Version 3.0 External Fund Administrator Request Form The information requested below will allow the FSC to initially consider a request for an external administrator to provide fund administration service to Experienced Investor Funds (EIFs) in accordance with Regulation 2 of the Financial Services (Experienced Investor Funds) Regulations 2012. To ensure that the request is dealt with promptly, it is requested that comprehensive answers are provided to avoid potential delays due to lack of information. Prior to completing this form it should also be noted that the appointment of an external fund administrator to service an EIF is aimed at “brand name” administrators under certain circumstances. The specific purpose being that such will allow the setting up of large funds which require a substantially large administrator in terms of size and international reputation. It is therefore intended to only allow the top few international fund administrators hence clear rationale, which includes details of why the service cannot be provided locally, should be provided. Please note that some of the information provided in this form may be discussed on a nonames basis with the established FSC Funds Panel. Information pertaining to the Panel can be sought from: http://www.fsc.gi/fsclists/pressrelease.aspx?PressReleaseID=108 1 Name of fund administrator (“the firm”). Details of directors of firm. Director Date of Birth Location of firm. Brief outline of current business plan of firm – i.e. what services are provided to funds together with information pertaining to the type and number of funds serviced. Information should also include the size of the firm in the jurisdiction where it is established. Details of regulatory regime the firm is subject to. For firms established in a jurisdiction outside of the EEA - details of jurisdictional equivalence should also be provided. Licences held by firm and details of issuing regulator. Details of protections afforded administrator’s jurisdiction. to investors in Total amount of assets of the funds the firm provides services to. Does the firm operate in any other jurisdictions? 2 Place of Birth Details of regulatory history (including regulatory breaches or warnings issued in respect of the firm). Where general consent is being sought - the intended number of EIFs the firm intends to provide services to should be specified. In the case of consent to provide services to specific EIFs the names and outline of investment objective and strategy of EIFs that have been identified for the firm to provide services to. Details of rationale for using this administrator over a locally licensed administrator. Intended local agent Any other information that the FSC should be aware of in considering the firm. 3 DECLARATION This declaration must be signed for and on behalf of the administrator by two directors of the administrator. The Administrator warrants and undertakes: that the information provided in this request form is truthful and any other information which might reasonably be considered relevant for the purpose of this request has been disclosed Furthermore that the administrator confirms that it wishes to be included on Gibraltar’s list of approved administrators1. Name of administrator Signed (Name of signatory in BLOCK CAPITALS) Position: Director of the Fund Administrator Signed (Name of signatory in BLOCK CAPITALS) Position: Director of the Fund Administrator 1 To note: Consent and listing of these administrators does not mean that these have been approved or licensed by the FSC. The FSC has no regulatory oversight of these entities and cannot be considered as approval/licensing of the entity. 4