial Owner, and Investment Entities wholly owned by Exempt Beneficial Owners. Please refer to the IGA for detailed definitions.

Indicate status {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Active Non-Financial Foreign Entity (NFFE)

Active Non-Financial Foreign Entity means any NFFE which is a Non-U.S. entity that meets any of the following criteria. Tick which criterions are relevant. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Direct Reporting NFFE

Entity has registered for a GIIN and elects to report information about its direct or indirect substantial U.S. owners to the relevant authorities.

Entity's GIIN {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Passive Non-Financial Foreign Entity

Entity is not active or a withholding foreign partnership or withholding foreign trust for US Treasury Regulation purposes. The NFFE is NFFE is not an Active Non-Financial Foreign Entity

Provide details of: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Substantial US Owners

Substantial US Owner {binding ItemNumber}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Tax reference type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Tax number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Controlling Person(s)

Controlling Person {binding ItemNumber}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Common Reporting Standard (CRS)

Declaration of All Tax Residency

Please indicate the Entity’s place of tax residence (if resident in more than one jurisdiction please detail all jurisdictions and associated tax reference number type and number).

For the purposes of the Common Reporting Standard (CRS), all matters in connection with residence are determined in accordance with the CRS and its Commentaries.

If an entity has no residence for tax purposes please indicate the jurisdiction in which its place of effective management is situated. Please indicate not applicable if jurisdiction does not issue or you are unable to procure a tax reference number or functional equivalent, and indicate the reason below.

Jurisdiction or Country of tax residency {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Tax reference number type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Tax reference number (eg. TIN) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

If applicable, please specify the reason for non-availability of a tax reference number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CRS Classification

Entity is a {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CRS Financial Institution

Entity is: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Specify the type of Non-Reporting Financial Institution: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Financial Institution resident in a Non-Participating Jurisdiction under CRS

Type of Financial Institution {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Are you a: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

You may apply the Controlling Persons test of a legal person as per the Controlling Person definition in Exhibit B, and where simplified due diligence procedures are permitted to be applied by the Financial Institution under the applicable AML regime in relation to the Account Holder and its Controlling Persons, no further information is required.

List Controlling Person(s)

Controlling Person {binding ItemNumber}

Full Name of any Controlling Person(s) - definition in Exhibit B {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CRS Active Non-Financial Entity (NFE)

Type of Active NFE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Stock Exchange

Provide the name of the stock exchange where traded {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

If you are a related entity of a regularly traded corporation, provide the name of the regularly traded corporation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Other Active Non-Financial Entity

Select qualifying criteria: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CRS Passive Non-Financial Entity (PNFE): Controlling Person(s)

Controlling Person {binding ItemNumber}

Full Name of any Controlling Person - definition in Exhibit B {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Entity Declaration and Undertakings

I/We declare (as an authorized signatory of the Entity) that the information provided in this form is, to the best of my/our knowledge and belief, accurate and complete. I/We undertake to advise the recipient promptly and provide an updated Self - Certification form within 30 days where any change in circumstances occurs, which causes any of the information contained in this form to be inaccurate or incomplete. Where legally obliged to do so, I/we hereby consent to the recipient sharing this information with the relevant tax information authorities.

I/we acknowledge that it is an offence to make a self-certification that is false in a material particular.

Signatories

Signatory {binding ItemNumber}

Authorised Signature (type Full Name) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Position/Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Controlling Persons

Controlling Person {binding ItemNumber}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Mailing Address different from above? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date of birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

City of birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Country of birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Are you a tax resident in one or more Reportable Jurisdictions {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Jurisdiction of Residence for Tax Purposes and related Taxpayer Reference Number or functional equivalent (TIN)

Tax jurisdiction {binding ItemNumber}

Jurisdiction(s) of tax residency {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Tax reference number type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Tax reference number (e.g. TIN) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

If applicable, please specify the reason for non-availability of a tax reference number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Relevant Entity(s) you Control

Entity {binding ItemNumber}

The legal name of the relevant entity Account Holder(s) of which you are a Controlling Person {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Controlling Person's Status {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Controlling Person Declaration and Undertakings

I acknowledge that the information contained in this form and information regarding the Controlling Person(s) and any Reportable Account(s) may be reported to the tax authorities of the jurisdiction in which this account(s) is/are maintained and exchanged with tax authorities of other jurisdiction(s) in which [I/the Controlling Person] may be tax resident pursuant to international agreements to exchange financial account information.

I certify that either (a) I am the Controlling Person, or am authorized to sign for the Controlling Person, of all the account(s) held by the entity Account Holder to which this form relates; or (b) I am authorized by the Account Holder to make this declaration.

I declare that all statements made in this declaration are, to the best of my knowledge and belief, correct and complete.

I acknowledge that it is an offence to make a self-certification that is false in a material particular.

I undertake to advise the recipient within 30 days of any change in circumstances which affects the tax residency status of the individual identified in Part IV of this form or causes the information contained herein to become incorrect, and to provide the recipient with a suitably updated self-certification and Declaration within 30 days of such change in circumstances.

Signature (type Full Name) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Note: If you are not the Controlling Person, and not authorized to sign the Declaration on behalf of the Account Holder, please indicate the capacity in which you are signing the form on behalf of the Controlling Person. If signing under a power of attorney or other equivalent written authorization, on behalf of the Controlling Person, please also attach a certified copy of the power of attorney or written authorization. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Authorization document {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Due Diligence Documents

To comply with applicable anti-money laundering laws and regulations and the Administrator’s Know Your Customer policies and procedures, the applicant is required to provide the following information and documentation to the Administrator.

The Cayman Islands legal system incorporates anti-money laundering laws and regulations in accordance with modern international best practice. The Administrator has its office domiciled in Cayman Islands, therefore the Fund and the Administrator must comply with the laws and regulations applicable in that jurisdiction. The Fund is required to obtain and keep on file extensive documentation of the identity of each investor and the source of funds. This note sets out the due diligence and investor identification requirements of the Fund.

The Administrator applies simplified due diligence in cases where the applicant is from an Approved Country and the source of funds is deemed compliant and in the case where the applicant is a regulated financial institution subject to an equivalent anti-money laundering regime, either investing on behalf of itself or a third party (known as “Designated Bodies”).

In cases where the applicant does not fall into a simplified or standard due diligence, the Administrator will apply enhanced due diligence on the applicant. Examples of enhanced due diligence scenarios are as follows:

1) Politically Exposed Person (“PEP”)

2) The applicant is from a non-approved country

3) Possible match as a result of a sanction screening or adverse media report

Originating Account Information

Bank Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Bank Country {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Bank Account Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Bank Account Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ABA No. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

SWIFT {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

The Bank Account Name must be the same as the Investor’s name.

If your bank is unable to wire the funds as per the specifications mentioned, the Administrator will request your bank to confirm in writing that the funds were wired from a bank account held with them in the name of the Applicant. The Administrator reserves the right to request such information and documentation as is necessary to verify the identity and source of funds of any Investor.

Bank is located in an Administrator approved jurisdiction: Argentina, Australia, Austria, Bahamas, Bahrain, Barbados, Belgium, Bermuda, Brazil, British Virgin Islands, Canada, Cayman Islands, Denmark, Finland, France, Germany, Gibraltar, Guernsey, Greece, Guernsey, Hong Kong, Iceland, India, Ireland, Isle of Man, Israel, Italy, Japan, Jersey, Liechtenstein, Luxembourg, Malta, Mexico, Netherlands, New Zealand, Norway, Panama, Portugal, Singapore, Spain, Sweden, Switzerland, The People’s Republic of China, Turkey, United Kingdom, United States {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Below are the KYC documentation the Administrator requires for Enhanced Due Diligence.

If bank is not from an approved jurisdiction, Enhanced Due Diligence requires the documents to all be certified.

Please note: A “certified document” is a copy of an original document that has been signed by a person of standing that can confirm that the document is a ‘true and correct copy’ or that the photograph is a ‘true likeness’ of an individual. The certifier must be a suitable person, e.g. a lawyer, an accountant, a notary public, etc., whereby such persons are expected to (a) adhere to ethical and/or professional standards and to (b) exercise his or her profession or vocation in a jurisdiction that has an effective anti-money laundering regime.

Investor Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

INDIVIDUALS (or each joint with rights of survivorship investor)

A certified copy of a valid passport (or national identity card, driver license, or government-issued identification with photograph) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified proof of current residential address dated within the last 12 months (which must match the address given for subscription) via an original or certified copy of recent bank statement or utility bill (mobile phone bills are not acceptable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

PRIVATE COMPANIES

Certified Copy of Certificate of Incorporation or equivalent {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified Copy of the Memorandum and Articles of Association or equivalent {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified Copy of Register of Directors {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified Copy of Register of Shareholders and ultimate beneficial owners {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified Identification documentation of two directors (or one director and one authorised signatory) (see document requirements for individuals). If the Director/Authorised Signatory is not an individual, identification documentation will be required as per the legal entity type. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified copy of a valid passport (or national identity card, driver's license, or government-issued identification with photograph) for any beneficial owner who own or control more than 10% of the share capital. If the beneficial owner is not an individual, identification documentation will be required as per the legal entity type. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified proof of current residential address dated within the last 12 months via an original or certified copy of recent bank statement or utility bill (mobile phone bills are not acceptable) for any beneficial owner who owns or controls more than 10% of the share capital. If the beneficial owner is not an individual, identification documentation will be required as per the legal entity type. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

PUBLIC BODIES

Name of the home state authority and the nature of its relationship with the public body {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Details of all persons who own or control more than 10% of the capital (name, residential address, and date of birth) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified copy of the most recent Audited Financial Statements {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

For 2 Officials:

{binding Name, mode=oneTime}

{binding Description}

{binding Name, mode=oneTime}

{binding Description}

PENSION SCHEMES

Confirmation of registration from Pensions Board or relevant tax authority, if applicable {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Or Provide All of the Following:

Certified Formation Document (eg, Trust Deed or equivalent); and {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Details of Trustees/Directors/Board Members or the equivalent (name, residential address, and date of birth) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Name and address of the Scheme Administrator. Additional documentation may be required in respect of the Scheme Administrator. This will be advised on receipt of the Scheme Administrator details. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

PRIVATE TRUSTS

Certified Copy of the Trust Deed or equivalent {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Details of all trustees (name, residential address, and date of birth) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified Identification documentation of two trustees (or one trustee and one authorised signatory) (see document requirements for individuals). If the Trustee/Authorised Signatory is not an individual, identification documentation will be required as per the legal entity type. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified Identification documentation in respect of the settler (see document requirements for individuals). If the Settler is not an individual, identification documentation will be required as per the legal entity type. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified Identification documentation for all beneficiaries who own more than 10% of the Trust (see document requirements for individuals). If the beneficiary is not an individual, identification documentation will be required as per the legal entity type. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

PARTNERSHIPS (where the partnership is a fund, documentation should be provided in line with requirements for a fund).

Certified copy of the Certificate of Formation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified copy of the Partnership Agreement or equivalent {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Details of all partners (name, residential address, and date of birth) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified Identification documentation of the General Partner or two partners (or one partner and one authorised signatory). If the General Partner or Partner/Authorised Signatory is not an individual, identification documentation will be required as per the legal entity form. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Certified Identification documentation for all partners who own more than 10% of the partnership capital, profit, or voting rights (see document requirements for individuals). If the Partner is not an individual, identification documentation will be required as per the legal entity type. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

LIMITED LIABILITY COMPANIES

Certified copy of the Certificate of Formation or equivalent {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

TCM (CAYMAN) Subscription Application

US Persons, Citizens and Residents should STOP and complete

this subscription application

Subscription Details

Individual Account Holder

Individual {binding ItemNumber}

Mailing Address

Declaration of Tax Residency (other than U.S.)

Individual Account Holder Identification and Self-Certification

Individual Declaration and Undertakings

Entity Identification and Self-Certification

Current Residence or Registered Address

Contact Details

Contact {binding ItemNumber}

Mailing Address

ERISA Status

US FATCA Classification for Non-US Entities

RFFI category and FATCA GIIN

Sponsored Financial Institution

Sponsoring Entity’s name and GIIN, and Sponsored Entity’s GIIN

Trustee Details

Certified or Registered Deemed Compliant FFI

Non-Participating Foreign Financial Institution (NPFI)

Exempt Beneficial Owner

Active Non-Financial Foreign Entity (NFFE)

Direct Reporting NFFE

Sponsored Direct Reporting NFFE

Passive Non-Financial Foreign Entity

Substantial US Owners

Substantial US Owner {binding ItemNumber}

Controlling Person(s)

Controlling Person {binding ItemNumber}

Common Reporting Standard (CRS)

Declaration of All Tax Residency

CRS Classification

CRS Financial Institution

Financial Institution resident in a Non-Participating Jurisdiction under CRS

List Controlling Person(s)

Controlling Person {binding ItemNumber}

CRS Active Non-Financial Entity (NFE)

Stock Exchange

Other Active Non-Financial Entity

CRS Passive Non-Financial Entity (PNFE): Controlling Person(s)

Controlling Person {binding ItemNumber}

Entity Declaration and Undertakings

Signatories

Signatory {binding ItemNumber}

Controlling Persons

Controlling Person {binding ItemNumber}

Jurisdiction of Residence for Tax Purposes and related Taxpayer Reference Number or functional equivalent (TIN)

Tax jurisdiction {binding ItemNumber}

Relevant Entity(s) you Control

Entity {binding ItemNumber}

Controlling Person Declaration and Undertakings

Due Diligence Documents

Originating Account Information

INDIVIDUALS (or each joint with rights of survivorship investor)

PRIVATE COMPANIES

PUBLIC BODIES

For 2 Officials:

PENSION SCHEMES

Or Provide All of the Following:

PRIVATE TRUSTS

PARTNERSHIPS (where the partnership is a fund, documentation should be provided in line with requirements for a fund).

LIMITED LIABILITY COMPANIES

REGISTERED CHARITIES/FOUNDATIONS

Or Provide All of the Following:

SCHOOLS, COLLEGES OR UNIVERSITIES

FUNDS

Electronic Delivery Form

NFA ByLaw 1101 Certification

TCM (CAYMAN) Subscription Application

US Persons, Citizens and Residents should STOP and complete

this subscription application

Subscription Details

Individual Account Holder

Individual {binding ItemNumber}

Mailing Address

Declaration of Tax Residency (other than U.S.)

Individual Account Holder Identification and Self-Certification