cam bastion and cam pinnacle funds - peregrine wealth

CAM Bastion and CAM Pinnacle Funds

8677360.1

A1

CHECK LIST Application Form – CAM Bastion and CAM Pinnacle Funds Please tick () once completed

1. Payment details --- A2 2. Investment details – CAM Bastion and CAM Pinnacle Funds A2 3. Details of applicant(s) A3 4. Redemption details A5 5. Introducer (if applicable) A7 6. Declarations A7 7. Investment suitability --- A10 8. Data protection --- A10 9. Identification of subscribers under money laundering regulations A11 10. Investor Tax Residency --- A25 11. AIFMD Acknowledgement A28 12. Signature A28

Appendix 1 – Payment Details A29 Appendix 2 – Additional Application Form --- A30 Appendix 3 – Redemption Form --- A33 Appendix 4 – Self-Certification for FATCA and CRS A35 Appendix 5 – Tax Forms (if applicable) A43

Appendix 6 – Data Protection Privacy Notice A44

Important Notice CAM Bastion Fund Limited, CAM Bastion Dollar Fund Limited, CAM Bastion Rand Fund Limited, CAM Pinnacle Dollar Fund Limited and CAM Pinnacle Rand Fund Limited are together authorised by the Guernsey Financial Services Commission as an open-ended, authorised collective investment scheme under the Protection of Investors (Bailiwick of Guernsey) Law, 1987 (as amended) (the "POI Law") and the Authorised Collective Investment Schemes (Class B) Rules, 2013 (the "Rules").

Application Form



8677360.1

A2

Please complete this Application Form which, together with the appendices, constitutes your agreement to subscribe for Participating Shares in the issuing Feeder Fund referred to below and on the terms and conditions described in the Joint Prospectus dated 1 July 2019 as updated or amended from time to time (the "Joint Prospectus"). As described in the Joint Prospectus, each issuing Feeder Fund invests solely, apart from any necessary currency hedging (where such Feeder Fund has a Base Currency other than US Dollars) into CAM Bastion Fund Limited (the "Master Fund"). Defined terms used in this Application Form have the meaning given in the Joint Prospectus (unless the context otherwise requires). Please mail or fax (if faxed, the original must also follow by mail) the completed Application Form to:

Northern Trust International Fund Administration Services (Guernsey) Limited PO Box 255, Trafalgar Court Les Banques St Peter Port Guernsey GY1 3QL

Tel: Fax: Email:

+353 (0) 1 434 5096 +353 (0) 434 5291 [email protected] (enquiries only)

If you have any questions or difficulties in relation to this application please do not hesitate to contact shareholder

services on the above number. Please ensure that you have read the Joint Prospectus before completing this Application

Form.

□

Please pay monies in accordance with the deadlines outlined in the Joint Prospectus. Please remit payment to the bank account details specified in Appendix 1.

Select Share Class

Please tick () the Class of Participating Shares in which the investment will be made

Name of Share Class Base Currency and Minimum

Initial Investment*

Issuing Feeder Fund

Dollar Class $25,000 CAM Bastion Dollar Fund Ltd. **

Rand Class ZAR1,000,000 CAM Bastion Rand Fund Ltd. **

Dollar Class $25,000 CAM Pinnacle Dollar Fund Ltd.**

Rand Class ZAR1,000,000 CAM Pinnacle Rand Fund Ltd.**

* The Directors may, from time to time in their absolute discretion, amend the minimum initial investment amount. The

minimum additional investment amounts for each Class are set out in the Additional Investment Application Form.

** The feeder funds may not be promoted in South Africa.

Please tick () the currency in which funds will be remitted in respect of the investment USD Rand Note: In accordance with the Joint Prospectus, payment in respect of the issue of Participating Shares must be received

by telegraphic transfer in cleared funds in the currency of the relevant Class of Participating Shares. The Administrator may, at its discretion, accept payment in other currencies, but such payments will be converted into the currency of the relevant Class at the then prevailing exchange rate available to the Administrator and only the net proceeds (after

Application Form


1. Payment details

2. Investment details – CAM Bastion and CAM Pinnacle Funds

mailto:[email protected]


8677360.1

A3

deducting the conversion expenses) will be applied towards payment of the subscription monies. This may result in a delay in processing the application.

Additional investments may be made by or on behalf of the Applicant by (a) completing the form contained in Appendix 2;

or (b) sending a written instruction to Northern Trust International Fund Administration Services (Guernsey) Limited

specifying all relevant details. Each time an additional investment is made, the Applicant will (unless they have notified

the Administrator in writing to the contrary in advance of such additional investment) be deemed to have acknowledged

and agreed that the representations, warranties and covenants contained in this Application Form are true and correct in

all material respects as of the date such additional investment is to be made and that all other information provided in

their Application Form remains true and correct in all material respects as of such date.

Monetary Amount (including currency of investment)

Amount in Words

All dealing instructions in relation to Participating Shares in the relevant Feeder Fund must be received before the time(s) specified in the Joint Prospectus. Dealing Instructions received after such times will generally be deemed to have been received for the next relevant Dealing Day unless the Directors in their absolute discretion, in exceptional circumstances, otherwise determine to accept one or more applications received after the Dealing Deadline for processing on that Dealing Day provided that such application(s) have been received within 5 Business Days of the Dealing Day. Investors wishing to subscribe for Participating Shares in more than one Feeder Fund must complete a separate

Application Form for each Feeder Fund.

Please register Participating Shares pursuant to this application in the name(s) and addresses set out below:

Full company/nominee name

Company Registration Number

Or Title (Mr/Mrs/Miss)

Surname

Forenames

Former names

Registered office address or, if an individual, usual residential address

Address

City

State

3. Details of applicant(s)


8677360.1

A4

Country

Zip/Post Code

Telephone No.

Fax No.

Email

Details of other Joint Holders (if any)

Title and full name (and any former names)

Title and full name (and any former names)

Source of Funds

Please indicate the Applicant’s source of funds for this investment.

Please note the Administrator and/or the Feeder Fund may request further information regarding your source of funds.

Principal business address (if different from the registered office address)

Address

City

State

Country

Zip/Post Code

In all cases please note:

(i) Shares will be registered in accordance with the above particulars.

(ii) Fraud has been committed by the interception of mail correspondence. You are invited to provide an alternative

secure address for correspondence and if you do so that address will be used for all notices, contract notes,

subscription acceptances, redemption correspondence and information material. If you wish to take advantage

of this service please provide full details below.

(iii) Please note that all email correspondence from the Administrator will be sent by way of secure email and a password may be required.


8677360.1

A5

Correspondence preferences

Please note: all correspondence will generally be by post, unless specified to contrary below.

I/we do NOT want to receive any notices, contract notes, subscription acceptances, redemption

correspondence and information material by post. I have provided details below how I/we wish to receive the

information:

Email address

Fax No.

I/We wish to receive information by email and/or fax in addition to post – details provided below:

Email address

Fax No.

Copy correspondence (if you wish copies to be sent to a third party)

I/we wish copies to be sent to a third party and provide details below:

Name

Company

Address

Email address

Fax No.

Where I/we have requested information to be provided to me/us via email, by ticking the box opposite, I/we hereby acknowledge to such information being encrypted in such manner as may be utilised from time to time by the Administrator in order to ensure such communications are secure.

Designated bank account for redemption proceeds

Redemptions will be paid by telegraphic transfer and may be subject to bank charges. Accordingly ALL applicants must

complete the section below providing details of the account to which such monies will be transmitted.

Upon receipt of a redemption instruction pay proceeds to:

Account name* / Beneficiary

4. Redemption details


8677360.1

A6

*Account must be in the name of the registered holder. Third party payments will not be made. A request to change

bank account details must be made in writing to the Administrator and must be accompanied by a bank statement or

banker’s reference.

Name of bank

Sort/SWIFT/BIC

Account no./IBAN no.

Address

Authorised signatories for redemption

All signatories listed below signing together or any of the signatories listed below signing together are authorised to

give redemption instruction (please insert the number of signatories required)

Name

Signature

Name

Signature

Name

Signature

Name

Signature

All redemption requests must be submitted on the form contained in Appendix 3.


8677360.1

A7

Name

Introducer code

8 digit introducer reference number or code beginning with BC or DT

Address

City

State

Country

Zip/Post Code

Telephone No.

Fax No.

Name

Check this box if you wish your introducer to receive copy information (e.g. monthly shareholder statements)

I/We confirm that I am/we are 18 years of age or over and have the full right, power and authority to make the

investment pursuant to this form whether this investment is in my/our own name or is made on behalf of another person or institution.

I/We, having received and considered a copy of the current Joint Prospectus, the current Articles of Incorporation of the relevant Feeder Fund, the Articles of Incorporation of the Master Fund and the most recent annual reports, hereby confirm and declare that this application is based solely on the information contained in such documentation and is made pursuant to the terms of this Application Form.

I/We agree that the issue to me/us of the Participating Shares is subject to the provisions of the Articles of

Incorporation of the relevant Feeder Fund and the Master Fund and the Joint Prospectus, that subscription for Participating Shares will be governed and construed in accordance with Guernsey law and I/we confirm that by subscribing for Participating Shares, I/we are not relying on any information or representation other than such as may be contained in the Articles of Incorporation of the relevant Feeder Fund and the Master Fund, the Joint Prospectus and the most recent annual report thereto.

I/We hereby represent and declare that I am/we are fully informed as to: (i) the legal requirements within my/our country for the purchase of Participating Shares and are permitted to purchase the Participating Shares under the laws and regulations of my/our home country in the manner in which the Participating Shares have been offered and sold to me/us; (ii) any foreign exchange restrictions applicable to me/us; and (iii) any relevant tax considerations relating to me/us arising out of my/our purchase and ownership of Participating Shares.

5. Introducer (if applicable)

6. Declarations


8677360.1

A8

I/we acknowledge that I am/we are aware of the risk involved in the proposed investment and of the fact that inherent in such investments is the potential to lose all of the sum invested.

I/We certify that I am/we are eligible to invest in the relevant Feeder Fund in accordance with the laws of the jurisdiction in which I am/we are resident and that and I am/we are not acquiring Participating Shares for or on behalf of, or for the benefit of, any person or entity who/which is not eligible to invest in the relevant Feeder Fund nor do I/we intend transferring any Participating Shares which I/we may purchase to any person or entity who/which is not eligible to invest in the relevant Feeder Fund.

I/We agree to notify the relevant Feeder Fund or the Administrator immediately if I/we become aware that any of the

representations, declarations or warranties given by me/us in this Application Form is/are no longer accurate and complete in all respects and agree immediately to take such action as the relevant Feeder Fund may direct, including where appropriate, redemption of my/our entire holding.

I/We agree to indemnify the Master Fund, the relevant Feeder Fund, the Investment Manager, the Investment

Advisor and the Administrator, on its own behalf and as agent of the Master Fund and the relevant Feeder Fund and agree to keep the Master Fund, the relevant Feeder Fund, the Investment Manager, the Investment Advisor and the Administrator indemnified against any loss of any nature whatsoever (including but not limited to any and all losses, liabilities, damages, penalties, costs, fees and expenses (including without limitation legal fees and disbursements) arising to any of them as a result of any inaccuracy in or breach of any of the representation, warranty or declaration given by me/us in this Application Form.

I/We, if not a natural person, am/are duly organised, validly existing and in good standing under the laws of the jurisdiction in which I am/we are organised and I/we have the power and authority to enter into and perform my/our obligations under this Application Form.

I am/we are able to bear the economic risk of an investment in the Participating Shares, including, without limitation,

the risk of loss of all or a part of my/our investment. I/we do not have an overall commitment to investments which are not readily marketable that is disproportionate to my/our net worth, and my/our investment in the Participating Shares will not cause such overall commitment to be excessive.

The Administrator and the relevant Feeder Fund are each hereby authorised and instructed to accept and execute any instructions in respect of the Participating Shares to which this application relates given by me/us in written form or by facsimile. I/We hereby agree to indemnify the relevant Feeder Fund and the Administrator, on its own behalf and as agent of the relevant Feeder Fund and agree to keep the relevant Feeder Fund and the Administrator indemnified against any loss of any nature whatsoever arising as a result of the relevant Feeder Fund and/or the Administrator acting upon facsimile instructions. The relevant Feeder Fund and the Administrator 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 due to anti-money laundering requirements operating within Guernsey, the Administrator or

the relevant Feeder Fund (as the case may be) may require further identification of the applicant(s) before the application can be processed and the Administrator, on its own behalf and as agent of the relevant Feeder Fund and the relevant Feeder Fund shall be held harmless and indemnified against any loss arising as a result of a failure to process the application, or a delay in processing any redemption requests, if such information requested by the Administrator or the relevant Feeder Fund has not been provided by me/us or has been provided in incomplete form.

I/We also warrant and declare that the monies being invested pursuant to this application do not represent directly or

indirectly the proceeds of any criminal activity and the investment is not designed to conceal such proceeds so as to avoid prosecution for an offence or otherwise.

I/We acknowledge that the relevant Feeder Fund or the Administrator also reserves the right to delay or refuse to

make any redemption payment or distribution to a Shareholder (where applicable) without notice if any of the Directors or the Administrator suspects or is advised that the payment of any redemption or distribution moneys 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 relevant Feeder Fund, its Directors or the Administrator with any such laws or regulations in any relevant jurisdiction. I/We hereby hold the relevant Feeder Fund and the Administrator harmless and indemnify them against any loss arising as a result of a failure to process the application if such information has been required and has not been provided by me/us.

I/We acknowledge that the relevant Feeder Fund reserves the right to cancel without notice any contract for which

payment has not been received by the relevant Settlement Date and to recover any losses incurred.


8677360.1

A9

I/We understand and agree that any redemption proceeds paid to me/us will only be paid to a bank account in my/our name and with a recognised financial institution.

I/We hereby accept such lesser number of Participating Shares, if any, than may be specified above in respect of which this application may be accepted.

I/We acknowledge that the relevant Feeder Fund reserves the right to reject any application in whole or part without assigning any reason therefore.

In respect of joint applicants only, we direct that on the death of one of us the Participating Shares for which we

hereby apply be held in the name of and to the order of the survivor or survivors of us or the executor or administrator of the last of such survivor or survivors. I/We acknowledge and agree that in the event of the death of one or more of us the Administrator will require further documentation in relation to any proposed change of name or authority to act in respect of the Participating Shares for which we hereby apply including without limitation a copy of the relevant Grant of Probate or copy of a will.

Whilst the Directors have the ability to declare dividends pursuant to the Articles of Incorporation and the Joint

Prospectus, it is the Directors' current intention not to distribute the profits of the Fund(s). All such profits shall be

reinvested in the Fund(s). In view of the fact that the Fund(s) may not pay dividends, an investment in the Fund(s) is

not suitable for investors seeking current income.

I/We have such knowledge and experience in business and financial matters or have obtained advice from a

professional adviser such that I am/we are capable of evaluating the merits, and the risks, of an investment by me/us in the Master Fund and the relevant Feeder Fund.

I/We understand that the tax disclosure set forth in the Joint Prospectus is of a general nature and may not cover the

jurisdiction in which I am /we are subject to taxation and that the tax consequences of my/our purchase of Participating Shares depend on my/our individual circumstances.

I/We acknowledge the right of the relevant Feeder Fund at any time to require the mandatory redemption of

Participating Shares in the circumstances provided for in the Joint Prospectus. Investment Company Representations:

Please tick () as appropriate (a) I am/We are neither an investment company required to be registered under the Investment Company Act of

1940, as amended (the “1940 Act”), nor an issuer that, but for an exception from the definition of “investment company” under the 1940 Act, would be an investment company, OR

(b) I am/We are an investment company subject to registration or would be an investment company but for an

exception under the 1940 Act. I/We have ____ U.S. Person beneficial owner(s).

(State the number, not the percentage, of U.S. Person beneficial owners. Investment companies with U.S. Person beneficial owners must contact the Administrator.)

General

I/We hereby acknowledge that any notice or document may be served by the relevant Feeder Fund or Administrator

on me/us in the manner specified from time to time in the Joint Prospectus or Articles of Incorporation, if I have provided an e-mail address or fax number to the relevant Feeder Fund or its delegate, consent to any such notice or document being sent to me/us by fax or electronically to the fax number or e-mail address previously identified to the relevant Feeder Fund or its delegate which I/we acknowledge constitutes effective receipt by me/us of the relevant notice or document.

I/We acknowledge that the Investment Adviser may, if eligible, be paid a placement fee of % of the subscription amount.


8677360.1

A10

I/We understand that the confirmations, representations, declarations, indemnities and warranties made or given herein are continuous and apply to all subsequent purchases of Participating Shares by me/us in the relevant Feeder Fund.

An investment in the relevant Feeder Fund is regarded as a speculative investment. The applicant confirms that it fully

understands and accepts the risks associated with an investment in the relevant Feeder Fund. The applicant

understands that its investment in the relevant Feeder Fund may fall rather than rise in value and acknowledges that it

can bear the risk of this investment for an indefinite period, including the loss of its entire investment in the relevant

Feeder Fund.

I/We acknowledge that that for the purposes of this Application Form:

1. By submitting the personal data to the Administrator (acting for and on behalf of the relevant Feeder Fund) in the case of an Applicant, where (a) the Applicant of a natural person or (b) where the Applicant is not a natural person, they represent and warrant that they:

a) have read and understood the terms of the Data Protection Privacy Notice as set out in Appendix 6 to this Application Form; and/or

b) have brought the Data Protection Privacy Notice to the attention of any underlying Data Subjects (individuals) on whose behalf the Applicant may act or whose Personal Information will be disclosed to the Administrator or the relevant Feeder Funds and their delegates, agents or affiliates as a result of the Applicant entering into this Application Form; and

c) the Applicant has compiled in all other respects with Data Protection Laws in respect of disclosure of personal data to the Administrator and to the relevant Feeder Funds.

2. Where the Applicant acts for or on account of an underlying Data Subject (individual), they shall, in respect of the personal data it processes in relation or arising out of this Application Form:

a) comply with all applicable Data Protection Laws; b) take appropriate technical and organisational measures against the unauthorised or unlawful

processing of the personal data and against the accidental loss or destruction of, or damage to the personal data;

c) if required agree with the Administrator or relevant Feeder fund, the responsibilities of each such entity as regards relevant data subjects’ rights and notice requirements; and

d) immediately on demand, fully indemnify the Administrator and the relevant Feeder Funds and keep them fully and effectively indemnified against all costs, demands, claims and expenses (including legal costs and disbursements on a full indemnity basis), losses (including indirect losses and loss of profits, business and reputation), actions, proceedings and liabilities of whatsoever nature arising from or incurred by the Administrator or the relevant Feeder Fund in connection with any failure by the Applicant to comply with the provisions of this paragraph 2.

I/We acknowledge that due to anti-money laundering requirements operating within Guernsey, the Administrator or the relevant Feeder Fund (as the case may be) may require further identification of the applicant(s) before the application can be processed and the Administrator , on its own behalf and as agent of the relevant Feeder Fund and the relevant Feeder Fund shall be held harmless and indemnified against any loss arising as a result of a failure to process the application, or a delay in processing any redemption requests, if such information requested by the Administrator or the relevant Feeder Fund has not been provided by me/us or has been provided in incomplete form. Anti-money laundering regulations

It is a condition of each subscription that, to ensure compliance with all relevant rules and regulations designed to avoid money laundering, the Administrator will require verification of the identity of any applicant subscribing for Shares. The Administrator in Guernsey will conduct its anti-money laundering checks in accordance with with the requirements of the Guernsey Financial Services Commission and any Guidance Notes issued by it together with the provisions of The Criminal Justice (Proceeds of Crime( (Financial Services Businesses) (Bailiwick of Guernsey) Regulations 2007 (as amended by The Criminal Justice (Proceeds of Crime( (Financial Services Businesses) (Bailiwick of Guernsey) Regulations, 2014 and the Handbook for Financial Services Businesses on Countering Financial Crime and Terrorist

8. Data protection

9. Identification of subscribers under money laundering regulations

7. Investment suitability


8677360.1

A11

Financing.. The making of an application to subscribe for Shares will constitute a warranty from the applicant that such application, and the related remittance of the necessary funds, will not in any way breach any rules and regulations designed to avoid money laundering. Each applicant must provide verification of identity upon request from, and to the satisfaction of, the Administrator and the applicant warrants that all information provided in connection herewith is complete, accurate and not misleading. The applicant acknowledges that due to anti-money laundering requirements operating within Guernsey , the Administrator or the Fund (as the case may be) may require further identification of the applicant before the application can be processed and the Administrator, on its own behalf and as agent of the Fund and the Fund shall be held harmless and indemnified against any loss arising as a result of a failure to process the application, or a delay in processing any redemption requests, if such information requested by the Administrator or the Fund has not been provided or has been provided in incomplete form. No redemption payment may be made until the Administrator is satisfied that all necessary anti-money laundering checks have been completed in full.

For the purposes of the anti-money laundering regulations, the following countries referred to as the Appendix C List, may be treated as if they were local. The List derives its name from the fact that it forms Appendix C to the Handbook on Countering Financial Crime and Terrorist Financing as issued by the Guernsey Financial Services commission Australia, Austria, Belgium, Bermuda, Bulgaria, Canada, Cayman Islands, Cyprus, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Hong Kong, Hungary, Iceland, Ireland, Isle of Man, Italy, Japan, Jersey, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, New Zealand, Norway, Portugal, Singapore, Slovenia, South Africa, Spain, Sweden, Switzerland, United Kingdom, United States of America.


8677360.1

A12

Due Diligence Documentation

Due Diligence Documentary Requirements in

accordance with The Criminal Justice (Proceeds of

Crime( (Financial Services Businesses) (Bailiwick of

Guernsey) Regulations 2007 (as amended by The

Criminal Justice (Proceeds of Crime( (Financial

Services Businesses) (Bailiwick of Guernsey)

Regulations, 2014 and the Handbook for Financial

Services Businesses on Countering Financial Crime

and Terrorist

1. Guide to completing this form.

Part I- This section must be completed by all

applicants.

Part II- Please provide the due diligence documentation

outlined in this section.

2. Certification of Documents –

Certified copies of personal identification documents

and corporate documentation are required. Documents

must be a ‘certified true copy of original’.

In terms of certifying a document as a true copy,

certification means that there is an original signature on

the document from a suitable person.

Suitable persons include:

An authorised signatory of a Regulated Financial Institution or Credit Institution.

An authorised signatory of a Financial Adviser. A Justice of the Peace. A Notary Public or Practicing Solicitor. A Practicing Chartered or Certified Public

Accountant. A person authorised to sign on behalf of an

Embassy or a Consul. A Police Officer

Certification of each document should include:

A signed statement confirming that this document is a true and accurate copy of the original document as seen by the person certifying the document.

The name (in block capitals), occupation and contact details (address, telephone number and email address) of the person certifying the

document, as a true copy of the original document.

The date of certification of the document, as a true copy of the original document.

Note 1: Where the document, being certified as a true

copy of the original document, contains a photograph,

the person certifying the document as a true copy

should also confirm that this a true likeness of the

person named in the document that they have met.

Note 2: The document being provided as a true and

accurate copy of the original document must include a

wet ink signature of the person certifying the document

as a true and accurate copy of the original document

(i.e. no scanned or photocopied copies of the document

being certified as a true copy of the original document,

can be accepted).

Note 3: For multiple page documents, the certifier

should sign or initial each page of the copy and confirm

on the first or last page of the document the actual

number of pages in the document.

Note 4: Where available, the statement of certification

as a true copy of the sighted original should be

accompanied by the professional stamp or seal of the

certifier.

Note 5: When certifying documents as true copies, the

certifier should not be a close family member of, or

have any apparent or potential conflicts of interest with,

the investor.

3. English Translations

Where due diligence documents are provided in a

language other than English, the prospective investor

should, at the same time, provide a relevant extract

translated by an independent source confirming also

the adequacy of the foreign language documents.

________________________________________________


8677360.1 A13

Due Diligence Documentation- Investor Type

Part I – All Investors

Please tick investor type below (Please note, investor type indicates the documents required to open account):

Individual Private Pension Scheme

Private Company

Foundations

Limited Partnership

Charity

Trust/Settlement (includingTrustees)

Club or Society

Collective Investment Scheme/Fund

School, College or University

Listed Company

Public Body

Corporate/Employee/Superannuation PensionScheme

Other- Please specify: ______________________

Please confirm whether you are a Politically Exposed Person

A Politically Exposed Person (‘PEP’) means an individual (or family member or close associate of such individual) who is, or has,

at any, been entrusted with a prominent public function.

Due Diligence Documentation- Leverage Across Investments

I hereby authorize NTIFASGL (the administrator) to leverage the due diligence documentation provided for the purposes of

compliance with applicable regulatory requirements across all investments which I currently hold/ may hold in the future across all

funds which are administered by NTIFASGL

Due Diligence Documentation- Ultimate Beneficial Owner

Ultimate Beneficial Owners are individuals who directly or indirectly hold ownership of 25% or more of the shares or voting r ights in

an entity, or otherwise exercise control over the management of the entity. The Ultimate Beneficial Owner section must be

completed. Non-completion could delay acceptance of subscription.

* In cases where shareholder(s) are entities with over 25% ownership or control, please provide the details of Individual(s) who hold

beneficial ownership over 25%.


8677360.1 A14

Please complete the below:

Name Address % Ownership Nationality Date of Birth

Note: If there is/ are no Individual(s) with a beneficial interest of 25% or more (either directly or indirectly) of the shares or voting

rights of the entity, or anyone that otherwise exercises control of the entity (where applicable), please check the box.

Declaration - I/We declare that the information contained in this form and the attached documentation, if any, is true and accurate to

the best of my/our knowledge and belief.

Signature 1 __________________ Print Name___________________ Date_______________

Signature 2 __________________ Print Name___________________ Date_______________


8677360.1 A15

Related Person Detail

Full names of all Related Persons:

In the case of a company, Related Persons means the directors.

In the case of a Partnership, Related Persons means the partners.

In the case of a limited liability company (LLC), Related Persons means the managing members.

In the case of a trust, foundation or similar entity, Related Persons means the trustees.

In the case of a charity/government body/ university/ school/ college/ club/ society, Related Persons means the authorising officers/ board members/ officials.

1.__________________________________ 2._____________________________________

3.__________________________________ 4._____________________________________

5.__________________________________ 6._____________________________________

7.__________________________________ 8._____________________________________

9.__________________________________ 10._____________________________________

11.__________________________________ 12._____________________________________

Due Diligence Documentation- Requirements

Part II- Due Diligence Requirements

Northern Trust International Fund Administration Services (Guernsey) Limited (“NTIFAS(G)L”) is a regulated financial services

business licensed by the Guernsey Financial Services Commission (“GFSC”), under the Protection of Investors (Bailiwick of

Guernsey) Law 1987.

As a regulated financial services business, NTIFAS(G)L is subject to the Criminal Justice (Proceeds of Crime) (Financial Services

Businesses) (Bailiwick of Guernsey) Regulations 2007 and the Handbook for Financial Services Businesses on Countering

Financial Crime and Terrorist Financing (together referred to in this guide as the “Regulations”).


8677360.1 A16

In order to comply with these, NTIFAS(G)L and its’ clients (also regulated by the GFSC and subject to the Regulations) are required

to identify and verify investors in funds that it administers by collecting appropriate client due diligence (“CDD”). It shou ld be

remembered that the CDD collected must always lead to natural persons/ultimate beneficial owners.

The Regulations require that underlying principals* are also identified and sometimes verified by the collection of CDD on them. In

addition, in certain circumstances you may be required to supply additional information for example details of the source of funds

(the activity that has generated the funds to be invested) and/or source of wealth (the activities which have generated the total net

worth of the person(s) investing).

Please refer to the appropriate section that is the most relevant investing entity type (e.g. individual, company etc.) for the CDD

requirements. This guide has been drafted to detail as many investor types as possible however, it is possible that your specific

investor type may not be detailed. Also, the suggested CDD to be provided by the investor is not exhaustive. If you have queries or

require further guidance, please contact NTIFAS(G)L.

Where documentation is provided to verify identification data, NTIFAS(G)L can accept original or certified true copies of

documentation. Please ensure the instructions detailed on page 12 are followed when providing certified copies to avoid

documents being considered inappropriate.

The prompt provision of CDD should aid the speed of the investing process however, failure to provide this may result in the

investment not being accepted (with any funds provided being returned) or the sum invested being blocked and not returned until

acceptable CDD has been provided.

Individuals / parties required to be identified and verified

Individuals / parties required to be identified and verified This guide sets out the above heading in each entity type description for

required identification data. Parties listed under this heading are defined as individuals or entities which must be verified with full

documentation provided in accordance with the applicable requirements set out in the document for the legal form identified.

* Underlying principals refers to any person who is not a beneficial owner but is a settlor, trustee, protector, enforcer,

director, authorised signatory

INDIVIDUALS

* Also applicable for Directors, Shareholders, Authorised Signatories, Settlors, Trustees (non- corporate), Protectors (non-corporate) etc. Required identification data: i) Full Name ii) Date of Birth iii) Place of Birth iv) Nationality v) Personal Identification Number vi) Former names vii) Profession viii) Permanent Residential Address (PO Box, C/O addresses are not permissible) Documentation considered appropriate to verify identification data:

Current Passport (i – v above) Current National Identity Card (i – v above) Armed Forces Identity Card (i – v above) Current Utility Bill (excluding mobile phone) (viii above) Lease / Tenancy Agreement (viii above) Letter from employer (viii above) Note: All documentation must reflect the current residential address and must be dated within the previous 6 months other than in the case of an official document known to be issued only or typically at fixed intervals of more than 6 months, in which case such document may be accepted during that period, to a maximum of 12 months (e.g. correspondence from local authorities).


8677360.1 A17

___________________________________________________________________________

PRIVATE COMPANY

Required identification data / documents:

i) Full name

ii) Registered number

iii) Registered office address

iv) Principal business address

v) Details of directors

vi) Details of beneficial owners who own more than 25% of the share capital

vii) Confirmation of legal status

viii) Authorised Signatory list

Individuals required to be identified and verified

Individuals signing subscription / application document*

Parties with 25% + beneficial ownership

* should individuals be signing on behalf of a corporate director, this entity will become a subject requiring

identification and verification in accordance with requirements detailed on page 5.

Documentation considered appropriate to verify identification data:

Certificate of incorporation (or jurisdictional equivalent) (i, ii above)

Company registry search, if applicable, including confirmation that the legal body has not been, and is not in the process

of being, dissolved, struck off, wound up or terminated (vii above)

Copy of the latest audited financial statements (i, ii, iii, iv, vi above)

Extracts from Memorandum and Articles of Association or equivalent constitutional documentation (i – iv above)

Directors’ Register (v above)

Shareholders’ Register (vi above)

Companies House (or equivalent) report (i – v, vii above)

____________________________________________________________________________________________

LIMITED PARTNERSHIP

Required identification data / documents:

i) Name of limited partnership


8677360.1 A18

ii) Registered number

iii) Registration date

iv) Registered office

v) Names, addresses and percentage ownership of each limited partner

vi) Name and address of General Partner*

vii) Authorised Signatory list


- Individuals signing subscription / application document

- Parties with 25% + beneficial ownership


- Constitutional Document / Limited Partnership Agreement (i, iii, iv, v, vi above)

- Companies house (or equivalent) report (i, ii, iii, iv, vi above)

- Limited Partnership register (v above)

* The general partner must be identified and verified in accordance with the requirements of the applicable legal form (e.g.

private company, individual etc.)

____________________________________________________________________________________________

TRUST/SETTLEMENT

Required identification data:

i) Name of Trust

ii) Date of Formation

iii) Jurisdiction and applicable Law

iv) Name of economic settlor

v) Name of protector (if applicable)

vi) Schedule of beneficiaries

vii) Confirmation of the nature and purpose of the trust

viii) Name of Trustees

ix) Authorised Signatory list of Trustees



8677360.1 A19


- Trustee (see below)


- Trust Deed Extracts (i, ii, iii, iv, vi, viii above)

TRUSTEE

The trustee is considered a verification subject and the requirements will be driven by the applicable legal form as follows:

Individual Trustee: See Individuals section of this document

Corporate Trustee: See Private Company section of this document

COLLECTIVE INVESTMENT SCHEMES (‘CIS’)


i) Full name of CIS

ii) Registered address of CIS

iii) Name & address of both the scheme promoter and scheme administrator

iv) Legal form of CIS (e.g. private company, unit trust, limited partnership)*

v) Evidence of members / shareholders including % ownership of CIS

vi) Authorised Signatory list

* Once legal form is identified full documentation will be required in accordance with the requirements as set out in this

document for the associated legal form.



- Scheme Administrator (in accordance with applicable legal form requirements)

- Members / shareholders identified as having 25%+ ownership


- Prospectus / scheme particulars / other constitutive document (i – iv above)

- Letter from the scheme administrator** confirming ownership structure of the CIS (v above)

** Scheme administrator must be regulated and supervised for anti-money laundering / countering the financing of terrorism

purposes for this option to be permissible. Refer to NTIFAS(G)L for guidance on this matter.


8677360.1 A20

LISTED COMPANY


i) Evidence that the entity is listed / quoted on a recognised stock exchange*

ii) Authorised signatory list

* Stock exchanges listed in section 9 of The Insider Dealing** (Securities and Regulated Markets) Order, 1996 as

amended and any exchange which is an ordinary, associate or affiliate member of the International Organisation of Securities

Commissions or any exchange which is regulated, or supervised by, such a member.

** See annex A for list of Regulated Markets

Click here for link to IOSCO Website




- Evidence of stock exchange listing

CORPORATE/OCCUPATIONAL/EMPLOYEE PENSION PLANS


i) Full name of plan

ii) Details of grantor / sponsoring employer


iv) Confirmation of legal form (e.g. trust, body corporate)

v) Confirmation of parties appointed to oversee the scheme or plan

vi) Nature and purpose of the pension plan

vii) Authorised signatory list of scheme or plan administrator



- Scheme or plan administrator

- Grantor / sponsoring employer


http://www.iosco.org/


8677360.1 A21

- Constitutional documents (i - vi above)

____________________________________________________________________________________________

PRIVATE PENSION SCHEME


i) Full name of plan

ii) Details of grantor / sponsoring employer


iv) Confirmation of legal form (e.g. trust, body corporate)

v) Confirmation of parties appointed to oversee the scheme or plan

vi) Authorised signatory list of scheme or plan administrator



- Scheme or plan administrator

- Grantor / sponsoring employer


- Constitutional documents (i - iv above)

__________________________________________________________________________________________

FOUNDATIONS


i) Foundation name

ii) Official number

iii) Date of registration

iv) Country of registration

v) Official number

vi) Legal status

vii) Confirmation as to the nature and purpose of the foundation

viii) Authorised signatory list

ix) Written confirmation from registered agent or foundation officials of:

- Founder(s)


8677360.1 A22

- Councilors

- Guardian(s)

- Beneficiaries including and default beneficiaries

- Any other person with ultimate control over the foundation assets


- Founder(s)


- Foundation controllers (i.e. councilors, guardians, authorised signatories)


- Certificate of registration (i - v above)

- Constitutional documents (i - v above)

- Companies House / Registry (or equivalent) report (i - vi above)

- Audited financial accounts (extracts only) (i - ix above)

- Charter document (i - v above)

- Council resolution authorising investment and appointing authorised signatories

CHARITY


i) Full name

ii) Registered office address

iii) Principal office address

iv) Authorised signatory list

v) Details of any beneficiaries (where ascertainable)

vi) Identify and evidence the stated purpose, aims and objective of the charity (e.g. educational)

vii) confirm and evidence if the charity is registered with a Government Authority (e.g. charities commission)

viii) Obtain confirmation and evidence as to how the charity is funded (e.g. endowment, contributions)

ix) Obtain documentary evidence establishing the existence of the charity for example its constitution, bye-laws, rules,

objectives

x) Authorised signatory list – including instrument appointing authorised signatories


- Any individual who has signed the subscription / application document


8677360.1 A23


- Constitutional document, bye-laws, trust deed etc. (i, ii, iii, v, vi, viii, x, ix above)

- Print out from appropriate Government Authority’s website e.g. charities commission (vi, vii, ix, x above)

CLUB OR SOCIETY


i) Official name of entity

ii) Legal form

iii) Nature and purpose of entity

iv) Date entity established

v) Jurisdiction

vi) Confirmation of governing body / controlling parties

vii) Confirmation of how the entity is funded

viii) Authorised signatory list – including instrument appointing authorised signatories




- Constitution document (or equivalent) (i – vi above)

- Minutes of entity appointing controlling individuals / members (vi above)

- Public domain resources (website, marketing, publications)

SCHOOL, COLLEGE OR UNIVERSITY


i) Official name of entity

ii) Legal form

iii) Nature and purpose of entity

iv) Date entity established

v) Jurisdiction

vi) Confirmation of governing body / controlling parties

vii) Authorised signatory list – including instrument appointing authorised signatories


8677360.1 A24




- Constitution document (or equivalent) (i – vi above)

- Minutes of entity appointing controlling individuals / members / authorised signatories (vi above)

- Public domain resources (website, marketing, publications)

PUBLIC BODY


i) Full name

ii) Registered office address

iii) Nature of business and legal form

iv) Remit of the public body (e.g. International, National, State, borough etc.)

v) Ownership of the entity

vi) Confirmation as to the funding of the entity

vii) Identify any other controlling parties, persons holding office or committee members

viii) Identify the individuals authorised to execute the application / subscription documents

ix) Authorised signatory list– including instrument appointing authorised signatories



Documentation considered appropriate to verify the identification data:

- A constitutional document (i, ii, iv, v, vi, vii above)

- Dependent upon the legal form identified e.g. private company, trust, full constitutional documents will need to be

collected on entity type. Please refer to the appropriate entity in this this document for requirement


8677360.1 A25

Investor Tax Residency

Please tick () the relevant boxes for each Applicant/Joint Applicant

A U.S. Taxpayer or U.S. Person Please complete the additional information in Part A below

B Non U.S. Taxpayer holding shares on behalf

of, or for the direct or indirect benefit of, a U.S.

Taxpayer or U.S. Person

Please complete the additional information in Part A below

C Non U.S. Taxpayer Please complete the additional information in Part B below

All investors must also provide:

1. A completed form:

a. W-8BEN - For non-US individuals (see Appendix 5); or

b. W-8BEN-E – For non-US entities (see Appendix 5); or

c. W9 – For US taxpayers (see Appendix 5); and

2. A completed self-certification for CRS and FATCA (see Appendix 4).

Foreign Account Tax Compliance Act (FATCA) and Tax Information

I/we hereby agree that in order to allow the Feeder Fund to comply with the rules of Sections 1471 through 1474 (inclusive) of the Internal Revenue Code of 1986 of the US, as amended, any current or future regulations or official interpretations thereof, any agreement entered into thereunder, or any fiscal or regulatory legislation, rules or practices adopted pursuant to any intergovernmental agreement entered into in connection with the implementation thereof (“FATCA”) or the OECD Common Reporting Standard (“CRS”), I/we will:

a) provide the Feeder Fund or the Administrator (or any nominated service provider) with any information, declarations,

certificates or documentation necessary for FATCA or CRS reporting; and

b) permit the Feeder Fund or the Administrator to:

(i) share such information with the US Internal Revenue Service, the Guernsey Financial Services Commission, the Re venue Service of the States of Guernsey or any other relevant tax or other government authority as required by FATCA or CRS;

(ii) compel or effect the sale of the Shares or repurchase and cancel the Shares if it fails to comply with the foregoing requirement; and

(iii) make any other amendments to any other documents entered into in connection with the subscription as may be

necessary to enable the Feeder Fund to comply with FATCA or CRS.

I/We hereby confirm that I/we have completed the relevant self-certification and US tax forms at Appendices 4-7 to this Application Form to the best or my/our knowledge and belief.

I/We agree to provide to the Feeder Fund and the Administrator at such times as each of them may request such declarations, certificates or documents as each of them may reasonably require (the “Tax Information”) in connection with this investment

(including for the purposes of tax and/or FATCA/CRS regulations/reporting requirements). Should any information furnished to any of them become inaccurate or incomplete in any way, I/we hereby agree to notify the Feeder Fund or the Administrator immediately of any such change and further agree to request the redemption of Shares in respect of which such confirmations have become incomplete or inaccurate where requested to do so by the Feeder Fund.

By providing the Tax Information, I/we represent and warrant the completeness and accuracy of such information (as at the date of submission) and authorise the Feeder Fund to act upon such information in good faith, including, but not limited to, disclosing or submitting such information to any relevant tax authorities. The Feeder Fund shall have no obligation to carry out any investigation with respect to the truth, accuracy or completeness of the Tax Information provided by us and I/We will, on demand, hold the Feeder Fund harmless from any liability resulting from the my/our failure to provide complete and accurate Tax Information.

10. Investor Tax Residency


8677360.1 A26

I/We hereby acknowledge that if I/we fail to provide the Tax Information on a timely basis, I/We may be subject to 30% U.S. withholding tax on the investor’s share of “withholdable payments” (as defined for purposes of FATCA) received by the Feeder Fund.

I/We hereby acknowledge that if I/we fail to provide the Tax Information and such failure results in the Feeder Fund being unable to comply with any intergovernmental agreement between Guernsey and the United States or any agreement entered into with the IRS in accordance with FATCA, the Feeder Fund and its' delegate may exercise its right to completely redeem an applicant (at any time upon any or no notice). I/We further acknowledge and agree to indemnify the Feeder Fund and its other investors (including those invested in other Feeder Funds) for any losses resulting from our failure to meet its obligations under this Section, including any U.S. withholding tax imposed on the Feeder Fund.

Part A – U.S. Taxpayers

Please tick () as appropriate: (a) I am a U.S. Person (as defined in the Joint Prospectus) and I understand and acknowledge that an investment in the

relevant Feeder Fund may not be suitable for U.S. Persons that are U.S. Taxpayers; or (b) I am/We are holding Shares on behalf of a U.S. Person or a U.S. Taxpayer and I/we understand the U.S. tax

consequences of such an investment. I/We agree to provide the relevant Feeder Fund with such additional tax information as it may from time to time request.

In particular: (a) I/we understand that the relevant Feeder Fund and the Master Fund have not been and will not be registered

under the United States Investment Company Act of 1940, as amended, that the Shares have not been registered and will not

be registered under the United States Securities Act of 1933, as amended, and that the Shares have not been qualified under

the securities laws of any state of the United States.

I/We declare that the entity hereby subscribing for Shares is neither a Benefit Plan Investor nor investing on behalf of or with

any assets of a Benefit Plan Investor as defined below. (Benefit Plan Investors should contact the relevant Feeder Fund.) “Benefit Plan Investor” is used as defined in U.S. Department of Labor (“DOL”) Regulation § 2510.3-101(f)(2), and includes (i) any employee benefit plan (as defined in Section 3(3) of the Employee Retirement Income Security Act of 1974, as amended (“ERISA”)), whether or not such plan is subject to Title I of ERISA (which includes both U.S. and non-U.S. plans, plans of governmental entities as well as private employers, church plans, and certain assets held in connection with nonqualified deferred compensation plans); (ii) any plan described in Section 4975(e)(1) of the Internal Revenue Code of 1986, as amended, (the “Code”) (which includes a trust described in Code Section 401(a)) which forms a part of a plan, which trust or plan is exempt from tax under Code Section 501(a), a plan described in Code Section 403(a), an individual retirement account described in Code Section 408 or 408A or an individual retirement annuity described in Code Section 408(b), a medical savings account described in Code Section 220(d) and an education savings account described in Code Section 530); and (iii) any entity whose underlying assets include plan assets by reason of a plan’s investment in the entity (generally because 25 per cent. or more of a class of interests in the entity is owned by plans). Benefit Plan Investors also include that portion of any insurance company’s general account assets that are considered “plan assets” and (except if the entity is an investment company registered under the 1940 Act) the assets of any insurance company separate account or bank common or collective trust in which plans invest.

If I am/we are a commodity pool, my/our investment is directed by an entity which (i) is not required to be registered in any

capacity with the CFTC or to be a member of the National Futures Association (“NFA”), (ii) is exempt from registration or (ii i) is duly registered with the CFTC in an appropriate capacity or capacities and is a member in good standing of the NFA.

Each U.S. Taxpayer must complete and sign IRS Form W-9 (see Appendix 5) to certify their tax identification number. Failure to submit a completed IRS Form W-9 will result in delay in the settling of redemption proceeds (no interest will accrue).

Amounts paid to Shareholders who are U.S. Taxpayers as a distribution from the relevant Feeder Fund, or as gross proceeds from

a redemption of Shares, may be reported to Shareholders who are U.S. Taxpayers and the IRS on an IRS Form 1099 (except as

otherwise noted below). Please note that the Feeder Fund and/or the Administrator may elect not to issue Form 1099s – as such,

U.S. Taxpayers should contact the Administrator prior to investing to determine the form of tax reporting (if any) that they will

receive. Failure to provide an appropriate and properly executed IRS Form W-9 (for Shareholders who are U.S. Taxpayers) may

subject such Shareholders to backup withholding tax. Backup withholding tax is not an additional tax. Any amounts withheld may

be credited against such Shareholders’ U.S. federal income tax liability.

Tax exempt entities, corporations, non-U.S. Shareholders and certain other categories of Shareholders generally will not be subject

to reporting on IRS Form 1099 or backup withholding, provided that, in the case of tax exempt entities and corporations such

Shareholders furnish the Administrator with an appropriate and properly executed IRS Form W-9 certifying as to their tax exempt

status.


8677360.1 A27

Part B – Non U.S Taxpayers

Please tick () to confirm:

I am/We hereby certify that (a) I am not/none of us is a U.S. Person and (b) the Shares are not being acquired for the account of or the benefit of, directly or indirectly, any U.S. Person nor in violation of any applicable law, and that I/we will not, subject to the conditions set forth in the Joint Prospectus, sell or offer to sell or transfer Shares in the United States or to or for the benefit of a U.S. Person.

Each Non U.S. Taxpayer must complete and sign IRS Form W-8BEN or W-8BEN-E (see Appendix 5). Failure to submit a completed IRS Form W-8BEN or W-8BEN-E will result in delay in the settling of redemption proceeds (no interest will accrue).

Additional Definitions

“United States” means the United States of America, its territories and possessions, any state of the United States, and the District

of Columbia.

“U.S. person” means:

(i) Any natural person resident in the United States;

(ii) Any partnership or corporation organised or incorporated under the laws of the United States;

(iii) Any estate of which any executor or administrator is a U.S. person;

(iv) Any trust of which any trustee is a U.S. person;

(v) Any agency or branch of a non-United States entity located in the United States;

(vi) Any non-discretionary account or similar account (other than an estate or trust) held by a dealer or other fiduciary for the

benefit of a U.S. person;

(vii) Any discretionary account or similar account (other than an estate or trust) held by a dealer or other fiduciary organised,

incorporated, or (if an individual) resident in the United States; and

(viii) Any partnership or corporation if: (A) organised or incorporated under the laws of any jurisdiction other than the United

States; and (B) formed by a U.S. person principally for the purpose of investing in securities not registered under the

United States Securities Act of 1933, as amended unless it is organised or incorporated, and owned, by “accredited

investors” (as defined in Rule 501(a) under the United States Securities Act of 1933, as amended) who are not natural

persons, estates or trusts.

Notwithstanding the foregoing paragraphs (i) through (viii):

• any discretionary account or similar account (other than an estate or trust) held for the benefit or account of a non-U.S. person by a dealer or other professional fiduciary organised, incorporated, or (if an individual) resident in the United States shall not be deemed to be a “U.S. person”;

• any estate of which any professional fiduciary acting as executor or administrator is a U.S. person shall not be deemed to be a “U.S. person” if: (i) an executor or administrator of the estate who is not a U.S. person has sole or shared investment discretion with respect to the assets of the estate; and (ii) the estate is governed by laws other than those of the United States;

• any trust of which any professional fiduciary acting as trustee is a U.S. person shall not be deemed to be a “U.S. person” if a trustee who is not a U.S. person has sole or shared investment discretion with respect to the trust assets, and no beneficiary of the trust (and no settlor if the trust is revocable) is a U.S. person;

• an employee benefit plan established and administered in accordance with (i) the laws of a country other than the United States and (ii) the customary practices and documentation of such country, shall not be deemed to be a “U.S. person”; and

• any agency or branch of a U.S. person located outside the United States shall not be deemed a “U.S. person” if: the agency or branch (i) operates for valid business reasons, (ii) is engaged in the business of insurance or banking, and (iii) is subject to substantive insurance or banking regulation, respectively, in the jurisdiction where located.

Further, none of the International Monetary Fund, the International Bank for Reconstruction and Development, the Inter-American

Development Bank, the Asian Development Bank, the African Development Bank, the United Nations, or their agencies, affiliates

and pension plans, or any other similar international organisation, or its agencies, affiliates and pension plans, shall be deemed to

be a “U.S. person”.

“U.S. Taxpayer” includes a U.S. citizen or resident alien of the United States (as defined for U.S. federal income tax purposes); any

entity treated as a partnership or corporation for U.S. tax purposes that is created or organized in, or under the laws of, the United

States or any state thereof (including the District of Columbia); any other partnership that is treated as a U.S. Taxpayer under U.S.

Treasury Department regulations; any estate, the income of which is subject to U.S. income taxation regardless of source; and any

trust over whose administration a court within the United States has primary supervision and all substantial decisions of which are

under the control of one or more U.S. fiduciaries. Persons who have lost their U.S. citizenship and who live outside the United

States may nonetheless, in some circumstances, be treated as U.S. Taxpayers.

An investor may be a “U.S. Taxpayer” but not a “U.S. Person.” For example, an individual who is a U.S. citizen res iding outside of

the United States is not a “U.S. Person” but is a “U.S. Taxpayer.”


8677360.1 A28

The Alternative Investment Fund Managers Directive (the "AIFMD") imposes limitations on the marketing of the Fund in certain

jurisdictions in the European Economic Area (the "EEA"). Accordingly, the Fund is only being offered in such jurisdictions where

the Fund is permitted to be marketed pursuant to Article 42 of the AIFMD. In all other cases, subscriptions from investors in an

EEA member state will only be accepted where such investor is investing in the Fund on its own initiative. If you are an investor in

the EEA but are not in a jurisdiction where the Fund is permitted to be marketed pursuant to Article 42 of the AIFMD, by submitting

this Application you represent and warrant that you are doing so on your own initiative and were not solicited by or on behalf of the

Fund.

I/We confirm that the above representation and warranty is true and accurate.

I/We declare that the information contained in this Application Form and any attached documentation is true and accurate to the

best of my/our knowledge and belief.

Date Signatory capacity if applicable (i.e. Director/manager)

Name Signature

Name Signature

Name Signature

12. Signature

11. AIFMD Acknowledgement


8677360.1 A29

For value on (day/month/year) Signature in accordance with bank mandate Signature

Date

Signature

Date

CAM Bastion Dollar Fund Ltd.

US Dollar payment

SWIFT: CNORUS33 Bank: The Northern Trust International Banking Corporation, New Jersey Fedwire ABA: 026001122 CHIPS ABA: 0112 Beneficiary Account Name: NTIFASGL re CAM Bastion Dollar Fund Ltd – Client money Beneficiary Account Number 179929-20010 Reference: Investor name or Shareholder Account Number

CAM Bastion Rand Fund Ltd.

Rand payment

Intermediary SWIFT: SBZAZAJJ Intermediary Bank: Standard Bank, Johannesburg Beneficiary Bank SWIFT: CNORUS33 Beneficiary Bank: The Northern Trust International Banking Corporation, New Jersey

A/C Number: 7228490

Beneficiary Account Name: NTIFASGL re CAM Bastion Rand Fund Ltd- Client money Beneficiary Account Number: 637728-20019 Reference: Investor name or Shareholder Account Number

CAM Pinnacle Dollar Fund Ltd.

US Dollar payment

SWIFT: CNORUS33 Bank: The Northern Trust International Banking Corporation, New Jersey Fedwire ABA: 026001122 CHIPS ABA: 0112 Beneficiary Account Name: NTIFASGL re CAM Pinnacle Dollar Fund Ltd - Client money

Beneficiary Account Number:179937-20010

Reference: Investor name or Shareholder Account Number

CAM Pinnacle Rand Fund Ltd.

Rand payment

Intermediary SWIFT: SBZAZAJJ Intermediary Bank: Standard Bank, Johannesburg Beneficiary Bank SWIFT: CNORUS33 Beneficiary Bank: The Northern Trust International Banking Corporation, New Jersey

A/C Number: 7228490

Beneficiary Account Name: NTIFASGL re CAM Pinnacle Rand Fund Ltd.- Client money

Beneficiary Account Number: 637736-20019

Reference: Investor name or Shareholder Account Number

Appendix 1 – Payment Details


8677360.1 A30

Please complete this Additional Application Form which constitutes your Agreement to subscribe for additional Participating Shares in the issuing Feeder Fund referred to below and on the terms and conditions described in the Joint Prospectus for CAM Bastion Fund Limited dated 1 July 2019 as updated or amended from time to time (the "Joint Prospectus"). As described in the Joint Prospectus, each issuing Feeder Fund invests solely, apart from any necessary currency hedging (where such feeder Fund has a Base Currency other than US Dollars) into CAM Bastion Fund Limited (the "Master Fund"). Please mail or fax (if faxed, the original must also follow by mail) the completed Application Form to:

Northern Trust International Fund Administration Services (Guernsey) Limited PO Box 255, Trafalgar Court Les Banques St Peter Port Guernsey GY1 3QL

Tel: Email:

+ 44 (0) 1 481 745001 [email protected] (enquiries only)

Words used in this Application Form have the same meaning as in the Joint Prospectus unless the context otherwise requires.

If you have any questions or difficulties in relation to this application please do not hesitate to contact shareholder services on the

above number.

Details must be identical to those on the original Application Form.

Full Registered Name

Account Number

Select Participating Share Class

Please tick () the Class of Shares in which the investment will be made

Name of Share Class Base Currency and Minimum

Additional Investment*

Issuing Feeder Fund

Dollar Class $10,000 CAM Bastion Dollar Fund Limited

Rand Class ZAR100,000 CAM Bastion Rand Fund Limited

Dollar Class $10,000 CAM Bastion Dollar Fund Limited

Rand Class ZAR100,000 CAM Bastion Rand Fund Limited

*The Directors may, from time to time in their absolute discretion, specify such other Minimum Additional Investment Amount or waive the requirement for a Minimum Additional Investment Amount. Please tick () the currency in which the investment will be made

USD Rand OTHER (Please Specify)

Note: In accordance with the Joint Prospectus, payment in respect of the issue of Participating Shares must be received by the

relevant Settlement Date by telegraphic transfer in cleared funds in the currency of the relevant Class of Shares. The Administrator may, at its discretion, accept payment in other currencies, but such payments will be converted into the currency of the relevant Participating Class at the then prevailing exchange rate available to the Administrator and only the net proceeds (after deducting the conversion expenses) will be applied towards payment of the subscription moneys. This may result in a delay in processing the application. Additional investments may be made by or on behalf of the Applicant by (a) completing the form contained in Appendix 2; or (b)

sending a written instruction to Northern Trust Fund Administration Services (Guernsey) Limited specifying all relevant details. Each

time an additional investment is made, the Applicant will (unless it has notified the Administrator in writing to the contrary in

advance of such additional investment) be deemed to have acknowledged and agreed that the representations, warranties and

Appendix 2 - Additional Application Form

2. Investment details – CAM Bastion and CAM Pinnacle Funds

1. Details of applicant(s)


8677360.1 A31

covenants contained in this Application Form are true and correct in all material respects as of the date such additional investment

is to be made and that all other information provided in his Application Form remains true and correct in all material respects as of

such date.

Amount to be invested

Amount in words

All dealing instructions in relation to Participating Shares in the relevant Feeder Fund must be received before the time(s) specified in the Joint Prospectus. Dealing Instructions received after such times will generally be deemed to have been received for the next relevant Dealing Day unless the Directors in their absolute discretion, in exceptional circumstances, otherwise determine to accept one or more applications received after the Dealing Deadline for processing on that Dealing Day provided that such application(s) have been received within 5 Business Days of the Dealing Day. Investors wishing to subscribe for Participating Shares in more than one Feeder Fund must complete a separate Application Form

for each Feeder Fund.


8677360.1 A32

Name

Introducer code 8 digit introducer reference number or code beginning with BC or DT

I/We hereby acknowledge and agree that I am/we are making this additional application on the terms and conditions contained in the Joint Prospectus together with those contained in the original Application Form previously executed by me/us and dated _____________. I/We further acknowledge and agree that the representations, warranties and covenants contained in the original Application Form are true and correct in all material respects as of the date set forth below and that all other information provided in the original Application Form remains is true and correct in all material respects as of the date set forth below. Source of Funds

Please indicate the Applicant’s source of funds for this investment.

Please note the Administrator and/or the Feeder Fund may request further information regarding your source of funds.

Signature Date

Print name

Capacity Individual Corporate representative

Signature Date

Print name


3. Introducer (if applicable)

4. Declarations

5. Signatures (all applicants must sign)


8677360.1 A33

Please complete this Redemption Form which constitutes your request to redeem Participating Shares in the issuing Feeder Fund referred to below on the terms and conditions described in the Joint Prospectus for CAM Bastion Fund dated 1 July 2019 and relevant supplement each as updated or amended from time to time (the "Joint Prospectus"). Please mail or fax (if faxed, the original must follow by mail) the completed Redemption Form to: Northern Trust International Fund Administration Services (Guernsey) Limited PO Box 255, Trafalgar Court Les Banques St Peter Port Guernsey GY1 3QL

Tel: Fax: Email:

+ 353 (0) 1 434 5096 + 353 (0) 1 434 5291 [email protected] (enquiries only)

Words used in this Redemption Form have the same meaning as in the Joint Prospectus unless the context requires otherwise.

I/We confirm that I/we will comply with the redemption procedures set out in the Joint Prospectus.

I/We represent and acknowledge that the information, representations, declarations and warranties contained in my/our initial

Application Form are true and correct in all material respects as of the date set forth below.

OR

I/We confirm that the information, represent actions, declarations and warranties contained in my/our initial Subscription Form are

no longer true and correct in all material respects as of the date set forth below and I/we will contact the Administrator in this regard.

REGISTERED INFORMATION

Full Registered Name

Account Number

Select Share Classes to be redeemed

Note: In accordance with the Joint Prospectus, the amount due on redemption of Shares will be paid by telegraphic transfer to an

account in the name of the Shareholder in the currency of the relevant Class (or in such other currency as the Directors shall determine) by the Settlement Date. Payment of redemption proceeds will be made to the registered Shareholder or in favour of the joint registered Shareholders as appropriate. The proceeds of the redemption of the Shares will only be paid on receipt by the Administrator of the original Application Form and relevant anti-money laundering documentation.

Please note that redemption proceeds will only be paid to the bank account details held on file by the Administrator. If these details are no longer correct, please contact the Administrator before completing this Redemption Form. Any redemption proceeds paid in currencies other than the designated currency of the relevant Class will be converted into that currency at prevailing exchange rates. This foreign exchange transaction will be arranged by the Administrator at the cost and risk of the relevant investor. This may result in a delay in processing the payment of redemption proceeds.

I/We hereby agree to indemnify and hold harmless the Master Fund, the relevant Feeder Fund the Administrator on its own behalf and as agent for the Master Fund and the relevant Feeder Fund and their respective directors, officers and employees against any loss, liability, cost or expense (including without limitation legal fees, taxes and penalties) which may result directly or indirectly, from any misrepresentation or breach of any warranty, condition, covenant or agreement set forth herein or in any document delivered by me/us to the Master Fund, the relevant Feeder Fund or the Administrator. The relevant Feeder Fund and/or the Administrator will not be responsible or liable for the authenticity of instructions received from me/us or any

Name of Share Class Issuing Feeder Fund Specify Value and currency to be

redeemed or FULL REDEMPTION

Dollar Class CAM Bastion Dollar Fund Ltd.

Rand Class CAM Bastion Rand Fund Ltd.

1. Details of Investor

Appendix 3 - Redemption Form

2. Investment Details

3. Bank Account Details

4. Declarations

mailto:[email protected]


8677360.1 A34

authorised person and may rely upon any instruction from any such person representing himself to be a duly authorised person reasonably believed by the relevant Feeder Fund or the Administrator to be genuine.

I/We confirm that I/we have the authority to make this redemption request.

Signature Date

Print name


Signature Date

Print name


5. Signatures (all applicants must sign)


8677360.1 A35

Self-Certification for FATCA and CRS

Instructions for completion We are obliged to collect certain information about each account holder’s tax arrangements. Please complete the sections below as directed and provide any additional information that is requested. Please note that by completing this application form you are providing personal information, which may constitute ‘personal data’ within the meaning of data protection legislation. Please note that in certain circumstances we may be legally obliged to share this information, and other financial information with respect to an account holder’s interests in the Fund, with relevant tax authorities. They in turn may exchange this information, and other financial information with foreign tax authorities, including tax authorities located outside the EU. If you have any questions about this form or defining the account holder’s tax residency status, please speak to a tax adviser or local tax authority. For further information on FATCA or CRS please refer to the Irish Revenue or the OECD website at: http://www.revenue.ie/en/business/aeoi/index.html or the following link: http://www.oecd.org/tax/automatic-exchange/ in the case of CRS only. If any of the information below about the account holder’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 *)

Entity Self-Certification

Account holders that are Individuals or Controlling Persons should not complete this form and should complete the form entitled “Individual (including Controlling Persons) Self-Certification for FATCA and CRS”." on page A31. *Section 1: Account holder Identification *Account holder Name: (the "Entity”)

Country of Incorporation or Organisation:

*Current (Resident or Registered) Address:

Number: Street: City, town, State, Province or County: Postal/ZIP Code: Country: Mailing address (if different from above):

Number: Street: City, town, State, Province or County: Postal/ZIP Code: Country: *Section 2: FATCA Declaration:

Please tick () either (a), (b) or (c) 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:

Or

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

Or

c) The Entity is a US person but not a Specified U.S. Person (please also complete Sections 3, 4 and 5)

Indicate exemption:

Appendix 4 – Self-Certification for FATCA and CRS

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

http://www.oecd.org/tax/automatic-exchange/


8677360.1 A36

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

3.3 the reason why you are unable to provide a GIIN.

I. Financial Institution in a model 1 or model 2 Partner Jurisdiction ⎕

II. Registered Deemed Compliant Foreign Financial Institution ⎕

III. Participating Foreign Financial Institution ⎕

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:

I. 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: ⎕⎕⎕⎕⎕⎕.⎕⎕⎕⎕⎕.⎕⎕.⎕⎕⎕

Note: this option is only available to Sponsored Investment Entities in Model 1 IGA jurisdictions. Sponsored Investment Entities that do not have U.S. reportable accounts are not required to register and obtain a GIIN with the IRS unless and until U.S. reportable accounts are identified.

⎕

II. The Entity is an Exempt Beneficial Owner,

Please tick and confirm the category of Exempt Beneficial Owner;

I. Government Entity

II. International Organisation

III. Foreign Central Bank

IV. Exempt Retirement Fund

V. Collective Investment Vehicle Wholly Owned by Exempt Beneficial Owners.

⎕

III. The Entity is a Certified Deemed Compliant Foreign Financial Institution

(including a deemed compliant Financial Institution under Annex II of the IGA Agreement)

Indicate exemption:

⎕

IV. The Entity is a Non-Participating Foreign Financial Institution ⎕

V. The Entity is an Excepted Foreign Financial Institution Indicate exemption:

⎕

VI. The Entity is a Trustee Documented Trust. Please provide your Trustee’s name and GIIN:

Trustee’s Name:

Trustee’s GIIN: ⎕⎕⎕⎕⎕⎕.⎕⎕⎕⎕⎕.⎕⎕.⎕⎕⎕

⎕

3.4 Non-Financial Institutions (Non-Foreign Financial Entity/NFFE) under FATCA: If the Entity is not a Financial Institution, please confirm the Entity’s FATCA classification below by ticking () one of the below

categories

I. Active Non-Financial Foreign Entity ⎕

II. Passive Non-Financial Foreign Entity (“NFFE”) (Please tick the box that applies)

I. Passive Non-Financial Foreign Entity with no Controlling Persons that are

specified U.S Persons.

II. Passive Non-Foreign Financial Entity with Controlling Persons that are specified U.S

Persons. (If this box is ticked, please indicate the name of all natural Controlling Person(s)

of the Entity in section 6.1 below and separately complete and include self-certification

forms for each of your Controlling Persons)

⎕ ⎕

III. Excepted Non-Financial Foreign Entity ⎕

IV. Direct Reporting NFFE

Please provide your GIIN ⎕⎕⎕⎕⎕⎕.⎕⎕⎕⎕⎕.⎕⎕.⎕⎕⎕

⎕


8677360.1 A37

*Section 4: Common Reporting Standard (“CRS”) Declaration of Tax Residency

(Note that Entities may have more than one country of Tax Residence) Please indicate the Entity’s country 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 (“TIN”)). Please refer to the OECD CRS Web Portal for AEOI for more information on Tax Residence. If the Entity is not tax resident in any jurisdiction (e.g., because it is fiscally transparent), please indicate that below and provide its place of effective management or country in which its principal office is located. NOTE: Under the Irish legislation implementing the CRS, provision of a Tax ID number (TIN) is required to be provided unless:

a) You are tax resident in a Jurisdiction that does not issue a (TIN) Or b) You are tax resident in a non-reportable Jurisdiction (i.e. Ireland or the USA).

Country of Tax Residency Tax ID Number ∞If TIN unavailable Select (A, B

or C) and check box below

∞If a TIN is unavailable, please provide the appropriate reason A, B or C where indicated below:

Reason A - The country/jurisdiction where the Account Holder is resident does not issue TINs or TIN equivalents to its residents Reason B - The Account Holder is otherwise unable to obtain a TIN (Please explain why you are unable to obtain a TIN if you

selected Reason B)

Reason C - No TIN is required. (Note: Only select this reason if the domestic law of the relevant country/jurisdiction does not

require the collection of the TIN issued by such country/jurisdiction)

*Section 5: Entity’s CRS Classification

(The information provided in this section is for CRS. Please note an Entity's CRS classification may differ from its FATCA

classification in Section 3 above). In addition please note that the information that the Entity has to provide may differ depending on

whether they are resident in a participating or non-participating CRS Jurisdiction. For more information please see the OECD CRS

Standard and associated commentary. http://www.oecd.org/tax/automatic-exchange/common- reporting-standard/common-

reporting-standard-and-related-commentaries/#d.en.345314

5.1 Financial Institutions under CRS: If the Entity is a Financial Institution, Resident in either a Participating or Non-Participating CRS Jurisdiction please review and tick () one of the below categories that applies and specify the type of Financial Institution below.

Note: Please check the Guernsey Revenue AEOI portal at the time of completion of this form to confirm whether your country of

Tax Jurisdiction is considered Participating or Non-Participating for the purposes of CRS Due-Diligence in Guernsey.

http://www.oecd.org/tax/automatic-exchange/common-reporting-standard/common-reporting-standard-and-related-commentaries/#d.en.345314




8677360.1 A38

I. A Reporting Financial Institution resident in a participating CRS jurisdiction ⎕

II. A Financial Institution Resident in a Non-Participating Jurisdiction.

An Investment Entity resident in a Non-Participating Jurisdiction and managed by another Financial Institution (If this box is ticked, please indicate the name of any Controlling Person(s) of the Entity in section 6 below and complete a separate individual self-certification forms for

each of your Controlling Persons“)

An Investment Entity resident in a Non-Participating Jurisdiction that is not managed by another Financial Institution

Other Financial Institution, including a Depository Financial Institution, Custodial Institution or

Specified Insurance Company

⎕

III. Non-Reporting Financial Institution under CRS. Specify the type of Non-Reporting Financial Institution below:

Governmental Entity International

Organization Central Bank

Broad Participation Retirement Fund

Narrow Participation Retirement Fund

Pension Fund of a Governmental Entity, International Organization, or Central Bank

Exempt Collective Investment Vehicle

Trust whose trustee reports all required information with respect to all CRS Reportable

Accounts

Qualified Credit Card Issuer

Other Entity defined under the domestic law as low risk of being used to evade tax. Specify the type provided in the domestic law:

⎕

5.2 Non Financial Institutions (“NFE”) under CRS: If the Entity is not defined as a Financial Institution under CRS then, please tick () one of the below categories confirming if you

are an Active or Passive NFE.

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

securities market.

Please provide the name if the established securities market on which the corporation is regularly traded:

⎕

II. Active Non-Financial Entity – if you are a Related Entity of a regularly traded corporation. Please provide the name of the regularly traded corporation that the Entity is a Related Entity of: Please provide details of the securities market that the entity is listed on:

⎕

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

IV. Active Non-Financial Entity – an International Organisation ⎕

V. Active Non-Financial Entity – other than those listed in I, II, III or IV above. (for example a start-up NFE or a non-profit NFE)

⎕

VI. Passive Non-Financial Entity (If this box is ticked, please also complete Section 6.1 below and indicate the name of all natural Controlling Person(s) of the Entity and complete a separate Individual Self-Certification Form for each of your Controlling Person(s))

⎕

Controlling Persons NB: Please note that each Controlling Person must complete a Separate Individual Self-Certification form. If there are no natural person(s) who exercise control of the Entity then the Controlling Person will be the natural person(s) who hold the position of senior managing official of the Entity.

For further information on Identification requirements under CRS for Controlling Persons, see the Commentary to Section VIII of the CRS Standard. http://www.oecd.org/tax/automatic-exchange/common-reporting-standard/common-reporting-standard-and-related-commentaries/#d.en.345314





8677360.1 A39

Name of All Controlling Person(s) of the Account Holder:

If you have ticked sections 5.2 VI above, then please complete section 6.1 and 6.2 below: 6.1 Indicate the name of all Controlling Person(s) of the Account Holder:

I.

II.

III.

Note: In case of a trust, Controlling Persons means the settlor(s), the trustee(s), the protector(s) (if any), the beneficiary (ies) or class(es) of beneficiary(ies), AND any other natural person(s) exercising ultimate effective control over the trust. With respect to an

Entity that is a legal person, if there are no natural person(s) who exercise control over the Entity, then the Controlling Person will be the natural person who holds the position of senior managing official of the Entity. 6.2 Complete a separate Individual (Controlling Person’s) Self-Certification for FATCA and CRS for each Controlling Person listed in Section 6.1.

*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 acknowledge the fact that the information contained in this form and information regarding the Account Holder may be reported to

the tax authorities of the country in which this account(s) is/are maintained and exchanged with tax authorities of another country or countries in which the Account Holder may be tax resident where those countries (or tax authorities in those countries) have entered into Agreements to exchange financial account information. I/We on behalf of the Entity undertake to advise the recipient promptly and provide an updated Self-Certification form within 30 days where any change in circumstance (for guidance refer to Irish Revenue or OECD website) 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):


8677360.1 A40

Individual (including Controlling Person’s) Self-Certification Instructions for completion Instructions for completion and Data Protection Notice We are obliged to collect certain information about each account holder’s tax arrangements. Please complete the sections below as directed and provide any additional information that is requested. Please note that by completing this form you are providing personal information which may constitute personal data within the meaning of data protection legislation. Please note that in in certain circumstances we may be legally obliged to share this information, and other financial information with respect to an account holder’s interests in the Fund, with Revenue, the Irish tax authority. They may in turn exchange this information, and other financial information with foreign tax authorities, including tax authorities outside the EU. If you have any questions about this form or defining the account holder’s tax residency status, please speak to a tax adviser or local tax authority. For further information on FATCA or CRS please refer to the Irish Revenue or OECD websites at: http://www.revenue.ie/en/business/aeoi/index.html or the following link to the OECD CRS Information Portal at: http://www.oecd.org/tax/automatic-exchange/ in the case of CRS only. If any of the information below about the account holder’s tax residence or FATCA/CRS classification changes in the future, please advise of these changes promptly. Please note that where there are joint account holders each account holder is required to complete a separate Self-Certification form. Section 1, 2, 3 and 5 must be completed by all Account holders or Controlling Persons. Section 4 should only be completed by any individual who is a Controlling Person of an entity account holder which is a Passive Non-Financial Entity, or a Controlling Person of an Investment Entity located in a Non-Participating Jurisdiction and managed by another Financial Institution. For further guidance see :http://www.oecd.org/tax/automatic-exchange/common-reporting- standard/common-reporting-standard-and-related-commentaries/#d.en.345314 (Mandatory fields are marked with an *) *Section 1: Account Holder/Controlling Person Identification

*Account Holder/Controlling Person Name*:

*Current Residential Address:

Number: Street: City, town, State, Province or County: Postal/ZIP Code: Country: Mailing address (if different from above):

Number: Street: City, town, State, Province or County: Postal/ZIP Code: Country: *Place and Date of Birth

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

*Date of Birth: ________________________

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






8677360.1 A41

*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. *Section 3: CRS Declaration of Tax Residency/Residencies (please confirm all Tax Residencies)

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 (“TINs”)). For further guidance please refer to the OECD CRS Information Portal (http://www.oecd.org/tax/automatic-exchange/). NOTE: Under the Irish legislation implementing the CRS, provision of a Tax ID number (TIN) is required to be provided unless:

a) You are tax resident in a Jurisdiction that does not issue a (TIN), or, b) You are tax resident in a non-reportable Jurisdiction (i.e. Ireland or the USA)

Country of Tax Residency Tax ID Number ∞If TIN unavailable Select (A, B

or C) and check box below

∞If a TIN is unavailable, please provide the appropriate reason A, B or C where indicated below:

Reason A - The country/jurisdiction where the Account Holder is resident does not issue TINs or TIN equivalents to its residents

Reason B - No TIN is required. (Note: Only select this reason if the domestic law of the relevant country/jurisdiction does not

require the collection of the TIN issued by such country/jurisdiction) Reason C - The Account Holder is otherwise unable to obtain a TIN (Please explain why you are unable to obtain a TIN if you

selected Reason C)

Section 4 – Type of Controlling Person

(ONLY to be completed by an individual who is a Controlling Person of an entity which is a Passive Non-Financial Entity or an Investment Entity located in a Non-Participating Jurisdiction and managed by another Financial Institution) For joint or multiple Controlling Persons please complete a separate Self-Certification form for each Controlling Person.

Please Confirm what type of Controlling Person applicable under CRS that applies to you/the investor by ticking the appropriate box.

Please Tick ()

Entity Name

Controlling Person of a legal person – control by ownership

Controlling Person of a legal person – control by other means

Controlling Person of a legal person – senior managing official

Controlling Person of a trust - settlor

Controlling Person of a trust – trustee

Controlling Person of a trust – protector

Controlling Person of a trust – beneficiary

Controlling Person of a trust – other

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

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

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

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



8677360.1 A42

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

*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 acknowledge the fact that the information contained in this form and information regarding the Account Holder may be reported to the tax authorities of the country in which this account(s) is/are maintained and exchanged with tax authorities of another country or countries in which the Account Holder may be tax resident where those countries (or tax authorities in those countries) have entered into Agreements to exchange financial account information. I undertake to advise the recipient promptly and provide 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.

*Authorised Signature: *Print Name: *Date: (dd/mm/yyyy): *Capacity (if Controlling Person):

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 jurisdiction.

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(ies) 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/)

https://en.wikipedia.org/wiki/Organisation_for_Economic_Co-operation_and_Development

https://en.wikipedia.org/wiki/Organisation_for_Economic_Co-operation_and_Development

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

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


8677360.1 A43

All investors are required to submit appropriate tax forms. The most current versions of such forms are located at the following

websites:

Form W-8BEN

http://www.irs. gov/pub/irs-pdf/fw8ben.pdf

Instructions for W-8BEN

http://www.irs. gov/pub/irs-pdf/iw8ben.pdf

Form W-8BEN-E

http://www.irs.gov/pub/irs-pdf/fw8bene.pdf

Instructions for W-8BEN-E

http://www.irs.gov/pub/irs-pdf/iw8bene.pdf

Form W-8ECI

http://www.irs. gov/pub/irs-pdf/fw8eci.pdf

Instructions for W-8ECI

http://www.irs. gov/pub/irs-pdf/iw8eci.pdf

Form W-8EXP

http://www.irs. gov/pub/irs-pdf/fw8exp.pdf

Instructions for W-8EXP

http://www.irs. gov/pub/irs-pdf/iw8exp.pdf

Form W-8IMY

http://www.irs.gov/pub/irs-pdf/fw8imy.pdf

Instructions for W-8IMY

http://www.irs.gov/pub/irs-pdf/iw8imy.pdf

Appendix 5 – Tax Forms

http://www.irs.ustreas.gov/pub/irs-pdf/fw8ben.pdf

http://www.irs.ustreas.gov/pub/irs-pdf/iw8ben.pdf

http://www.irs.gov/pub/irs-pdf/fw8bene.pdf

http://www.irs.gov/pub/irs-pdf/iw8bene.pdf

http://www.irs.ustreas.gov/pub/irs-pdf/fw8eci.pdf

http://www.irs.ustreas.gov/pub/irs-pdf/iw8eci.pdf

http://www.irs.ustreas.gov/pub/irs-pdf/fw8exp.pdf

http://www.irs.ustreas.gov/pub/irs-pdf/iw8exp.pdf

http://www.irs.gov/pub/irs-pdf/fw8imy.pdf

http://www.irs.ustreas.gov/pub/irs-pdf/iw8imy.pdf


8677360.1 A44

This Privacy Notice sets out how personal data is collected, processed and disclosed in connection with the Master Fund and the

Feeder Fund (together the "Funds").

We take privacy and security of your information seriously and will only use such personal information as set out in this Privacy

Notice.

As a result of your investment (or an investment made by a person firm or entity with which you have a connection) in the Funds, your personal information may be provided to the Funds, Peregrine Guernsey Limited (the "Manager") and Northern Trust International Fund Administration Services (Guernsey) Limited (the "Administrator"). The Funds will act as a data controller and the Manager and Administrator will process data on behalf of the Funds. When processing your personal information, there may also be times where the Manager and the Administrator will act as a data controller. The Funds, the Manager or the Administrator of the Funds, may process your personal information or such data in respect of your directors, officers, employees or beneficial owners. As each of the Funds, the Manager and the Administrator are entities incorporated in Guernsey, the Funds, the Manager and the Administrator are obliged to comply with the provisions of the Guernsey data protection laws.

This Privacy Notice should be read in conjunction with the Data Privacy Notice of the Northern Trust group, which can be

accessed at https://www.northerntrust.com/emea-privacy-notice.

1 Where we obtain your personal data:

1.1 Your personal data comprises the following categories:

1.1.1 information obtained from identification documentation (including name, contact details, nationality and national identify numbers (where applicable));

1.1.2 employment history, income and personal wealth and source of wealth; 1.1.3 tax status and tax identification numbers; and 1.1.4 bank account details.

1.2 We primarily collect your personal data from the following sources:

1.2.1 from information which you or your authorized representative gives to us, including but not limited to:

(a) information set out in any application form with the Funds; (b) such other forms and documents as we may request that are completed in relation to the

administration/management of any investment in the Funds; (c) client due diligence documentation as part of our regulatory requirements; and (d) any personal data provided by you by way of correspondence with us by phone, e-mail or otherwise;

1.2.2 personal data we receive from you or any third party sources which may include:

(a) entities in which you or someone connected to you has an interest; (b) your legal and/or financial advisors; (c) other financial institutions who hold and process your personal data to satisfy their own regulatory

requirements; and (d) credit reference agencies and financial crime databases for the purposes of complying with our

regulatory requirements.

1.3 We may also collect and process your personal data in the course of dealing with advisors, regulators, official authorities and service providers by whom you are employed or engaged or for whom you act.

Appendix 6 – Data Protection Privacy Notice

https://www.northerntrust.com/emea-privacy-notice


8677360.1 A45

2 Why we collect your Personal data: Lawful grounds for processing:

2.1 The Funds, the Manager and the Administrator are entitled to hold and process your personal data on the following lawful grounds:

2.1.1 the processing is necessary for the legitimate interests of the Funds, the Manager and the Administrator

provided your interests and fundamental rights do not override those interests;

2.1.2 where the Applicant is a natural person, the processing is necessary to comply with our respective contractual duties to you under the terms of our application form with you and all supplemental agreements thereto;

2.1.3 to comply with the legal and regulatory obligations of each of the Funds, the Manager and the Administrator;

2.1.4 (on exceptional occasions) where we have obtained your consent; and

2.1.5 (on rare occasions) where it is needed in the public interest.

Some of the grounds for processing described above will overlap and there may be several grounds which justify

our use of your personal data.

Inaccurate or Amended Information

2.2 Please let us know if any of your personal data (including correspondence details) changes as soon as possible. Failure

to provide accurate information or to update changed information may have a detrimental impact upon your investment including, the processing of any subscription or redemption instructions or the suspension of your account. Failure to provide information where the same is required for anti-money laundering, pursuant to automatic exchange of information agreements, or other legal requirements means that the Funds may not, or may no longer, be able to accept you as an investor in the Funds.

Purposes of processing

2.3 Pursuant to paragraph 2.1, the Funds, the Manager and the Administrator may process your personal data, for the

purposes set out below (“Purposes”). Those based wholly or partly on our legitimate interests are set out in paragraphs 2.1.1 to 2.3.7 inclusive):

2.3.1 conducting credit reference checks;

2.3.2 to facilitate the opening of your account with the Funds, the management and administration of your holdings

in the Funds and any related account on an on-going basis which are necessary for the performance of your contract with the Funds, including without limitation the processing of redemption, conversion, transfer and additional subscription requests, and the payment of distributions;

2.3.3 communicating with you as necessary in connection with your affairs and generally in connection with your

investment in the Funds;

2.3.4 operating the Funds', the Manager's and the Administrator's IT systems, software and business applications;

2.3.5 supporting our IT and business applications support teams, accounting, legal, reporting, internal audit and risk management, administrative, transfer, document storage, record keeping and other related functions, including but not limited to processing personal data in connection with the Funds;

2.3.6 monitoring and recording telephone and electronic communications and transactions: (a) for quality, business analysis, training and related purposes in order to improve service delivery;


8677360.1 A46

(b) for investigation and fraud prevention purposes, for crime detection, prevention, investigation and prosecution of any unlawful act (or omission to act); and

(c) to enforce or defend the Funds’, the Manager and the Administrator's respective rights, either themselves

or through third parties to whom we each may delegate such responsibilities or rights in order to comply with a legal or regulatory obligations imposed on each of us;

2.3.7 disclosing your personal data (including identity and Interest in the Funds to any bank, financial institution or

other third party lender providing any form of facility, loan, finance or other form of credit or guarantee to the Funds;

2.3.8 detecting and preventing crime such as fraud, money laundering, terrorist financing, bribery, corruption, tax evasion and to prevent the provision of financial and other services to persons who may be subject to economic or trade sanction on an ongoing basis ("Regulatory Assessments");

2.3.9 facilitating the internal administration of each of the Funds, the Manager and the Administrator and retaining your personal data as part of our Regulatory Assessments or future services entered into by you;

2.3.10 liaising with or reporting to any regulatory authority (including tax authorities) with whom the Funds, the Manager or the Administrator is either required to cooperate with, or report to, or with whom it decides or deems appropriate to cooperate in relation to an investment, and which has jurisdiction over the Funds or its investments, the Manager or the Administrator in a third country without the same or similar data protection laws as Guernsey or any EU member state (a "Third Country without Adequacy");

2.3.11 communicating with our professional advisers for the purposes of obtaining professional advice; and

2.3.12 conducting business analytics and diagnostics.

We will only use your personal information for the purposes for which we collected it unless we reasonably consider

that we need to use it for another reason and that reason is compatible with the original purpose. If we need to use

your personal information for an unrelated purpose, we will notify you and we will explain the legal basis which allows

us to do so. Please note that we may process your personal information without your knowledge or consent, in

compliance with the above rules, where these are required or permitted by law.

2.4 To the extent that such personal data contains special category data such as, for example: data relating to racial or ethnic origin, political opinion, religious or philosophical belief, trade union membership or criminal data then the processing of such data shall solely be for the purpose of complying with any duty imposed on the Funds, the Manager and/or the Administrator by an enactment including, but not limited to, legislation and regulatory obligations relating to Anti-Money Laundering and Combatting the Financing of Terrorism and all other related legislation.

2.5 None of the Funds, the Manager or the Administrator makes decisions about you based on automated processing of

your personal data.

3 Sharing personal data 3.1 The Funds, the Manager and/or the Administrator may share your personal data with group companies and third

parties (including bank, financial institution or other third party lenders, IT service providers, auditors and legal professionals) under the terms of any appropriate delegation or contractual arrangement. Those authorized third parties may, in turn, process your personal data abroad and may have to disclose it to foreign authorities to help them in their fight against crime and terrorism.

3.2 Data processing (as described above) may be undertaken by any entity in the Bailiwick of or an entity who is located

outside the Bailiwick of Guernsey or the European Economic Area in a Third Country without Adequacy including but not limited to South Africa.

3.3 This means that the country or countries to which we transfer your data are not deemed to provide an adequate level

of protection for your personal information. However, to ensure that your personal data receives an adequate level of protection we will put in place Standard Contractual Clauses to ensure that your personal information is treated by


8677360.1 A47

those third parties in a way that is consistent with and which respects the EU laws and the laws of the Bailiwick of Guernsey on data protection. Please contact the Funds, the Manager or the Administrator for copies of the Standard Contractual Clauses that have been entered into on behalf of the Funds.

4 Retention of personal data

4.1 Your personal data will be retained for the longest of the following periods:

4.1.1 for the Funds, the Manager, the Administrator and/or any authorised third parties to carry out the Purposes for which the data was collected or as long as is set out in any relevant agreement you enter into with us);

4.1.2 in order to establish or defend legal rights or obligations or to satisfy any reporting or accounting obligations;

and/or

4.1.3 any retention period that is required by Data Protection Laws and any applicable laws or regulatory requirements.

4.2 The Funds, the Manager and the Administrator shall endeavour to store your personal data securely in accordance with

accepted market standards and may do so either electronically or manually.

4.3 Whilst the Funds, the Manager and the Administrator have taken every reasonable care to ensure the implementation of appropriate technical and security measures, the Funds, the Manager and the Administrator cannot guarantee the security of your personal data over the internet, via email or via their websites nor do the Funds, the Manager and the Administrator accept, to the fullest extent permitted by law, any liability for any errors in data transmission, machine, software or operating error or any other cause.

5 Your rights

5.1 You have, under certain circumstances, the following rights in respect of personal data:

5.1.1 the right to access and port personal data;

5.1.2 the right to rectify personal data;

5.1.3 the right to restrict the use of personal data;

5.1.4 the right to request that personal data is erased; and

5.1.5 the right to object to processing of personal data.

5.2 You also have the right to lodge a complaint with the Guernsey Data Protection Authority or a supervisory authority in the EU member state of your usual residence or place of work or of the place of the alleged breach if you consider that the processing of your personal data carried out by the Funds, the Manager, the Administrator of any other service provider to the Funds, has breached data protection laws. You may also appeal to certain courts against (i) any failure of the Guernsey Data Protection Authority to give written notice of whether the complaint is either being investigated or not being investigated and where applicable, the progress and the outcome of the investigation and (ii) a determination of the Guernsey Data Protection Authority not to investigate the complaint or a determination that a controller or processor has not breached or is not likely to breach an operative provision in connection with the complaint.

5.3 In limited circumstances we may approach you for your written consent to allow us to process certain particularly sensitive data or to use data for another purpose. Where you may have provided your consent to the collection, processing and transfer of your personal data for a specific purpose, you have the right to withdraw your consent for that specific processing at any time. To withdraw your consent, please contact [email protected]. Once we have received notification that you have withdrawn your consent, we will no longer process your information for the purpose or purposes you originally agreed to, unless we have another legitimate basis for doing so pursuant to applicable law.


8677360.1 A48

6 How to contact us:

If you have any questions about our use of your personal data, our retention procedures or our security processes, please contact [email protected] .