orchard funds public limited company - orchard … … · · 2017-09-18orchard funds public...

of 21 V7.180917

Orchard Funds Public Limited Company

Application Form A & B Share Class

For assistance in completing this form, please contact either:

CACEIS Ireland Limited at +353 1672 1600 or Orchard Wealth Management Limited at +44 1534 616818

IMPORTANT INFORMATION:

1. Completed forms should be sent by fax or via email as a PDF attachment with the original copy to follow by post

immediately thereafter along with all additional documents required in Section 7 of this document. The application must

be received by 12pm (Irish time) on the relevant dealing day.

FAX OR EMAIL THIS COMPLETED FORM TO: THEN DELIVER/MAIL IT TO:

CACEIS Ireland Limited Orchard Funds PLC Attention: Manager, Shareholder Services CACEIS Ireland Limited +353 1790 0461 One Custom House Plaza [email protected] International Financial Services Centre Dublin D01 C2C5 Ireland 2. Failure to provide the documents mentioned in point 1 above may result in:

A delay to the acceptance and/or payment of a redemption request. No redemption, conversion or transfer requests will be processed unless all documentation requested at the time of application for Shares (including anti-money laundering information) has been obtained, all anti-money laundering procedures have been completed, and the original of the Application Form has been received by the Administrator.

Any amendments to an investor’s registration details or payment instructions will only be effected on receipt of original confirmation documentation.

In accordance with the Financial Regulator’s requirement, redemptions will not be processed on non-compliant /non-verified accounts.

3. Payment for shares applied for should be made by electronic transfer to the appropriate bank account listed on Page 3.

4. Cleared subscription monies must be received for value on the same day as the application form. 5. To be valid, Subscription Forms must be signed by each Applicant/Authorised Signatory. In the case of a Corporate body/entity (not a Limited Company), the Subscription Form should be completed in the name(s) of and signed by the Proprietor(s)/Beneficial Owner(s) or other suitably authorised person(s). A Corporation should execute this Subscription Form under Seal or under the hand of a duly Authorised Person who should state his/her capacity and furnish a certified copy of the authority pursuant to which such person is authorised. 6. The Fund prospectus and supplement and KIID's are available free of charge from the Investment Manager, the Distributor and the Administrator or can be downloaded from www.owmfunds.com. 7. Should any information provided in the Application Form change in the future, please ensure you advise us of the changes promptly.

of 21 V7.180917

Section 1 - Investor Details Please confirm in which capacity you are executing this application Individual Joint Corporate Nominee Intermediary Trustee

Other (Please state capacity)

Registration Details First Applicant Title Mr / Mrs / Miss / Ms / Other___________ Date of Birth

Family Name First Name Nationality Occupation Joint Applicants Title Mr / Mrs / Miss / Ms / Other___________ Date of Birth

Family Name First Name Nationality Occupation Company Name / Nominee/ Intermediary / Trustee / Other:

Address Details: Registered Office/Residential Address

No PO Box numbers are permitted for registered address Correspondence Address (If different from above)

Email Address (for investor statements)

Name of Independent Financial Advisor (IFA)

Do you want the IFA to receive copy investor statements: Yes / No, if Yes, please provide an email address below.

d d m m y y y y

d d m m y y y y

of 21 V7.180917

Source of Wealth Please provide a detailed description of the source of wealth that has generated your total net worth including where, geographically, the wealth was generated. In some instances *1, it may be necessary for you to provide documentary evidence regarding your source of wealth. We need this information in order to comply with our regulatory responsibilities. (Please choose accordingly): Own business or employment: (name and nature of business) Inheritance: (from whom) Divestment: (name of investment) Sale of property or business: (name and nature of business) Other: (Please specify) *1 Documentary evidence of the source of wealth must be provided for all individual, joint and trust accounts. In other

instances documentary evidence may be requested at the discretion of the Administrator. Investor Bank Account Details For Subscriptions/Redemptions/Dividends*2

Name of Bank:

Swift/Sort Code:

Beneficiary Account Number:

Beneficiary Name:

Bank Address:

Correspondent Bank:

IBAN:

*2 Subscriptions: Money must come from the account detailed above. Redemption / Distribution Dividend Money will be paid to the account above. No Third Party payments will be made. General Eligibility Representations and Elections

Representation Select one option

Politically Exposed Person Status

(a) The Applicant confirms that the application is not being made by, on behalf of, for

the benefit of, or to be transferred to a Politically Exposed Person ("PEP") /

immediate family member of a PEP / close associate of a PEP/ a beneficial owner

who is a PEP.

Further information on the definition of a PEP in Appendix A.

of 21 V7.180917

Representation Select one option

(b) The Applicant confirms that the application is being made by, on behalf of, for the

benefit of, or to be transferred to a Politically Exposed Person ("PEP") / immediate

family member of a PEP / close associate of a PEP/ a beneficial owner who is a

PEP.

Further information to be completed in Appendix A.

Section 2 - Investment Details Please indicate the share class and the amount to purchase: (Accumulating) Initial Charge (A) Share Class Please insert amount: GBP (Distributing) Initial Charge (B) Share Class Please insert amount: GBP DIVIDEND PAYMENTS - B Share Class only Subject to the discretion of the Directors, dividends (if any) will be declared and paid on a quarterly basis. Payment will be made by telegraphic transfer in the functional currency to the Shareholders Account or if the Shareholder opts for dividend reinvestment by ticking the box below, in which case such payment will be automatically reinvested in the purchase of Shares of the relevant class, for the account of the relevant Shareholder. Dividend payments will be credited to the applicant’s bank account given in Section 1. To avail of the dividend reinvestment option, please tick the box: Subscription monies delivered by an investor to the Fund prior to the relevant Dealing Day are required to be sent by bank transfer to the account details in the Application Form. Provided that all documentation required by the Fund and the Administrator for anti-money laundering and customer identification purposes has been received, subscriptions will be processed and Shares in the Fund issued on the relevant Dealing Day. Subscriptions will not be processed and Shares will not issue until all anti-money laundering documentation has been received [and cleared funds have been received]. Accordingly, subscription monies received prior to the Dealing Day will not be subject to the Investor Money Regulations 2015 or any equivalent client asset protection regime and shall not form part of the assets of the Fund/relevant Sub-Fund until transferred to the Fund/Sub-Fund’s account. Accordingly, Investors should note that prior to transfer to the Fund/Sub-Fund account, Investors may be exposed to the creditworthiness of the relevant credit institution where subscription monies are held and neither the Directors nor the Fund shall have any fiduciary duties to the investor in respect of such monies. In the event of the failure or a delay on the part of the investor in the settlement of subscription proceeds owed to the Fund, the Fund reserves the right to charge the relevant Shareholder for any interest or other costs incurred by the Fund arising from such delay or failure to settle subscription monies on time including any costs associated with temporary borrowing. If the Shareholder fails to reimburse the Fund for those charges, the Fund will have the right to sell all or part of the investor’s holdings of Shares in the Fund in order to meet those charges and/or to pursue that Shareholder for such charges. Further, the Fund reserves the right to reverse any allotment of Shares in the event of a failure by an applicant to settle the subscription monies on a timely basis. In such circumstances, the Fund shall compulsorily redeem any Shares issued and the Shareholder shall be liable for any loss suffered by the Company in the event of any shortfall arising from the redemption proceeds. Any failure to supply the Fund or the Administrator with any documentation requested by them for anti-money laundering or client identification purposes will result in a delay in the settlement of redemption proceeds. In such circumstances, the Administrator will process any redemption request received by a Shareholder. Upon redemption, the Shares of the redeemed Shareholder will be cancelled and the Shareholder will be treated as an unsecured creditor of the Fund. However the proceeds of that redemption shall remain an asset of the Fund and the redeeming investor will rank as an unsecured creditor of the Fund until such time as the Administrator is satisfied that its anti-money-laundering and anti-

of 21 V7.180917

fraud procedures have been fully complied with, following which redemption proceeds will be released. In the event of the insolvency of the Fund before such monies are transferred from the Fund’s account to the redeeming investor, there is no guarantee that the Fund will have sufficient funds to pay its unsecured creditors in full. Investors who are due redemption proceeds which are held in the Fund’s account will rank equally with other unsecured creditors of the relevant Fund and will be entitled to pro-rata share of any monies made available to all unsecured creditors by the insolvency practitioner. Accordingly, Shareholders and investors should ensure that all documentation required by the Fund or administrator to comply with anti-money laundering and anti-fraud procedures are submitted promptly to the Fund/Administrator when subscribing for Shares. Any failure to supply the Fund or the Administrator with any documentation requested by them for anti-money laundering or client identification purposes, as described above, will result in a delay in the settlement of dividend payments. In such circumstances, any sums payable by way of dividend to Shareholders shall remain an asset of the Fund until such time as the Administrator is satisfied that its anti-money-laundering and client identification purposes have been fully complied with, following which such dividend will be paid. In the event of the insolvency of the Fund before such monies are transferred to the Shareholder there is no guarantee that the Fund will have sufficient funds to pay its unsecured creditors in full. Investors who are due dividend proceeds which are held in the Fund’s account will rank equally with other unsecured creditors of the Fund and will be entitled to pro-rata share of any monies made available to all unsecured creditors by the insolvency practitioner. The subscriber hereby confirms that subscription monies delivered by him/her to the Fund prior to the relevant Dealing Day, are not to be held on trust for the subscriber by the Fund. The subscriber accordingly acknowledges that such monies shall not be subject to the Investor Money Regulations 2015 or to any equivalent client asset protection account and that the subscribers may be exposed to the creditworthiness of the relevant credit institution where such subscription monies are held. The subscriber hereby acknowledges and agrees that in such circumstances neither the Fund, the Administrator nor the Depositary shall have any liability or responsibility for any loss of such monies prior to the transfer of such monies to the Fund’s account. The subscriber hereby acknowledges that in accordance with applicable anti money laundering and terrorist financing requirements (the “AML Requirements), redemption monies or dividend payments shall not be paid on un-verified accounts. In the event that the subscriber fails to submit the necessary documentation requested by the Fund or its delegate as required under the AML Requirements, redemption monies or dividend monies will be held in the Fund/relevant Sub-Fund’s account and shall remain an asset of the Fund/ relevant Sub-Fund and the subscriber will not benefit from the application of any investor money protection rules (i.e. the redemption monies/dividend monies will not be held on trust for me/us). In such circumstances, the subscriber acknowledges that it/they will be unsecured creditors of the Fund/relevant Sub-Fund in respect of such redemption monies or dividend payments until such time as the relevant documentation required by the Fund has been received to its satisfaction and the redemption monies/dividend payments have been paid to the subscriber. In the event that Shares are allotted/issued notwithstanding that cleared funds have not been received within the usual time limits by the Fund as set out in the Prospectus, the subscriber acknowledges that the Fund may cancel the allotment/issue of my/our Shares and I/we will be liable to pay to the Fund interest at such rate as may be determined by the Directors from time to time and/or other losses, charges or expenses suffered or incurred by the Fund, the Depositary or their delegates as a result of late payment or non-payment by me/us of subscription monies. Section 3 - General Representations (i) I or we, the undersigned declare that I am or we are over the age of 18, not a US Person as defined in the Prospectus, not an ERISA or Benefit Plan Investor, and that I am or we are not acting on behalf of a US Person(s) nor do I or we intend selling or transferring any Shares which I or we may purchase to any person who is a US Person. (ii) I or we, warrant that I or we have the right and authority to make the investment pursuant to this Application Form whether the investment is my or our own or is made on behalf of another person or entity and that I or we will not be in breach of any laws or regulations of any competent jurisdiction and I or we hereby indemnify the Company, the Administrator and other shareholders for any loss suffered by them as a result of this warranty/representation not being true in every respect. (iii) I or we, agree to provide the representations in this Application Form to the Company on an annual basis at the request of the Administrator or the Company and at such other times as the Administrator or the Company may request and to provide on request such certificates, documents or other evidence as the Company may reasonably require to substantiate such representations.

of 21 V7.180917

(iv) I or we, agree to notify the Company immediately if I or we become aware that any of the representations are no longer accurate and complete in all respects and, if deemed necessary by the Company at its absolute discretion, agree immediately to sell or to tender to the Company for redemption a sufficient number of Shares to allow the representation to be made. (v) I or we, hereby confirm that the Company, the Directors and the Administrator are each authorised and instructed to accept and execute any instructions in respect of the Shares to which this application relates given by me or us by facsimile. If instructions are given by me or us by facsimile, I or we undertake to confirm them in writing. I or we hereby indemnify the Company, the Directors and the Administrator and agree to keep each of them indemnified, against any loss of any nature whatsoever arising to each of them as a result of any of them acting on facsimile instructions. The Company, the Directors and the Administrator may rely conclusively upon and shall incur no liability in respect of any action taken upon any notice, consent, request, instructions or other instrument believed, in good faith, to be genuine or to be signed by properly authorised persons. (vi) I or we, apply to be entered in the Register of the Shareholders as the holder/holders of the Shares issued in relation to this application. (vii) I or we, hereby acknowledge that by signing and submitting this Application Form, I or we will by applying irrevocably for Shares in the Company all subject to the terms of the Prospectus (which I or we have read in full and understood) and the Memorandum and Articles of the Fund. (ix) I or we acknowledge that it is a pre-condition to acceptance of this application that I or we have received the latest available KIID in respect of the Share Class/Sub-Fund in which I am or we are investing in. (x) Prior to making this application I or we have received free of charge and read the latest available KIID in respect of the relevant Share Class and Sub-Fund. (xi) I or we acknowledge that this application is made on the terms of the Prospectus (including the relevant Sub-Fund Supplement), and material contracts referred to therein the relevant KIID together (where applicable) (which I or we have read in full and understood) with the most recent annual report and accounts of the Company and (if issued after such report and accounts) its most recent unaudited half yearly report and subject to the provisions of the Company’s Constitution from time to time in force. (xii) I or we, warrant that (1) I am or we are not, and the Shares applied for will not, be held for the benefit of a US person (as defined in Regulation S under the United States Securities Act of 1933, as amended) and (2) I or we will fall within the category of persons described in Article 11(3) of the United Kingdom Financial Services Act 1986 (Investment Advertisements) (Exemptions) Order 1996 or (3) I am or we are a person who may otherwise lawfully subscribe for Shares in the Fund. (xiii) I or we hereby acknowledge that my or our personal information will be handled by the Administrator (as Data Processor on behalf of the Company) in accordance with the Data Protection Acts 1988 to 2003. I or we hereby acknowledge that my or our information will be processed for the purposes of carrying out the services of Administrator, Registrar and Transfer Agent of the Company, and to comply with legal obligations including legal obligations under company law and anti-money laundering legislation. The Administrator or Company will disclose my or our information to third parties where necessary, or for legitimate business interests. This may include disclosure to third parties such as auditors, the Irish Revenue Authorities pursuant to the EU Savings Directive, the Irish Financial Services Regulatory Authority or agents of the Administrator who process the data for anti-money laundering purposes or for compliance with foreign regulatory requirements. I or we hereby consent to the processing of my or our information, which may include the recording of telephone calls with the Administrator for the purpose of confirming data, and the disclosure of his/her/our information as outlined above and to the Investment Manager and where necessary, or in the Company's or the Administrator's legitimate interests, to any company in the Administrator’s and/or the Investment Manager’s group of companies or agents of the Administrator, including companies situated in countries outside of the European Economic Area, which may not have the same data protection laws as in Ireland. (xiv) I or we acknowledge that it is my or our responsibility to inform the Investment Manager of any changes in any personal information provided to the Investment Manager. I or we undertake that I or we will advise the recipient promptly and provide any additional information as may be required by law and/or 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 incorrect. I or we acknowledge that the Investment Manager may also be required to disclose this information and other personal data to the tax authority(ies) of which I am or we are tax resident or the Irish Revenue Commissioners, and otherwise co-operate with formal requests from such tax authority(ies).

of 21 V7.180917

Please do/do not send me any further information on other products and services. [* delete as appropriate.] Section 4 - EU Savings Directive Requirements NATURAL PERSONS

I or we hereby declare that I am or we are making this investment on my or our own behalf and not on behalf of any other person or entity.

I or we acknowledge that I or we will provide a certified copy of our Passport(s) or a national identity card(s) which must display a photograph and give details of my or our date and place of birth. I or we will also provide details of my or our tax identification number(s) if this does not appear on the Passport(s) or other identity card(s) provided. Documentary proof such as a certificate of tax residency from a relevant tax authority may also be required. These items are in addition to providing proof of my or our permanent resident residential address which may be in the form of two address verification documents which are no more than 6 months old.

I or we agree to undertake to ensure all such information is up to date and will notify the Administrator of any change in the information provided as soon as reasonably possible.

I or we agree to indemnify and hold harmless the Administrator in its capacity as "Paying Agent" against any loss liability costs or expenses, which may be incurred by the Administrator as a result of my or our failure to provide the information required. I or we acknowledge that Shares may not be issued and repurchase proceeds may be frozen until all required information and documentation required by the Administrator pursuant to the EU Savings Directive is provided.

LEGAL PERSONS We hereby declare that we are:-

a legal person not being an individual and not acting in a representative capacity on behalf of an individual; or

an entity liable to corporation tax in Ireland or an equivalent tax in another country; or

an undertaking for collective investment in transferable securities ("UCITS") or have elected for the purpose of the EU Savings Directive to be treated as a UCITS.

If the Legal Person is unable to make any of these declarations please contact the Administrator Section 5 - CERTIFICATION OF NON-US OR US STATUS (for purposes of the Foreign Account Tax Compliance Act (“FATCA”)) Certification of non-US status Please send to the Administrator together with your Application Form either: (i) the appropriate US Internal Revenue Service (“IRS”) W-8 tax form; or (ii) a self-certification form (only for individuals)(which will be issued to you together with this Application Form by the Administrator), completed and signed as required. Please see the links set out below to the IRS website for the various W-8 tax forms and instructions for their completion: • Form W-8BEN - Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting

(Individuals): http://www.irs.gov/pub/irs-pdf/fw8ben.pdf • Form W-8BEN-E - Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting

(Entities): http://www.irs.gov/pub/irs-pdf/fw8bene.pdf • Form W-8IMY - Certificate of Foreign Intermediary, Foreign Flow-Through Entity, or Certain U.S. Branches for

United States Tax Withholding and Reporting: http://www.irs.gov/pub/irs-pdf/fw8imy.pdf • Form W-8ECI - Certificate of Foreign Person's Claim That Income Is Effectively Connected With the Conduct of a

Trade or Business in the United States: http://www.irs.gov/pub/irs-pdf/fw8eci.pdf • Form W-8EXP - Certificate of Foreign Government or Other Foreign Organization for United States Tax Withholding

and Reporting: http://www.irs.gov/pub/irs-pdf/fw8exp.pdf You hereby acknowledge that neither the Company, the Investment Manager nor the Administrator are tax advisors and that they are unable to advise on the completion of the foregoing IRS W-8 forms.

of 21 V7.180917

Section 6 - Anti-Money Laundering Declarations

1. I or we acknowledge that measures aimed at the prevention of money laundering will require verification of my or our identity, address and source of funds/wealth. I or we acknowledge that Shares will not be issued until such time as the Administrator has received and is satisfied with all the information and documentation requested to verify my or our identity and source of funds/wealth. I or we acknowledge that the Administrator shall be held harmless against any loss arising as a result of a failure to process my or our application for Shares if such information and documentation as has been requested by the Administrator has not been provided by me or us.

2. I or we acknowledge that the Fund or the Administrator also reserves the right to refuse to make any redemption

payment or distribution to a Shareholder, (otherwise than to the account in the name of the Shareholders from a recognised financial institution from which the corresponding subscription funds were paid) if any of the Directors of the Fund or the Administrator suspects, or is advised, that the payment of any redemption or distribution monies to such Shareholder might result in a breach or violation of any applicable anti-money laundering, or other laws or regulations, by any person in any relevant jurisdiction, or such refusal is considered necessary or appropriate to ensure the compliance by the Fund, its Directors or the Administrator with any such laws or regulations in any relevant jurisdiction.

3. I or we understand and agree that the Fund prohibits the investment of funds by any persons or entities that are

acting, directly or indirectly, (i) in contravention of any applicable laws and regulations, including anti-money laundering regulations or conventions, (ii) on behalf of terrorists or terrorist organisations, including those persons or entities that are included on the List of Specially Designated Nationals and Blocked Persons maintained by the U.S. Treasury Department's Office of Foreign Assets Control ("OFAC"), as such list may be amended from time to time, (iii) for a senior foreign political figure, any member of a senior foreign political figure's immediate family or any close associate of a senior foreign political figure, unless the Fund, after being specifically notified by me or us in writing that I am or we are such a person, conducts further due diligence, and determines that such investment shall be permitted, or (iv) for a foreign shell bank (such persons or entities in (i) - (iv) are collectively referred to as "Prohibited Persons").

4. I or we represent, warrant and covenant that: (i) I am or we are not, nor is any person or entity controlling,

controlled by or under common control with me or us, a Prohibited Person, and (ii) to the extent I or we have any beneficial owners, (a) I or we have carried out thorough due diligence to establish the identities of such beneficial owners, (b) based on such due diligence, I or we reasonably believe that no such beneficial owners are Prohibited Persons, (c) I or we hold the evidence of such identities and status and will maintain all such evidence for at least five years from the date of my or our complete redemption from the Fund, and (d) I or we will make available such information and any additional information that the Fund may require upon request.

5. If any of the foregoing representations, warranties or covenants ceases to be true or if the Fund no longer

reasonably believes that it has satisfactory evidence as to their truth, notwithstanding any other agreement to the contrary, the Fund may be obligated to freeze my or our investment, either by prohibiting additional investments, declining or suspending any redemption requests and/or segregating the assets constituting the investment in accordance with applicable regulations, or my or our investment may immediately be redeemed by the Fund, and the Fund may also be required to report such action and to disclose my or our identity to OFAC or other authority. In the event that the Fund is required to take any of the foregoing actions, I or we understand and agree that I or we shall have no claim against the Fund, the Investment Manager, the Administrator, and their respective affiliates, directors, members, partners, shareholders, officers, employees and agents for any form of damages as a result of any of the aforementioned actions.

6. I or we understand and agree that any redemption proceeds paid to me or us will be paid to the same account

from which my or our investment in the Fund was originally remitted, provided always the account is in my or our name and with a recognised financial institution.

7. I or we agree to indemnify and hold harmless the Fund, the Investment Manager, the Administrator, and their

respective affiliates, directors, members, partners, shareholders, officers, employees and agents from and against any and all losses, liabilities, damages, penalties, costs, fees and expenses (including legal fees and disbursements) which may result, directly or indirectly, from any inaccuracy in or breach of any representation, warranty, covenant or agreement set forth in this section.

8. (Designated Bodies*1 only) I or we declare that I am or we are licensed as.......................................................

(description) by the............................................................................................. (regulatory body) under the laws of ........................................................... (country) and am or are thereby subject to regulations and/or guidelines which to the best of my or our knowledge and understanding are in accordance with the Financial Action Task

of 21 V7.180917

Force Recommendations (“FATF”) on the prevention of money-laundering. I or we attach independent verification of our licensed status. This application is made in my or our name on behalf of my or our clients whose identity has been properly verified by me or us in accordance with the guidelines. Evidence of such verification will be retained for such period as is required by the country or our domicile and will be promptly supplied to the Administrator or the Fund upon request. I or we are not aware of any legal impediment to our providing any such requested verification documentation. I or we confirm I or we will provide the Administrator with a letter of assurance in connection with these matters in a form acceptable to the Administrator.

*1 A Designated Body is an individual or other entity which is regulated in respect of the provision of banking or investment services in a country which is a member of the European Union or the Financial Action Task Force.

9. (Individuals only) I or we declare that I am or we are a private investor(s) who is/are making this application on my or our own behalf and not in any way as representative(s) of any other party.

Section 7 - Declaration of residence outside Ireland (non-resident composite declaration) Applicants resident outside Ireland are required by the Irish Revenue Commissioners to make the following declaration which is in a format authorised by them, in order to receive payment without deduction of tax. It is important to note that this declaration, if it is then still correct, shall apply in respect of any subsequent acquisitions of shares/units. Terms used in this declaration are defined in the Prospectus.

Declaration on own behalf I or we declare that I am or we are applying for the shares/units on my own or our own behalf and that I am or we are entitled to the shares/units in respect of which this declaration is made and that: I am or we are or the company is not currently resident or ordinarily resident in Ireland, and should I or we or the company become resident in Ireland I or we will so inform you, in writing, accordingly.

Declaration as Intermediary I or we declare that I am or we are applying for shares on behalf of persons: who will be beneficially entitled to the shares, and who to the best of my or our knowledge and belief, are neither resident or ordinarily resident in Ireland, and I or we also declare that

unless I or we specifically notify you to the contrary at the time of application, all applications for Shares made by me or us from the date of this application will be made on behalf of such persons; and I or we will inform you in writing if I or we become aware that any person, on whose behalf I or we hold shares/units, becomes resident in Ireland.

of 21 V7.180917

Signature(s) (All applicants must sign) All applicants MUST sign below for this Application Form to be valid. Thereafter, the Fund will only accept any instructions in respect of your Shares (including, without limitation, in respect of redemption instructions) given by all of you. Applicant Name(s): __________________________________ __________________________________ Capacity of Authorised Signatory(s): __________________________________ __________________________________ (if Applicable) Signature of Applicant or Authorised Signatory(s):__________________________________ __________________________________ Date: __________________________________ _________________________________ IMPORTANT INFORMATION WHICH MUST BE READ 1. Non-resident declarations are subject to inspection by the Irish Revenue Commissioners and it is a criminal offence to make a false declaration. 2. To be valid, the application form (incorporating the declaration required by the Irish Revenue Commissioners) must be signed by the applicant. Where there is more than one applicant, each applicant must sign. In the case of a company, the declaration must be signed by the company secretary or other authorised officer. 3. If the application form (incorporating the declaration required by the Irish Revenue Commissioners) is signed under Power of Attorney, a duly certified copy of the Power of Attorney should be furnished in support of the signature detailing the scope and powers of such Power of Attorney. 4. If you are resident or ordinarily resident in Ireland or are an exempt resident as defined in the prospectus or are an Irish resident company within the charge to corporation tax, please contact the Administrator immediately.

of 21 V7.180917

Section 8 - Documents to be provided Individual/Joint Applicants, please supply the following:

a) Certified* copy of your passport, drivers licence or national identity card. The documents must be within expiry date and show the photograph, full name, date of birth and signature; and

b) TWO forms of address verification: Acceptable address verification documents are the original or certified* copies of any two of the following; electricity bill, gas bill, water bill, telephone bill, cable television bill, bank statement or credit card statement, social insurance documents, household/ motor insurance certificates, statement for Tax/Revenue. Documents must originate from a different source, show the full name and residential address of the individual and must be dated within six months of submission. Please note that mobile phone bills are not admissible.

c) Certified* copy of source of wealth documentation**: i.e. Own business or employment: audited financial statements for the business or bank account statements for the employment, Salary: payslips, Savings: bank account statements, Divestment: proof of sale of the investment, Inheritance: probate and will, Sale of property or business: sale agreement of the property/business.

Corporate applicants We hereby declare that the corporation was duly registered on................................................................. (date) under the laws of......................................................................... (country) and that it is not a financial intermediary. Please supply the following:

a) Certified* copy of Certificate of Incorporation (or equivalent); b) Certified* copy of Certificate of Good Standing (or equivalent); c) Certified* copy of Memorandum and Articles of Association (or equivalent document showing registered

corporate office); and d) Certified* copy of the corporation or entity’s list of authorised signatories. e) List of all directors’ names, occupations, residential and business addresses and dates of birth. f) Copy of latest Audited Financial Report and Accounts.

g) Identification as per individual investor (see above) for two directors and all persons authorised to operate on the account. If the corporation is not listed on a recognised exchange or FATF domiciled, identification of two directors and two authorised signatories is required.

h) List of names, addresses, dates of birth and occupations of Shareholders holding 25% or more of the share capital.

Institutional applicants (e.g. pension fund, local authority, or charity), please supply the following:

a) Certified* authorised signatory list and properly authorised mandate of persons completing the form to act on behalf of the applicant.

b) Documentary evidence of the regulatory status of the applicant, please contact the administrator for further details.

(Partnership or Trust applicants), please supply the following:

a) List of names, date of birth, occupation and permanent addresses of all partners/trustees/beneficiaries where ascertainable/settlors.

b) Certified* copies of the above partners’/trustee’s/beneficiaries’ where ascertainable/settlors identification as per for an individual and for a company.

c) Evidence of the above partners’/trustee’s authority to make investments in the Fund on behalf of the partnership/trust and an appropriate certified* authorised signatory list.

d) Certified* copy of partnership agreement/trust deed. e) Letter from the Trustees stating that they know the identity of each unit holder and have conducted due diligence

on these individuals in accordance with E.C. Money Laundering Rules and that there are no anonymous Principals. f) Certified* copy of source of wealth documentation**: i.e. Own business or employment: audited financial

statements for the business or bank account statements for the employment, Salary: payslips, Savings: bank account statements, Divestment: proof of sale of the investment, Inheritance: probate and will, Sale of property or business: sale agreement of the property/business.

of 21 V7.180917

* All certified copies should be certified by a notary public; a commissioner for oaths; a police officer; an embassy/consular official; a chartered or certified public accountant; a practising solicitor; or a designated body in a prescribed country. Copies must be marked “true copy of original document” and stamped and dated by the certifying party. ** Source of Wealth Documentation - the Administrator should be contacted as per the contact details provided on page 1 to establish what documentation is required. Note: The Administrator may request from the Applicant such additional information to enable the Administrator to determine the Applicant’s compliance with applicable regulatory requirements or the Applicant’s anti-money laundering verification status and the Applicant shall provide to the Administrator from time to time such information as may reasonably be requested. Each person acquiring Shares in the Fund must satisfy the foregoing both at the time of subscription and at all times thereafter until such person ceases to be a Shareholder. Accordingly, the Applicant agrees to notify the Administrator promptly if there is any change with respect to any of the foregoing information, declarations or representations and to provide the Administrator with such further information as the Administrator may reasonably require. Section 9 - Payment details

Payment by telegraphic transfer. The Directors reserve the right to defer acceptance of such applications until monies are cleared. Funds should be paid in MT103 format with the following details - GBP (Pound Sterling) Correspondent Bank: HSBC Bank Plc Correspondent Bank Swift Code: MIDLGB22 Sort Code: 40-05-15 Beneficiary Bank: CACEIS Bank Luxembourg - Dublin Branch IBAN: GB56MIDL40051576888255 Bank Account number: 768888255 Beneficiary Name: CAILDB/Orchard Funds plc a/c Beneficiary Swift Code: ISAEIE2D Reference: Orchard Funds PLC - (Investor Name(s)) The remitter should instruct the remitting bank to send a SWIFT advice (format MT 103) to CACEIS Bank Luxembourg – Dublin Branch (SWIFT Address: MIDLGB22) advising details of remittance, including the name of applicant(s), for ease of identification. Any bank charges in respect of telegraphic transfers or otherwise will be deducted from the amount or value of subscriptions and the net amount invested in Shares, unless otherwise requested by the remitting bank. Section 10 – Data Protection – Customer Information Notice The Common Reporting Standard (CRS), formally referred to as the Standard for Automatic Exchange of Financial Account Information, is an information standard for the automatic exchange of Information (AEOI), developed in the context of the Organisation for Economic Co-Operation and Development (OECD). The standard requires that Financial Institutions in participating jurisdictions gather certain information from account holders (and, in particular situations, also collect information in relation to relevant Controlling Persons of such account holders). Under CRS account holder information (and, in particular situations, information in relation to relevant Controlling Persons of such account holders) is to be reported to the relevant tax authority where the account is held, which, if a different country to that in which the account holder resides, will be shared with the relevant tax authority of the account holder’s resident country, if that is a CRS-participating country. Information that may be reported includes name, address, date of birth, place of birth, account balance, any payments including redemption and dividend/interest payments, Tax Residency(ices) and TIN(s). Further information is available on the OECD website: http://oecd.org/tax/automatic-exchange/ and on the Irish Revenue website – http://www.revenue.ie.en.business/aeoi/.

http://oecd/tax/automatic-exchange/

http://www.revenue.ie.en.business/aeoi/

of 21 V7.180917

Appendix A

POLITICALLY EXPOSED PERSONS

TO BE READ BY ALL INVESTORS AND COMPLETED IF THE INVESTOR INITIALLED BOX 2(B) OF THE GENERAL

ELIGIBILITY SECTION ON PAGE 4

The following information provides the definition of a Politically Exposed Person.

Investors should complete section A where the PEP rules apply with reference to the following definitions.

Politically-Exposed Person ("PEP") is an individual who has at any time in the preceding 12 months been, entrusted with a

prominent public function. This includes the following individuals (but excluding any middle ranking or more junior official):

a. a "specified official"; b. a member of the administrative, management or supervisory body of a state-owned enterprise;

A "specified official" is (including any such officials in an institution of the European Communities or an international body):

a. a head of state, head of government, government minister or deputy or assistant government minister;

b. a member of a parliament; c. a member of a supreme court, constitutional court or other high level judicial body whose

decisions, other than in exceptional circumstances, are not subject to further appeal; d. a member of a court of auditors or of the board of a central bank; e. an ambassador, chargé d'affairs or high-ranking officer in the armed forces.

An immediate family member of a PEP includes any of the following persons:

a. any spouse of the PEP; b. any person who is considered to be equivalent to a spouse of the PEP under the national or other

law of the place where the person or PEP resides; c. any child of the PEP; d. any spouse of a child of the PEP; e. any person considered to be equivalent to a spouse of a child of the PEP under the national or

other law of the place where the person or child resides; f. any parent of the PEP; g. any other family member of the PEP who is of a class prescribed by the Minister for Justice under

section 37(11) of the Act.

A close associate of a PEP includes any of the following persons

a. any individual who has joint beneficial ownership of a legal entity or legal arrangement, or any other close business relations, with the PEP;

b. any individual who has sole beneficial ownership of a legal entity or legal arrangement set up for the actual benefit of the PEP.

As an example, a "beneficial owner" of a body corporate is any individual who (other than a company having securities listed on

a regulated market):

a. ultimately owns or controls, whether through direct or indirect ownership or control (including through bearer shareholdings), more than 25 per cent of the shares or voting rights of the body; or

b. otherwise exercises control over the management of the body.

SECTION A: TO BE COMPLETED ONLY IF THE PEP RULES APPLY WITH REFERENCE TO THE ABOVE DEFINITIONS

the application is being made by a PEP / immediate family member of a PEP / close associate of a PEP

OR

the applicant has a beneficial owner who is a PEP / immediate family member of a PEP / close associate of a PEP

OR

the application is being made for the benefit of a PEP / immediate family member of a PEP / close associate of a PEP

OR

of 21 V7.180917

it is intended to transfer the shares to a PEP / immediate family member of a PEP / close associate of a PEP.

Name of PEP Address of PEP

Office of PEP

Relationship of Applicant or

Applicant’s Beneficial Owner to PEP

Source of wealth of the Applicant (e.g. income from employment, Income from company business, inheritance, etc.)

Source of actual funds being invested (e.g. savings, employment income, sale of assets etc.)

of 21 V7.180917

Appendix B

GBP Bank Instruction Letter – use this letter to subscribe for GBP Class Shares Please fill in the blanks

Date: To the Manager: Dear Sirs Bank Transfer Request Please treat this instruction as authority to make the following GBP transfer, gross of any transfer fees from my/our account:

Amount GBP ______________________________________

IMPORTANT NOTICE: The account details of both HSBC Bank and CACEIS Bank Luxembourg – Dublin Branch must be included in the instruction or monies will be returned

To credit

Correspondent Bank: HSBC Bank PLC

Correspondent Bank Swift Code: MIDLGB22

Sort Code: 40-05-15

Beneficiary Bank: CACEIS Bank Luxembourg – Dublin Branch

IBAN: GB56MIDL40051576888255

Beneficiary Bank Account number: 76888255

Beneficiary Swift Code: ISAEIE2D

Beneficiary Name: CAILDB/Orchard Funds plc a/c

Reference: Orchard Fund – [ Insert Investor Name(s) ]

Reference: (insert Remitting Bank Details) Yours faithfully ____________________________________ _____________________________________ First Signatory Second Signatory (if applicable)

Sort code:

Account Number:

Account Name:

of 21 V7.180917

Entity Information for FATCA and CRS

Instructions for completion

We are obliged under Section 891E and Section 891F of the Taxes Consolidation Act 1997 (as amended) and regulations made pursuant to that section to collect certain information about each investor’s tax arrangements. Please complete the sections below as directed and provide any additional information that is requested. Please note that in certain circumstances we may be obliged to share this information with relevant tax authorities.

If you have any questions about this form or defining your tax residency status, please speak to your tax adviser or local tax authority.

For further information on FATCA please refer to the Irish Revenue website at http://www.revenue.ie or at http://www.revenue.ie/en/business/international/agreement-ireland-usa-compliance-fatca.pdf .

For further information on CRS please refer to the OECD automatic exchange of information portal

If any of the information below about the Investor’s tax residence or FATCA/CRS classification changes in the future, please ensure that we are advised of these changes promptly.

(Mandatory fields are marked with an *)

Investors that are individuals should not complete this form and should complete the form entitled “Individual Self-Certification”.

Section 1: Investor Identification

Investor Name*: _________________________________________________________________ (the "Entity”)

Country of Incorporation or Organisation: _________________________________________________

Fund Name: __________________________________________________

Registered Address*:

Number: ___________ Street: _________________________________________________________________

City, town, State, Province or County: _________________________________________________________________

Postal/ZIPCode: __________________ Country: ___________________________________________

Mailing address (if different from above):

Number: ___________ Street: _________________________________________________________________

City, town, State, Province or County: _________________________________________________________________

Postal/ZIP Code: __________________ Country: ___________________________________________

Section 2: FATCA Declaration Specified U.S. Person: Please tick either (a) or (b) below and complete as appropriate. a) The Entity is a Specified U.S. Person and the Entity’s U.S. Federal Taxpayer Identifying number (U.S. TIN) is as follows:

U.S. TIN: _________________________________________________ b) The Entity is not a Specified U.S. Person (please also complete Sections 3, 4 and 5)

http://www.revenue.ie/

http://www.revenue.ie/en/business/international/agreement-ireland-usa-compliance-fatca.pdf

of 21 V7.180917

Section 3: Entity’s FATCA Classification* (the information provided in this section is for FATCA, please

note your classification may differ from your CRS classification in Section 5):

3.1 Financial Institutions under FATCA : If the Entity is a Financial Institution, please tick one of the below categories and provide the Entity’s GIIN at 3.2

3.2 Please provide the Entity’s Global Intermediary Identification number (GIIN) _____________________________

3.3 If the Entity is a Financial Institution but unable to provide a GIIN, please tick one of the below reasons:

3.2 Non-Financial Institutions under FATCA: If the Entity is not a Financial Institution, please tick one of the below categories

Section 4: CRS Declaration of Tax Residency*

Please indicate the Entity’s place of tax residence for CRS purposes, (if resident in more than one country please detail all countries of tax residence and associated tax identification numbers).

I. Irish Financial Institution or a Partner Jurisdiction Financial Institution

II. Registered Deemed Compliant Foreign Financial Institution

III. Participating Foreign Financial Institution

I. Partner Jurisdiction Financial Institution and has not yet obtained a GIIN

II. The Entity has not yet obtained a GIIN but is sponsored by another entity which does have

a GIIN

Please provide the sponsor’s name and sponsor’s GIIN :

Sponsor’s Name:________________________ Sponsor’s GIIN:___________________

III. Exempt Beneficial Owner

IV. Certified Deemed Compliant Foreign Financial Institution (including a deemed compliant

Financial Institution under Annex II of the Agreement)

V. Non-Participating Foreign Financial Institution

VI. Excepted Foreign Financial Institution

VII. U.S. person but not a Specified U.S. person

a. Active Non-Financial Foreign Entity

b.

Passive Non-Financial Foreign Entity

(If this box is ticked, please include individual self-certification forms for each of your Controlling

Persons)

c. Excepted Non-Financial Foreign Entity

d. The Entity is a U.S. person but not a Specified U.S. person

Country of Tax Residency Tax ID Number

of 21 V7.180917

Section 5: Entity’s CRS Classification*(the information provided in this section is for CRS, please note your

CRS classification may differ from your FATCA classification in Section 3):

NB: Please note that each Controlling Persons must complete an individual self-certification form

Section 6: Declarations and Undertakings

I/We declare (as an authorised 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 where any change in circumstance occurs which causes any of the information contained in this form to be incorrect.

Authorised Signature(s)*:

_____________________________________ _____`__________________________________

Print Name(s)*:

_____________________________________ _______________________________________

Capacity in which declaration is made*:

_____________________________________ _______________________________________

Date: (dd/mm/yyyy):* _______________________________

a. Financial Institution under CRS

b.

An Investment Entity located in a Non-Participating Jurisdiction and managed by another

Financial Institution (If this box is ticked, please include individual self-certification forms for

each of your Controlling Persons)

c. Active Non-Financial Entity – a corporation the stock of which is regularly traded on an

established securities market or a corporation which is a related entity of such a corporation

d. Active Non-Financial Entity – a Government Entity or Central Bank

e. Active Non-Financial Entity – an International Organisation

f. Active Non-Financial Entity – other than (c)-(e) (for example a start-up NFE or a non-profit

NFE)

g. Passive Non-Financial Entity (If this box is ticked, please include individual self-certification

forms for each of your Controlling Persons)

of 21 V7.180917

Individual Information for FATCA and CRS

Instructions for completion

We are obliged under Section 891E and Section 891F of the Taxes Consolidation Act 1997 (as amended) and regulations made pursuant to that section to collect certain information about each investor’s tax arrangements. Please complete the sections below as directed and provide any additional information that is requested. Please note that in certain circumstances we may be obliged to share this information with relevant tax authorities.

If you have any questions about this form or defining your tax residency status, please speak to your tax adviser or local tax authority.

For further information on FATCA please refer to Irish Revenue website at http://www.revenue.ie or at http://www.revenue.ie/en/business/international/agreement-ireland-usa-compliance-fatca.pdf

For further information on CRS please refer to the OECD automatic exchange of information portal. If any of the information below about the Investor’s tax residence or FATCA/CRS classification changes in the future, please ensure that we are advised of these changes promptly.

Please note that where there are joint account holders each investor is required to complete a separate Self-Certification form.

(Mandatory fields are marked with an *)

Section 1: Investor Identification

Investor Name*: _____________________________________

Fund Name: _____________________________________

Residential Address*:

Number: ___________ Street: __________________________________________________________________

City, Town, State, Province or County: __________________________________________________________________


Mailing address (if different from above):

Number: ___________ Street: __________________________________________________________________

City, Town, State, Province or County: __________________________________________________________________


Place Of Birth*

Town or City of Birth*: ________________________ Country of Birth*: ________________________

Date of Birth*: __________________

Section 2: FATCA Declaration of U.S. Citizenship or U.S. Residence for Tax purposes*:

Please tick either (a) or (b) and complete as appropriate.

(a) I confirm that I am a U.S. citizen and/or resident in the U.S. for tax purposes and my U.S. federal taxpayer identifying number

(U.S. TIN) is as follows: ______________________________________________

OR

(b) I confirm that I am not a U.S. citizen or resident in the U.S. for tax purposes.

http://www.revenue.ie/

http://www.revenue.ie/en/business/international/agreement-ireland-usa-compliance-fatca.pdf

of 21 V7.180917

Section 3: CRS Declaration Declaration of Tax Residency (please note you may chose more than one

country)*

Please indicate your country of tax residence (if resident in more than one country please detail all countries of tax residence and associated tax identification numbers).

Section 4 – Type of Controlling Person(to be completed by any individual who is a controlling person of an entity)

For Joint or multiple Controlling person’s please use a separate form for each Controlling person.

Please provide the Controlling Person’s Status by ticking the appropriate

box.

Entity Name

a. Controlling Person of a legal person – control by ownership

b. Controlling Person of a legal person – control by other means

c. Controlling Person of a legal person – senior managing official

d. Controlling Person of a trust - settlor

e. Controlling Person of a trust – trustee

f. Controlling Person of a trust – protector

g. Controlling Person of a trust – beneficiary

h. Controlling Person of a trust – other

i. Controlling Person of a legal arrangement (non-trust) – settlor-

equivalent

j. Controlling Person of a legal arrangement (non-trust) – trustee-

equivalent

k. Controlling Person of a legal arrangement (non-trust) – protector-

equivalent

l. Controlling Person of a legal arrangement (non-trust) – beneficiary-

equivalent

m. Controlling Person of a legal arrangement (non-trust) – other-

equivalent

Country of Tax Residency Tax ID Number

of 21 V7.180917

Section 5: 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 where any change in circumstances occurs which causes any of the information contained in this form to be incorrect.

Authorised Signature*: ________________________________________

Print Name*: ________________________________________

Date: (dd/mm/yyyy)*: ________________________________________

Capacity*: ________________________________________