F&C Portfolios Fund
Application Form
Part 1
New shareholder/s information
Individual shareholders (please add similar detail on a separate sheet for
additional holders if required)
Entity shareholders (please add similar detail on a separate sheet for
additional holders if required)
Title (Mr/Mrs/Miss/Other)
Registered name:
Surname
Designation (if applicable):
First name(s)
Address:
Residential address (including postcode)
All shareholder communications will be sent to this address.
Please note that “PO Box” and “Care of” will not be accepted.
Telephone
Fax
email
Postcode
Country
Telephone
Fax
email
Minor Yes (less 18 years old) Date of birth
Country of birth
No
Source of wealth:
InheritanceSalary
Town of birth
Savings
Nationality
Other
Occupation
(if retired, please state former occupation)
Part 2
Choose your investment
Please choose the sub-fund/s and state the subscription amount or the number of shares you wish to invest. For further information including fees please
see the Prospectus. For further information please contact your sales contact.
F&C Portfolios Fund sub-fundISIN
Investing on behalf of Self Share
class
Base
currency
Subscription amount
(please include currency)
No. of shares
Third Party
Please note If the currency of investment is different from the currency denomination of the relevant sub-fund, the necessary currency conversion will be
arranged on behalf of, and at the risk and expense of, the shareholder.
Page 1
Part 2
Choose your investment (continued)
EU Savings Directive
Subscription requests on some sub-funds by EU citizens are subject to taxation on any distribution derived from accumulated interest payments. Refer to the
latest Prospectus for more details. Shareholders have two options, please choose one by ticking the appropriate box:
Withholding tax:
Luxembourg withholding tax will be deducted from any dividends or redemptions paid to me/us in accordance with the Luxembourg Law on Savings
Income. My/our name/s, address and taxation details will not be reported to the tax authorities.
Exchange of information:
I/we hereby authorise State Street Bank Luxembourg S.A (SSB), as Paying Agent, to report information on the amount of my/our reportable
transactions to the tax authorities of my/our country of residence, including my/our name, address, tax identification number or date and place of birth,
account number and the total amount of dividends and redemptions paid to me/us from relevant sub-funds.
First shareholder
Tax identification no.Tax residence country
Second shareholder or guardian (if applicable)
Tax identification no.Tax residence country
Bank details for subscriptions for all sub funds except F&C Responsible Sharia Global Equity
Payment can be made in EUR, GBP and USD however, if the currency of investment is different from the currency denomination of the relevant sub-fund the
necessary currency conversion will be arranged on behalf of, and at the risk and expense of the shareholder.
If the currency of payment is not specified, it will be assumed that payment will be made in the currency in which the sub-fund is denominated.
EUR bank details Bank Bank of America N.A GBP bank details USD bank details
Bank of America N.A Bank of America N.A
BIC/SWIFT CODE BOFADEFX BOFAGB22 BOFAUS3N
(ABA026009593)
IBAN DE70 5001 0900 0019 5370 17 GB44 BOFA 1650 5052 8630 18 -
Account Name F&C PORTFOLIO F&C PORTFOLIO F&C PORTFOLIO
Account Number 19537017 52863018 6550068033
BACS -
301635 -
CHAPS -
165050 -
Bank details for subscriptions into the F&C Responsible Sharia Global Equity sub fund
For subscriptions into the F&C Responsible Sharia Global Equity sub fund please use the following bank details.
EUR bank details Bank Bank of America N.A GBP bank details USD bank details
Bank of America N.A Bank of America N.A
BIC/SWIFT CODE BOFADEFX BOFAGB22 BOFAUS3N
(ABA026009593)
IBAN DE90 5001 0900 0019 5380 15 GB64 BOFA 1650 5052 8640 16 -
Account Name F & C PORTFOLIO FUND- F&C SHARIA SUST OPPRT F & C PORTFOLIO FUND- F&C SHARIA SUST OPPRT F & C PORTFOLIO FUND
F&C SHARIA SUST OPPRT
Account Number 19538015 52864016 6550868034
BACS -
301635 -
CHAPS -
165050 -
Page 2
Part 3
Reporting
When transferring funds please add the name of the relevant sub-fund and deal reference (if available) to which the telegraphic transfer refers.
Please choose which currency you wish to receive statements, contract notes and redemption notices.
Reporting currency EUR
GBP
USD
Reporting by fax Yes No
Fax number including country code
Reporting by post Yes No
Part 4
Payment instruction
Please note that payments from/to third party bank accounts are not accepted (except if the shareholder is a minor – in this case, the payment will be sent to
the guardian). All payments should go from/to a bank account in the name of the shareholder.
Bank details subscription will be transferred from
Bank name
Postcode
CityCountry
BIC / SWIFT code
And/or National Bank Code
(eg. BLZ, sort code...)
Account number (IBAN)
Account holder name
Account currency *
* If the currency of investment is different from the currency denomination of the relevant sub-fund, the necessary currency conversion will be arranged on
behalf of, and at the risk and expense of, the shareholder.
Dividend payment instructions (if this section is not completed dividends will be automatically reinvested)
In case of dividends, payment should be either (please tick appropriate box):
Paid to the investors bank account as detailed belowReinvested
Bank account details to be used for redemption proceeds / dividend payment if different from above
Bank name
Postcode
CityCountry
BIC / SWIFT code
And/or National Bank Code
(eg. BLZ, sort code...)
Account number (IBAN)
Account holder name
Account currency *
* If the currency of investment is different from the currency denomination of the relevant sub-fund, the necessary currency conversion will be arranged on
behalf of, and at the risk and expense of, the shareholder.
Page 3
Part 5
Intermediary information (if applicable to be completed by the Intermediary)
An Intermediary is an entity who intercedes between SSB and the underlying beneficiary. Depending on the contractual agreement in place, the Intermediary
may be the registered shareholder or the underlying beneficiary may be the registered shareholder with the Intermediary acting on their behalf.
General information on Intermediary
Intermediary name
Intermediary registered office address
Postcode
CityCountry
Tel.
Fax
Contact person
email
Regulation
Is the Intermediary regulated?
Yes No
If “Yes” Name of the regulatory body
Registration number
Regulator web site address of the page showing the name of the Intermediary
Please choose the frequency of regular statements for your client’s investment to be sent to you
Monthly
Quarterly
None
Please choose method for receiving statements:
Contact name / department reporting to be sent to:
Reporting by fax Yes No Fax number including country code
Reporting by post Yes No Intermediary stamp
Page 4
Part 6
Individual Self-Certification for FATCA and CRS
Instructions for completion
We are obliged under local laws and regulations to collect and report to the Luxembourg tax authorities and the relevant foreign tax authorities certain
information about financial accounts held by some of our Account Holders.
For joint or multiple Account Holders, please complete a separate form for each Account Holder.
If you are completing the form on the Account Holder’s behalf, then you should indicate the capacity in which you have signed in Section 4. For
example you may be the custodian or nominee of an account on behalf of the account holder, or you may be completing the form under a signatory
authority or power of attorney
If you have any questions about this form or defining your FATCA or CRS status, please speak to your tax adviser or local tax authority.
For further information on CRS please refer to the OECD automatic exchange of information portal:
http://www.oecd.org/tax/automatic-exchange/
(Mandatory fields are marked with an *)
Section 1: Account Holder Identification (please refer to glossary)
Name*:
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 identification number (U.S. TIN) is
as follows:
Residential Address:
Number:Street:
City, Town, State, Province or County:
OR
(b)
I confirm that I am not a U.S. Citizen or resident in the U.S. for tax
purposes.
Postal/ZIP Code:
Country:
Mailing address (if different from above):
Number:Street:
Section 3: CRS Declaration Declaration of Tax Residence
(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).
Country of Tax Residency TAX ID Number
City, Town, State, Province or County:
Postal/ZIP Code:
Section 4: Declarations and Undertakings:
Country:
I declare that the information provided in this form is, to the best of my
knowledge and belief, accurate and complete.
Place of Birth*
I undertake to advise the recipient within 30 days 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.
Town or City of Birth*: Country of Birth*:
Authorised Signature*: Print Name*:
Date of Birth*:
Capacity in which declaration is made:
Date:
D
D
M M
Y
Y
Page 5
Part 6
Glossary CRS
Note: These are selected definitions provided to assist you with the completion of this form. Further details can be found in the Directive 2014/107/EU of
9 December 2014 “as regards mandatory automatic exchange of information” and in the OECD Standard for Automatic Exchange of Financial Account
Information (“OECD Common Reporting Standard, CRS”).
“Account Holder”
The “Account Holder” in Section 1 is the person listed or identified as the holder of the Debt or Equity Interest in Part 1. This is regardless of whether such
person is a flow-through Entity.
A person, other than a Financial Institution, holding Shares for the benefit or account of another person as agent, custodian, nominee, signatory, investment
advisor, or intermediary, is not treated as holding the account, and such other person is treated as holding the account.
“Financial Institution”
The term “Financial Institution” means a “Custodial Institution”, a “Depository Institution”, an “Investment Entity”, or a “Specified Insurance Company”. Please
see the relevant domestic guidance and the CRS for further classification definitions that apply to Financial Institutions.
“Resident for tax purposes”
Generally, a Person will be resident for tax purposes in a jurisdiction if, under the laws of that jurisdiction (including tax conventions), it pays or should be paying
tax therein by reason of his domicile, residence, place of management or incorporation, or any other criterion of a similar nature, and not only from sources in
that jurisdiction.
“TIN” (including “functional equivalent”)
The term “TIN” means Taxpayer Identification Number or a functional equivalent in the absence of a TIN. A TIN is a unique combination of letters or numbers
assigned by a jurisdiction to an individual or an Entity and used to identify the individual or Entity for the purposes of administering the tax laws of such
jurisdiction.
Some jurisdictions do not issue a TIN. However, these jurisdictions often utilise some other high integrity number with an equivalent level of identification (a
“functional equivalent”). Examples of that type of number include, for individuals, the social security number.
Page 6
Part 7
Entity Self-Certification for FATCA and CRS
Instructions for completion
We are obliged under local laws and regulations to collect and report to the Luxembourg tax authorities and the relevant foreign tax authorities certain
information about financial accounts held by some of our Account Holders.
For joint or multiple Account Holders, please complete a separate form for each Account Holder.
If you are completing the form on the Account Holder’s behalf, then you should indicate the capacity in which you have signed in Section VI. For example you
may be the custodian or nominee of an account on behalf of the account holder, or you may be completing the form under a signatory authority or power of
attorney
If you have any questions about this form or defining your FATCA or CRS status, please speak to your tax adviser or local tax authority.
For further information on CRS please refer to the OECD automatic exchange of information portal:
http://www.oecd.org/tax/automatic-exchange/
(Mandatory fields are marked with an *)
Account Holders that are individuals should not complete this form and should complete the form entitled “Individual Self-Certification”.
Section 1: Account holder identification (please refer to the glossary)
Name*:
(the “Entity”)
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:
Country of Incorporation or Organisation:
If the Entity is a Financial Institution, please tick one of the below categories
and provide the Entity’s GIIN at 3.2
Residential Address:
I. Luxembourg Financial Institution or a Partner Jurisdiction Financial
Institution
II. Registered Deemed Compliant Foreign Financial Institution
III. Participating Foreign Financial Institution
Number:Street:
City, Town, State, Province or County:
3.2 Please provide the Entity’s Global Intermediary Identification Number (GIIN):
Postal/ZIPCode:
Country:
3.3 If the Entity is a Financial Institution but unable to provide a GIIN, please
tick one of the below reasons:
Mailing address (if different from above):
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:
Number:Street:
City, Town, State, Province or County:
Postal/ZIPCode:
Sponsor’s GIIN:
Country:
III. Exempt Beneficial Owner
Section 2: FATCA Declaration Specified U.S. Person:
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
Please tick either (a) or (b) below and complete as appropriate.
VI. Excepted Foreign Financial Institution
(a)
VII. U.S. Person, but not a Specified U.S. Person
OR
(b)
The Entity is a Specified U.S. Person and the Entity’s U.S. Federal
Taxpayer Identification number (U.S. TIN) is as follows:
The Entity is not a Specified U.S. Person (please also complete
Sections 3, 4 and 5)
Page 7
Part 7
Entity Self-Certification
3.4 Non-Financial Institutions under FATCA:
Section 6: Declarations and Undertakings:
If the Entity is not a Financial Institution, please tick one of the below categories
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. Active Non-Financial Foreign Entity
II. Passive Non-Financial Foreign Entity (If this box is ticked, please
include Controlling Person self-certification forms for each of your
Controlling Persons that is a Specified U.S. person)
III. Excepted Non-Financial Foreign Entity
IV.The Entity is a U.S. Person but not a Specified U.S. person
I/We undertake to advise the recipient within 30 days 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)*:
Section 4: CRS Declaration of Tax Residency* (please refer to the
glossary)
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).
Authorised Signature(s)*:
Country of Tax Residency TAX ID Number
Capacity in which declaration is made*:
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) (please refer to the glossary):
I.Custodial Institution, Depository Institution, Specified Insurance
Company or Investment Entity other than an Investment Entity
under A(6)(b) of Section VIII of the CRS resident in a NonParticipating Jurisdiction
II. An Investment Entity under A(6)(b) of Section VIII of the CRS
resident in a Non-Participating Jurisdiction (If this box is ticked,
please include Controlling Person self-certification forms for each
of your Controlling Persons)
Date: (dd/mm/yyyy):*
D
D
M M
Y
Y
Y
Y
III.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
If you fall under the definition of (I), please provide the name of the
established securities market on which the corporation is regularly
traded:
If you fall under the definition of (II), please provide the name of the
regularly traded corporation that the entity identified in section I of this
form is a Related Entity of:
IV. Active Non-Financial Entity – a Government Entity or Central Bank
V. Active Non-Financial Entity – an International Organisation
VI.
Active Non-Financial Entity – other than (c)-(e) (for example a startup NFE or a non-profit NFE)
VII.Passive Non-Financial Entity (If this box is ticked, please include
Controlling Person self-certification forms for each of your
Controlling Persons)
Page 8
Glossary CRS
Note: These are selected definitions provided to assist you with the completion of this form. Further details can be found in the Directive 2014/107/EU of
9 December 2014 “as regards mandatory automatic exchange of information” and in the OECD Standard for Automatic Exchange of Financial Account
Information (“OECD Common Reporting Standard, CRS”).
“Account Holder”
The “Account Holder” in Section 1 is the person listed or identified as the holder of the Debt or Equity Interest in Part 1. This is regardless of whether such
person is a flow-through Entity.
A person, other than a Financial Institution, holding shares for the benefit or account of another person as agent, custodian, nominee, signatory, investment
advisor, or intermediary, is not treated as holding the account, and such other person is treated as holding the account.
“Active NFE”
An entity will be classified as Active NFE if it meets any of the following criteria:
a)less than 50% of the NFE’s gross income for the preceding calendar year or other appropriate reporting period is passive income and less than 50%
of the assets held by the NFE during the preceding calendar year or other appropriate reporting period are assets that produce or are held for the
production of passive income;
b) the stock of the NFE is regularly traded on an established securities market or the NFE is a Related Entity of an Entity the stock of which is regularly
traded on an established securities market;
c) the NFE is a Governmental Entity, an International Organisation, a Central Bank, or an Entity wholly owned by one or more of the foregoing;
d) substantially all of the activities of the NFE consist of holding (in whole or in part) the outstanding stock of, or providing financing and services to, one
or more subsidiaries that engage in trades or businesses other than the business of a Financial Institution, except that an Entity does not qualify for this
status if the Entity functions (or holds itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or any
investment vehicle whose purpose is to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes;
e)the NFE is not yet operating a business and has no prior operating history, (a “ start-up NFE”) but is investing capital into assets with the intent to operate
a business other than that of a Financial Institution, provided that the NFE does not qualify for this exception after the date that is 24 months after the
date of the initial organisation of the NFE;
f)the NFE was not a Financial Institution in the past five years, and is in the process of liquidating its assets or is reorganising with the intent to continue or
recommence operations in a business other than that of a Financial Institution;
g) the NFE primarily engages in financing and hedging transactions with, or for, Related Entities that are not Financial Institutions, and does not provide
financing or hedging services to any Entity that is not a Related Entity, provided that the group of any such Related Entities is primarily engaged in a
business other than that of a Financial Institution; or
h) the NFE meets all of the following requirements (a “non-profit NFE”) :
i. it is established and operated in its jurisdiction of residence exclusively for religious, charitable, scientific, artistic, cultural, athletic, or educational
purposes; or it is established and operated in its jurisdiction of residence and it is a professional organisation, business league, chamber of
commerce, labour organisation, agricultural or horticultural organisation, civic league or an organisation operated exclusively for the promotion of
social welfare;
ii. it is exempt from income tax in its jurisdiction of residence;
iii. it has no shareholders or members who have a proprietary or beneficial interest in its income or assets;
iv.the applicable laws of the NFE’s jurisdiction of residence or the NFE’s formation documents do not permit any income or assets of the NFE to be
distributed to, or applied for the benefit of, a private person or non-charitable Entity other than pursuant to the conduct of the NFE’s charitable
activities, or as payment of reasonable compensation for services rendered, or as payment representing the fair market value of property which the
NFE has purchased; and
v. the applicable laws of the NFE’s jurisdiction of residence or the NFE’s formation documents require that, upon the NFE’s liquidation or dissolution,
all of its assets be distributed to a Governmental Entity or other non-profit organisation, or escheat to the government of the NFE’s jurisdiction of
residence or any political subdivision.
“Control”
“Control” over an Entity is generally exercised by the natural person(s) who ultimately has a controlling ownership interest (typically on the basis of a certain
percentage (e.g. 25%)) in the Entity. Where no natural person(s) exercises control through ownership interests, the Controlling Person(s) of the Entity will be the
natural person(s) who exercises control of the Entity through other means. Where no natural person(s) is/are identified as exercising control of the Entity through
ownership interests, then under the CRS the Reportable Person is deemed to be the natural person who hold the position of senior managing official.
“Controlling Person(s)”
“Controlling Persons” are the natural person(s) who exercise control over an entity. Where that entity is treated as a Passive Non-Financial Entity (“Passive
NFE”) then a Financial Institution is required to determine whether or not these Controlling Persons are Reportable Persons. This definition corresponds to
the term “beneficial owner” described in Recommendation 10 of the Financial Action Task Force Recommendations (as adopted in February 2012).
In the case of a trust, the Controlling Person(s) are the settlor(s), the trustee(s), the protector(s) (if any), the beneficiary(ies) or class(es) of beneficiaries, or any
other natural person(s) exercising ultimate effective control over the trust (including through a chain of control or ownership). Under the CRS the settlor(s),
the trustee(s), the protector(s) (if any), and the beneficiary(ies) or class(es) of beneficiaries, are always treated as Controlling Persons of a trust, regardless of
whether or not any of them exercises control over the activities of the trust.
Where the settlor(s) of a trust is an Entity then the CRS requires Financial Institutions to also identify the Controlling Persons of the settlor(s) and when
required report them as Controlling Persons of the trust. In the case of a legal arrangement other than a trust, “Controlling Person(s) means persons in
equivalent or similar positions.
Page 9
“Financial Institution”
The term “Financial Institution” means a “Custodial Institution”, a “Depository Institution”, an “Investment Entity”, or a “Specified Insurance Company”. Please
see the relevant domestic guidance and the CRS for further classification definitions that apply to Financial Institutions.
“Investment Entity”
The term “Investment Entity” includes two types of Entities:
(i)
an Entity that primarily conducts as a business one or more of the following activities or operations for or on behalf of a customer:
• Trading in money market instruments (cheques, bills, certificates of deposit, derivatives, etc.); foreign exchange; exchange, interest rate and
index instruments; transferable securities; or commodity futures trading;
• Individual and collective portfolio management; or
• Otherwise investing, administering, or managing Financial Assets or money on behalf of other persons.
Such activities or operations do not include rendering non-binding investment advice to a customer.
(ii) ”The second type of “Investment Entity” (“Investment Entity managed by another Financial Institution” – as defined under §A(6)(b) of Section VIII of the
CRS) is any Entity the gross income of which is primarily attributable to investing, reinvesting, or trading in Financial Assets where the Entity is managed by
another Entity that is a Depository Institution, a Custodial Institution, a Specified Insurance Company, or the first type of Investment Entity.
“Investment Entity managed by another Financial Institution”
An Entity is “managed by” another Entity if the managing Entity performs, either directly or through another service provider on behalf of the managed Entity,
any of the activities or operations described in clause (i) above in the definition of ‘Investment Entity’.
An Entity only manages another Entity if it has discretionary authority to manage the other Entity’s assets (either in whole or part).
“NFE”
An “NFE” is any Entity that is not a Financial Institution.
“Non-Participating Jurisdiction”
A “Non-Participating Jurisdiction” means a jurisdiction with which no agreement is in place pursuant to which it will provide the information set out in the CRS.
“Participating Jurisdiction Financial Institution”
The term “Participating Jurisdiction Financial Institution means (i) any Financial Institution that is tax resident in a Participating Jurisdiction, but excludes
any branch of that Financial Institution that is located outside of that jurisdiction, and (ii) any branch of a Financial Institution that is not tax resident in a
Participating Jurisdiction, if that branch is located in such Participating Jurisdiction.
“Passive NFE”
Under the CRS a “Passive NFE” means any: (i) NFE that is not an Active NFE; and (ii) Investment Entity as defined under §A(6)(b) of Section VIII of the CRS
resident in a Non-Participating Jurisdiction.
“Related Entity”
An Entity is a “Related Entity” of another Entity if either Entity controls the other Entity, or the two Entities are under common control. For this purpose control
includes direct or indirect ownership of more than 50% of the vote and value in an Entity.
“Resident for tax purposes”
Generally, an Entity will be resident for tax purposes in a jurisdiction if, under the laws of that jurisdiction (including tax conventions), it pays or should be
paying tax therein by reason of his domicile, residence, place of management or incorporation, or any other criterion of a similar nature, and not only from
sources in that jurisdiction. Dual resident Entities may rely on the tiebreaker rules contained in tax conventions (if applicable) to solve cases of double
residence for determining their residence for tax purposes. An Entity such as a partnership, limited liability partnership or similar legal arrangement that has no
residence for tax purposes shall be treated as resident in the jurisdiction in which its place of effective management is situated. A trust is treated as resident
where one or more of its trustees is resident.
“TIN” (including “functional equivalent”)
The term “TIN” means Taxpayer Identification Number or a functional equivalent in the absence of a TIN. A TIN is a unique combination of letters or numbers
assigned by a jurisdiction to an individual or an Entity and used to identify the individual or Entity for the purposes of administering the tax laws of such
jurisdiction.Some jurisdictions do not issue a TIN. However, these jurisdictions often utilise some other high integrity number with an equivalent level of
identification (a “functional equivalent”). Examples of that type of number include, for Entities, a Business/company registration code/number.
Page 10
Part 8
Declarations and signature of the shareholder
I/We hereby confirm that the money or assets invested by me/us in the sub-fund are neither directly nor indirectly the proceeds of any criminal act within the
meaning of applicable Luxembourg law.
I/We confirm and accept that this application is solely made on the basis of the information contained in and subject to the Key Investor Information
Document of the Fund, Articles of Incorporation and latest Annual and Semi-Annual Financial Reports. In particular I/we declare that I/we have received the
Key Investor Information Document (KIID) and understand that this acknowledgment will apply to any subsequent investment and that KIIDS are available at
www.bmogam.com/kiids/. I/we have evaluated the risks connected with an investment in the sub-funds of the F&C Portfolios Fund.
I/We declare that I am/we are not a U.S. Person (as defined in the Prospectus) and that the Shares are not being acquired for the benefit or account of,
directly or indirectly, any U.S. Person. Upon such notification, or if the Administrator or the Fund determines that there is a reasonable basis for believing that
the investor has become a U.S. Person, the investor’s account may be frozen and/or compulsorily redeemed and further investments or switches will not be
accepted. Other rights attaching to the interests previously purchased will not be affected.
Pursuant to data protection law applicable in Luxembourg (including, but not limited to, the Luxembourg law of 2 August 2002 on the Protection of Persons
with regard to the Processing of Personal Data, as amended from time to time) any personal data that is furnished in connection with an investment in the
Fund being subscribed for may be held on computers and processed by the Fund, acting as data controller, as well as its various service providers, mainly
the Management Company, the Investment Manager(s), Bank of Montreal, the Custodian, Registrar, Transfer, Domiciliary, Paying and Administrative Agent
(each as defined in the Prospectus) and their affiliates and agents (together hereafter the “Entities”) acting as data processors.
Personal data may be processed by the Entities as well as the Fund for the purposes of carrying out their services and complying with applicable legal or
regulatory obligations including but not limited to legal obligations in Luxembourg as well as in other jurisdictions under applicable company law, anti-money
laundering law and regulations and tax laws such as but not limited to FATCA (Foreign Account Tax Compliance Act) or similar laws and regulations (e.g. on
OECD level).
Personal data shall be disclosed to third parties where necessary for legitimate business interests only. This may include disclosure to third parties such
as governmental or regulatory bodies including tax authorities, auditors and accountants in Luxembourg as well as in other jurisdictions. Agents of the
Entities may include investment managers, investment advisers, paying agents and subscription and redemption agents, distributors as well as permanent
representatives in places of registration and any other agents of the Entities who may process the personal data for carrying out their services and complying
with legal and regulatory obligations as described above.
I/We accept that my/our failure to fill in the information regarding the subscriber and, when necessary, to provide the required documents shall cause the
Transfer Agent to refuse subscription.
By signing this application form, I/we consent to the aforementioned processing of my/our personal data and in particular, the disclosure of my/our personal
data to, and the processing of my/our personal data by the parties referred to above including parties situated in countries outside of the European Union
(such as but not limited to Canada and India) which may not offer a similar level of protection as the one deriving from Luxembourg data protection law. I/We
acknowledge that the transfer of my/our personal data to these parties may transit via and/or my/our personal data may be processed by parties in countries
which may not have data protection requirements deemed equivalent to those prevailing in the European Union.
Shareholders may request access to, rectification of or deletion of any personal data provided to any of the parties above or stored by any of the parties
above in accordance with applicable data protection law.
While the Fund and the Entities have taken reasonable measures to ensure confidentiality of the personal data, due to the fact that such data is transferred
electronically and available outside of Luxembourg, the same level of confidentiality and the same level of protection in relation to data protection law as
currently in force in Luxembourg may not be guaranteed while the personal data is kept abroad.
The Fund will accept no liability with respect to any unauthorised third party receiving knowledge and/or having access to the shareholders’ personal data,
except in case of wilful negligence or gross misconduct of the Fund.
Personal data shall not be held for longer than necessary with regard to the purpose of the data processing, subject always to applicable legal minimum
retention periods.
I/We declare that I/we are over 18 years of age or in cases of application on behalf of shareholders under 18 years of age, that I/we comply with the
provisions set out in the Key Investor Information Document.
I/We acknowledge and agree that my/our personal detail will be held by the Transfer Agent and the F&C Portfolios Fund. I/We acknowledge that this data
may be subject to recording and various processing for subscriptions, redemptions and transfers. I/We acknowledge that I/we have access to such data and
the right to request relevant amendments of the data. I/we may be consulted by F&C Management Limited for the purposes of Shareholder servicing.
I/We hereby declare that the information contained in the application form is correct and I/we hereby undertake to inform the F&C Portfolios Fund of any
change in my/our details contained herein.
I/We agree to accept communications conveyed by electronic methods such as facsimile and acknowledge that these are not secure forms of
communication, which may accordingly give rise to higher risks of manipulation or attempted fraud, for which the Manager or any of its delegates shall have
no liability.
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Part 8
Declarations and signature of the shareholder (continued)
Shareholder signature (or guardian signature in case of minor)
Date
Joint shareholder signature(s)
Date
Please ensure all sections are completed and send this Form in conjunction with the Anti-Money Laundering Form (and associated documents) to the
Transfer Agent.
State Street Bank (Luxembourg) S.A.
49 Avenue John F Kennedy
L-1855 Luxembourg
Grand Duchy of Luxembourg
Fax No. +352 2452 9066
Tel. No. +352 4640 107460
If you are unclear about any of the requirements or terms covered in this document please contact State Street Bank (Luxembourg) S.A.
The F&C Portfolios Fund is a Luxembourg Umbrella SICAV comprising various sub funds referred to as the fund/portfolio. Applications may only be made on the basis of the current Key Investor
Information Document. F&C Management Limited is the investment manager of F&C’s Portfolio Fund and is Authorised and regulated by the Financial Conduct Authority FRN:119230. BMO
Global Asset Management is a trading name of F&C Management Limited, which is authorised and regulated by the Financial Conduct Authority. CM07412 02/16
Page 12