SSgA Liquidity PLC – I Accumulating Shares
All Applicants wishing to purchase shares in State Street Global Advisors Liquidity PLC (the ‘Company’) must first complete this form and send it addressed to:
State Street Fund Services (Ireland) Limited
SSgA Registration Team – Transfer Agency
78 Sir John Rogerson's Quay
Dublin 2
Ireland
Any new account queries may be made by e-mail to TARegistration.mm@statestreet.com or by telephone +353 1 853 8281
No purchase of shares may be executed until the original completed form along with the applicable support documentation has been received and accepted
by the Administrator. Upon acceptance of an application, the Administrator will allocate a shareholder account number to each Applicant. Unless otherwise
specified, defined terms used in this application form have the meaning assigned to them in the prospectus of the Company.
SSgA Representative
SSgA Contact Name
SSgA Office
1. Registration Details
Name of Entity (“The Applicant”)This is the name the shares will be registered in.
Full Legal Name
(The Registered
Shareholder)
Type of Legal Entity
Public Listed Company
Private Company
Pension Scheme
Charitable
Organisation
Nominee
State-owned Entity
Trust
Investment
Fund/Company
Other (Please specify)
Account Designation
(if any)
Contact Name
Telephone
Registered Address
(Not post office box)
Facsimile
Email
Contact Address and Details for Statements, Contract notes and Correspondence (if different from the registered details provided above)
Contact Name
Telephone
Mailing Address
Facsimile
Email
2. Telephone and Electronic Dealing
If the Applicant wishes to instruct deals and obtain other information by telephone or electronic means please contact the Administrator, details above.
Please note that telephone calls will be recorded. If the Applicant wishes to use telephone dealing then the name on the authorised signatory list (section 12)
will become applicable to place trades unless otherwise instructed by the Applicant.
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3. Bank Details for Redemption Proceeds and Other Payments
REDEMPTIONS AND OTHER PAYMENTS WILL NOT BE PROCESSED ON NON-CLEARED/VERIFIED ACCOUNTS
The following details are required in connection with the payment of redemption proceeds and other payments by wire transfer to the Applicants designated
bank account. The Applicant may only designate one bank account for each currency. Redemption proceeds and other payments will be paid in the base
currency of the relevant share class unless otherwise agreed with the Investment Manager. Redemption proceeds and other payments can only be paid to
an account in the name of the registered shareholder.
EUR Payment Details
Bank Name
Correspondent Bank
(If required)
Bank Address
SWIFT (BIC)
Bank Name
Bank Address
Beneficiary Bank
SWIFT/ABA/Sort Code
Account Name
IBAN Account Number
Payment Type (please select one)
MT202
MT103
Account in Own Name
Nominee Account
Payment Reference (If applicable)
For Further Credit Account Details (If applicable)
Relationship of Registered Address to above
Account
Other (Please specify)
GBP Payment Details
Bank Name
Correspondent Bank
(If required)
Bank Address
SWIFT (BIC)/Sort Code
Bank Name
Bank Address
Beneficiary Bank
SWIFT/ABA/Sort Code
Account Name
Account Number
Payment Type ( please select one)
MT202
MT103
Account in Own Name
Nominee Account
Payment Reference (If applicable)
For Further Credit Account Details (If applicable)
Relationship of Registered Address to above
Account
Other (Please specify)
USD Payment Details
Bank Name
Correspondent Bank
(If required)
Bank Address
SWIFT/ABA/Fedwire
Bank Name
Bank Address
Beneficiary Bank
SWIFT/ABA/Sort Code
Account Name
Account Number
Payment Type ( please select one)
MT202
MT103
Account in Own Name
Nominee Account
Payment Reference (If applicable)
For Further Credit Account Details (If applicable)
Relationship of Registered Address to above
Account
Other (Please specify)
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State Street Representative
If the Applicants above bank details are with State Street, please insert your State Street contact name
State Street Contact Name
State Street Office
4. Declaration of Residence Outside the Republic of Ireland
Applicants resident outside the Republic of 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 till correct, shall apply in
respect of any subsequent acquisitions of shares. Terms used in this declaration are defined in the Prospectus. Please tick option (a) or (b) if applicable.
(a) Declaration on Own Behalf
I/we* declare that I am/we are* applying for the shares/units
on my own/our own behalf /on behalf of a company* and that I
am/we are/the company* is entitled to the shares/units in respect
of which this declaration is made and that:
 I am/we are/the company is* not currently resident or ordinarily
resident in Ireland, and
 Should I/we/the company* become resident in Ireland I/we/the
company* will so inform you, in writing, accordingly
(b)
Declaration as Intermediary
I am/we* declare that I am/ we are* applying for shares/units on behalf of
persons:
 Who are beneficially entitled to the shares/units; and
 Who, to the best of my/our* knowledge and belief, are neither resident
nor ordinarily resident Ireland.
I/we* also declare that:
 Unless I/we specifically notify you to the contrary at the time of the
application, all applications for shares/units made by me/us* from the
date of the application will be made on behalf of such persons; and
 I/we* will inform you in writing, if I/we* become aware that any person,
*Delete as appropriate
on whose behalf I/we* holds shares/units, becomes resident in Ireland.
*Delete as appropriate
Notes: Non-resident declarations are subject to inspection by the Irish Revenue Commissioners and it is a criminal offence to make a false declaration.
Applicants who are resident or ordinarily resident in the Republic of Ireland or are an Exempt Irish Resident as defined in the Prospectus please
contact the Administrator to invest.
5. Tax Declarations
Council Directive 2003/48/EC of 3 June 2003 (the “EU Savings Directive”), which deals with the taxation of savings income in the form of interest payments,
seeks to ensure that an individual who is resident in a member state of the European Union (an “EU Member State”) and who receives savings income from
another EU Member State, is taxed in the EU Member State in which he/she is resident for tax purposes. In this regard the Fund is obliged to establish the
identity and residence of such individuals.
For completion by Applicants who are tax resident outside the EU Member States
The Applicant confirms by ticking the box to the right that the Applicant is not resident in an EU Member State and has not verified its identity for the
purposes of the Fund money laundering verification requirements by use of an EU passport/official identity
Applicants who are tax resident in the EU Member States should complete either Section (1) or Section (2) below:
Section 1: This Section 1 is to be completed by an Applicant resident in an EU Member State who is not a natural person (i.e., not an individual,
unincorporated body, unincorporated partnership, or any of the foregoing acting as trustee of a trust).
A.
B.
C.
Is Applicant a legal person, e.g., an incorporated entity? (tick yes or no as applicable)
YES
or
NO
Are Applicant’s profits taxed under general arrangements for business taxation? (tick yes or no as applicable)
YES
or
NO
(i) Is Applicant a UCITS or (ii) has Applicant been issued a certificate by Applicant’s EU Member State allowing Applicant to be treated as a UCITS for
the purposes of the EU Savings Directive? (tick yes or no as applicable)
YES
or
NO
Section 2: This Section 2 is to be completed by natural person Applicants (i.e., an individual, an unincorporated body, an unincorporated partnership, or any
of the foregoing acting as a trustee of a trust) residing in an EU Member State or who, in completing the Trust’s money laundering verification requirements,
have verified his/her identity by use of an EU Member State passport/official identity
A.
B.
C.
Specify the EU Member State in which Applicant is tax resident
__________________________________________________________
Please insert the Tax Identification Number (“TIN”) issued to Applicant by that EU Member State
_____________________________________________________________________________________________________________
Is Applicant’s EU passport or official identity issued by the same EU Member State that appears in Applicant’s address in section 1
(tick yes or no as applicable)
YES
or
NO
Applicant’s date, place, and country of birth:
_________________________________________________________________________
If Applicant answered YES to Section 1(c) (ii) above, Applicant must provide a certified copy of the certificate.
If Applicant answered NO to Section 2(b) above, than Applicant must provide a “certificate of residence for tax” issued by Applicant’s local taxation authority,
otherwise Applicant’s EU residency will be decided and reported upon the basis of information contained in Applicant’s passport/official identity card and/or
other documentation provided for the purposes of satisfying the Company’s money laundering verification requirements.
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6. Declaration of Non US Person
I/We declare that I am/we are not a US person as defined in the current Prospectus and that I am/we are not applying as the nominee or agent of such a
person or to a person who is acquiring the shares with the assets of an ERISA plan (unless otherwise permitted at the sole discretion of the Directors), and
that such subscriber will not sell or offer to sell or transfer, hypothecate or otherwise assign such shares in the U.S. or to, or for the benefit of, a U.S. Person
or to an ERISA plan (unless otherwise permitted at the sole discretion of the Directors).
The person(s) if any signing on behalf of the Applicant represent(s) and warrant(s) that they are duly authorised to sign this Form and to subscribe for or
redeem Shares in the Company.
7. Further Declarations
I/We hereby agree that this application and any purchase, redemption, or exchange of shares is made on the basis of and subject to the current Prospectus,
a copy of which I/we have received.
I/We declare that I am/we are over 18 years of age.
I/We hereby confirm my/our agreement with the distribution policy as outlined in the Prospectus.
The Administrator and the Company are each hereby authorised and instructed to accept and execute any instructions in respect of the shares to which this
application relates given by me/us (or by an authorised delegate of mine/ours) in written form, facsimile, telephone or electronic dealing. If the instructions
are given by me/us (or by an authorised delegate of mine/ours) by facsimile, telephone or electronic dealing, I/we undertake to confirm them in writing. I/we
hereby agree to indemnify each of the Administrator and the Company and agree to keep each of them indemnified against any loss of any nature
whatsoever arising to any of them as a result of any of them acting upon facsimile instructions. In circumstances where such instructions relate to a change
in the registration details or bank account details for redemption Payments referred to above, I/we confirm that we will provide you with an original instruction
in writing. The Administrator and the Company may rely conclusively upon (and shall incur no liability in respect of any action taken upon) any notice,
consent, request, instruction or other instrument believed in good faith to be genuine or to be signed by properly authorised persons.
I/We acknowledge that (i) my/our personal information will be handled by the Administrator (as Data Processor on behalf of the Company) in accordance
with the Irish Data Protection Acts 1988 to 2003, (ii) my/our information will be processed for the purposes of carrying out the services of Administrator and
transfer agent of the Company and to comply with legal obligations including legal obligations under company law and anti-money laundering legislation and
(iii) the Administrator and/or the Company will disclose my/our information to third parties where necessary or for legitimate business interests (including, but
not limited to, disclosure to third parties such as auditors and the Irish Financial Services Regulatory Authority or agents of the Administrator who process
the data for anti-money laundering purposes or for compliance with regulatory requirements).
I/we consent to the processing of my/our information and the disclosure of my/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 associate company in the State Street Group or to agents of the
Administrator including companies situated in countries outside the European Economic Area which may not have the same data protection laws as in
Ireland. For the purposes of the Data Protection Acts 1988- 2003, the Company is deemed to be a Data Controller.
I/We confirm that I/We have taken all required steps to determine my/our eligibility to invest in the company’s shares.
8. Politically Exposed Persons
Please complete EITHER Section A or B below, with reference to the definitions below
A 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.
b.
c.
d.
e.
f.
g.
any spouse of the PEP;
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;
any child of the PEP;
any spouse of a child of the PEP;
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;
any parent of the PEP;
any other family member of the PEP who is of a class prescribed by the Minister for Justice under section 37(11) of the Criminal Justice Money
Laundering and Terrorist Financing Act 2010
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:
a.
in the case of a body corporate other than a company having securities listed on a regulated market, 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 in the body; or
b.
otherwise exercises control over the management of the body.
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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
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)
SECTION B: PLEASE TICK BOX BELOW IF THE PEP RULES DO NOT APPLY WITH REFERENCE TO THE DEFINITIONS ABOVE:
I/we confirm that the application is NOT being made by a PEP / immediate family member of a PEP / close associate of a PEP
AND
the Applicant does NOT have a beneficial owner who is a PEP / immediate family member of a PEP / close associate of a PEP
AND
the application is NOT being made for the benefit of a PEP / immediate family member of a PEP / close associate of a PEP
AND
it is NOT intended to transfer the shares to a PEP / immediate family member of a PEP / close associate of a PEP
9. Indemnity
I/We hereby agree to indemnify the Company, its Directors, the Administrator, other shareholders of the Company and any affiliates or duly appointed agents
of any of the foregoing entities for any and all loss suffered as a result of the acquisition of Shares by me/us in breach of the laws of any competent
jurisdiction.
I/We agree to indemnify the Administrator, the Company and its Directors and agree to keep each of them jointly and severally indemnified against any loss
of any nature whatsoever arising to any of them as a result of them acting upon facsimile, telephone instructions or electronic instructions.
10. Return of Values (Investment Undertakings) Regulations 2013
Pursuant to the Return of Values (Investment Undertakings) Regulations 2013 (S.I. 245 of 2013) (the "Regulations"), the Company is required to collect
certain information from non-Excepted Share Holders. All Applicants, whether individuals, bodies corporate or unincorporated bodies of persons, which are
Irish resident or ordinarily resident should review the list of Excepted Share Holders set out below.
If the Applicant is Irish resident or non-Irish resident and is not an Excepted Share Holder, please provide the following information and documentations:
Tax Identification Number (TIN) / PPS Number: ____________________
Any one of the following additional documents is required to verify the TIN or PPS Number (either an original or a copy will suffice):






P60
P45
P21 Balancing Statement
Payslip (where employer is identified by name or tax number)
Drug Payment Scheme Card
Tax Assessment






Tax Return Form
PAYE Notice of Tax Credits
Child Benefit Award Letter / Book
Pension book
Social Services Card
Public Services Card
In addition, printed documentation issued by the Irish Revenue Commissioners or the Department of Social Protection which includes your name, address
and tax reference number is also acceptable. In the case of joint account holders, the additional documentation is required for each Applicant.
Your personal information will be handled by the Administrator, the Company or its duly appointed delegates as Data Processor for the Company in
accordance with the Data Protection Acts 1988 to 2003. Information provided herein will be processed for the purposes of complying with the Regulations
and this may include disclosure to the Irish Revenue Commissioners.
Excepted Share Holders
Share Holders
TCA 1997
reference
The following entities will constitute Excepted Share Holders
provided the Fund has obtained a duly completed
appropriate declaration:
An investment undertaking
An investment limited partnership
A pension scheme which is an exempt approved scheme
A company carrying on a life assurance business
A special investment scheme
A unit trust to which section 731(5) applies
739D(6)(c)
739D(6)(cc)
739D(6)a)
739D(6)(b)
739D(6)(d)
739D(6)(e)
A charity
739D(6)(f)(i)
ARFs, AMRFs
739D(6)(h)
A qualifying fund manager
739D(6)(g)
Share Holders
A qualifying savings manager
PRSA providers
The National Pensions Reserve Fund
The National Asset Management Agency
A Section 110 Company
A Credit Union
An Irish resident company but only where the Fund is a
money market fund
A non-Irish resident unit holder in respect of whom the Fund
has obtained a completed non-resident declaration or where
the Fund has adopted the Equivalent Measures Regime
A unit holder who holds their units in a recognised clearing
system
TCA 1997
reference
739D(6)(g)
739D(6)(i)
739D(6)(l)
739D(6)(ka)
739D(6)m)
739D(6)(j)
739D(6)(k)
739D(7)
739D(7B)
739B
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11. Key Investor Information Confirmation
Please complete SECTION A and SECTION B as applicable
SECTION A: PLEASE TICK BOX TO CONFIRM RECEIPT OF THE KEY INVESTOR INFORMATION DOCUMENT (“KIID”)
I/We, confirm that I/we have been provided with and have considered the relevant KIID for this investment.
SECTION B: PLEASE TICK BOX TO CONFIRM PROVISION OF THE KIID FOR FUTURE APPLICATIONS BY ELECTRONIC MEANS. YOU WILL BE NOTIFIED
ELECTRONICALLY OF THE ADDRESS OF THE WEBSITE, AND THE PLACE ON THE WEBSITE WHERE THE KIID MAY BE ACCESSED BY YOU.
I/We consent to receipt of the KIID in respect of all future subscriptions to the Fund via the SSgA website(www.ssga.com).Please send details of the website
by email to the following address:
;
12. Signatures
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 must sign. In the case of a partnership the application form should be signed by all the partners/proprietors. In the case of a
corporation, the application form should be executed under seal or signed by a duly authorised signatory, provided that a certified copy of the authority and
an authenticated list of signatories accompany the application form.
If this application form is signed under power of attorney (or equivalent), such power of attorney or a duly certified copy thereof must accompany this
application form.
Name of Applicant/Intermediary or
Date
Authorised Signatory (Declarant)
Capacity of Intermediary and/or
Authorised Signatory
Signature
Name of Joint Applicant
Date
Signature
Checklist
Have you signed the form?
Have you attached an authorised signatory list
Have you provided the necessary supporting documents?
with specimen signatures?
(See section 13)
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13. Anti-Money Laundering – Know your Customer Requirements
Under Irish legislation covering anti-money laundering and the taxation of savings the Company and the Administrator are required to obtain the following
documentation to verify the identity, permanent address and tax residency status of all new clients. Please note that the application may not be accepted
until all the relevant information has been received. Additional confirmation of identity or authority of the Applicant or the source of funds may be required in
certain circumstances.
The documentation requirements listed below are outlined as a guide only and may not be exhaustive. Before proceeding with an application please contact
the Administrator for complete details in this regard.
Documentation which may be required for designated bodies1 in certain countries2
 Confirmation of name and address
 Confirmation of regulatory body1
 Original authorised signatory list with specimen signatures
Documentation which may be required for non designated bodies1
 Confirmation of name3 and address4
 Confirmation of regulatory body (if applicable)
 Certificate of incorporation or certificate to trade (certified5)
 Memorandum and articles of association (certified)
 List of directors to include full name, dates of birth, occupation, residential and business addresses
 Authorised mandate or board resolution to establish the business relationship (original)
 Original authorised signatory list with specimen signatures
 One personal verification and two address verification documents for at least two directors (original or certified)
 One personal verification and two address verification documents for all persons authorised to operate the account (original or certified)
 Names and addresses of shareholders holding 10% or more of the issued share capital, and in the case of individual shareholders, names, residential
addresses, occupations and dates of birth. Where a body corporate holds 25% or more of the issued share capital, names, residential addresses,
occupations and dates of birth of the ultimate beneficial owners of that body corporate should be obtained.
Documentation which may be required for pension fund accounts in certain countries
Documentation for UK/Irish pension schemes (additional documentation will be required for non UK/Irish schemes)
 Original fully completed application form
 Confirmation of name and address
 Copy of revenue approval
 Copy of Scheme Rules/Trust Deed
 Original authorised signatory list with specimen signatures
AML checks will be undertaken on parent/investment manager of pension fund (who will be entered on to the register)
Documentation which may be required for a nominee company
 Confirmation of name and address of nominee company
 Original authorised signatory list with specimen signatures for the nominee
 Confirmation of name and address of parent of nominee
 Confirmation of regulatory body of parent of nominee
 Original authorised signatory list with specimen signatures for parent
 Original letter of assurance completed and duly signed by parent (please contact the Administrator – available on request)
Please note that the Administrator can only accept application forms from an entity that has legal capacity to enter into contracts on its own right and may
require the constitutive document to legitimate legal status.
Notes:
1) For a full definition of designated bodies, non designated bodies and regulatory body please contact the Administrator.
2) Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Guernsey, Hong Kong, Iceland, Ireland, Italy, Jersey, Luxembourg, Isle of Man,
Netherlands, Norway, Portugal, Singapore, Spain, Sweden, Switzerland, United Kingdom, United States. (Please note this list is subject to change).
3) Acceptable personal verification documents are a certified copy of a passport or a driver’s license or national identity card. The certified documents must be in date,
show a picture of the person, full name, date of birth and signature of the person.
4) Acceptable address verification documents are 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. Documents must originate from a different source, show the full name
and residential address of the Applicant and must be dated within 6 months of submission.
5) Verification documents must be certified by a suitable person/entity, such as; the Companies Registration Office (or the equivalent in the investors jurisdiction) with
regard to incorporation documentation, a notary public, an embassy/consular official, a chartered or certified public accountant, a practicing solicitor, or any
designated body. Documents should be stamped with the official stamp of the person, dated and signed by that person.
This product is not registered for public distribution in all jurisdictions; it may therefore only be available to certain qualifying investors and is not intended for public distribution.
The Funds are authorised by the Central Bank of Ireland as a UCITS. The Funds referred to are not registered for public distribution outside Ireland and are only available via
private placement in certain jurisdictions. This information is only intended for qualified sophisticated investors experienced in investing in similar unregistered Funds and
strategies. These Funds are not available to other types of investors. The Funds are not available to US investors. Not all products will be available to all investors.
For more information:
State Street Global Advisors Limited, 20 Churchill Place, London E14 5HJ
 Telephone: 020 3395 6000  Facsimile: 020 3395 6340  Web: ssga.com
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