Specimen: Request for admission to collective safe custody of investment funds
[Letterhead of the issuing bank (issuing agent/lead manager), if required]
Specimen
Specimen Street 2
S-12345 Specimen Town
Specimen Country
Clearstream Banking AG
New Issues Frankfurt
Neue Börsenstrasse 8
D-60487 Frankfurt am Main
Germany
Request for admission to collective safe custody
Dear Sir or Madam
We kindly ask you to admit the following investment fund or asset class(es) to collective safe custody
with Clearstream Banking AG, Frankfurt am Main (CBF):
Name of the investment fund: ______________________ Unit class: _______________________
ISIN: XX0000000000 / German securities code (WKN): XXXXXX
Base currency (EUR, USD, GBP etc.):1 _________________
Type of investment fund (please mark with a cross where applicable):
0 Alternative investment fund
Documentation: physical securities certificate, copy of the valid general terms and conditions
of investment (GTC) and/or special terms and conditions of investment (STC)
0 German retail fund / non-German fund:
Documentation: physical securities certificate, copy of the valid sales prospectus and a (uncertified)
copy of the permission granted by the supervisory authority responsible for fund distribution
licences.
We will send these documents and, if applicable, a detailed list (if more than five investment funds are
concerned) by email to: fonds-frankfurt@clearstream.com. We are aware that the timely admission of
securities is only possible if CBF receives the above-mentioned documents in due time before the
scheduled admission date, always under the proviso that the required checking and validation
processes have been successfully concluded.
Distribution/issue date (DD.MM.YYYY): ________________
Term:
 unlimited
 limited until ____________
Appropriation of income:
 distribution
 reinvestment
Smallest transferable unit:2
________________ (equal or greater than 0.001)
Financial year:
________________
1
A list of all available currencies can be called up via the CASCADE transaction code KVAV IW.
2
This unit is relevant for the transfer of units in connection with the settlement of securities transfers by book entry.
Specimen: Request for admission to collective safe custody of investment funds
Issue of physical individual securities:
 excluded
Global coupon sheet:  yes
 no
Tax treatment:
 standard procedure
 not excluded
 special procedure
We confirm that



the global certificate(s) (to be) delivered (no(s).1/xxxx) of the above investment fund has/have
been duly and legally signed by [Mr or Ms A] and [Mr and Ms B];
all formal requirements connected with the global certificate(s) (to be) delivered (no(s).1/xxxx)
have been fulfilled and
a standard banking compliance check on the issuer (including a ‘know your customer’ (KYC)
audit regarding anti-money laundering (AML), terrorism financing and/or (capital market) fraud
has been carried out.
Furthermore we declare that



we have an account connection with CBF [no. XXXX] and assumed the function of issuing
bank (agent/lead manager) for the securities issue in question. Marking up and marking down
of the nominal value in accordance with the currently issued volume will be instructed and
settled via this CBF account;
we will act as the principal paying agent for all issue-related transactions carried out via CBF
through our CBF account [no. XXXX]; all payments due in connection with the above
investment fund will be settled through this account.
Or alternatively:
[XY bank] will act as the principal paying agent for all issue-related transactions carried out via
CBF through this bank’s CBF account [no. XXXX]; all payments due in connection with the
above investment fund will be settled through this account; separate written confirmation of
assumption of the paying agent function will be provided.
Yours faithfully
[legally binding signature]
[legally binding signature]
[First name and surname of signatories in block letters or stamp]