ARTESIAN CORPORATE BOND FUND –CLASS A APPLICATION FORM
This application form accompanies the Product Disclosure Statement (PDS)/Information Memorandum (IM)relating to units in the following product/s issued by Equity Trustees Limited (ABN 46 004 031 298, AFSL
240975). The PDS/IM contains information about investing in the Fund/Trust. You should read the PDS/IM in
its entirety before applying.
Artesian Corporate Bond Fund - Class A
The law prohibits any person passing this Application Form on to another person unless it is accompanied by acomplete PDS/IM.
If completing by hand, use a black or blue pen and print within the boxes in BLOCK LETTERS, if you
make a mistake, cross it out and initial. DO NOT use correction fluid
The investor(s) must complete and sign this form
Keep a photocopy of your completed Application Form for your records
U.S. Persons: This offer is not open to any U.S. Person. Please refer to the PDS/IM for further information.

Foreign Account Tax Compliance Act (FATCA) and Common Reporting Standard (CRS)
We are required to collect certain information to comply with FATCA and CRS, please ensure you complete
section 7.

If investing with an authorised representative, agent or financial adviser
Please ensure you, your authorised representative, agent and/or financial adviser also complete Section 6.

Provide certified copies of your identification documents
Please refer to section 9 on AML/CTF Identity Verification Requirements.

Send your documents & make your payment
See section 2 for payment options and where to send your application form.

Equity Trustees Application Form – 2022

SECTION 1 – YOUR CONSUMER ATTRIBUTESIn relation to our Design and Distribution Obligations (DDO) under the Corporations Act, we seek thefollowing information about your attributes as an investor (please tick only 1 box for each question below)

1. Have you received advice prior to applying to invest in the Fund?

☐

I/We have received personal advice in relation to my investment in this Fund☐

I/We have received general advice in relation to my investment in this Fund☐

I/We have not received any advice in relation to my investment in this Fund

2. What is your primary investment objective(s)?

☐Capital growth☐

Capital preservation☐

Capital guaranteed☐

Income Distribution

3. Please select the intended use of this Fund in your investment portfolio☐

Solution/Standalone – A large allocation (75%-100% of portfolio)☐Core component – A medium allocation (25%-75% of portfolio)☐

Satellite/Small Allocation – A small allocation (<25% of portfolio)

4. Please select the Intended investment timeframe☐

Short term (<=2 years)☐

Long term (>8 years)☐

Medium term (>2 years)

5. What is your tolerance for risk?

☐

Low - I/we can tolerate up to 1 period of
underperformance over 20 years☐

Medium - I/we can tolerate up to 4 periodsof underperformance over 20 years.

☐

High - I/we can tolerate up to 6 periods ofunderperformance over 20 years☐

Very High - I/we can tolerate more than 6
periods of underperformance over 20
years

6. What do you anticipate your withdrawal needs may be?

☐

Daily

☐

Weekly☐Monthly☐

Quarterly☐

Annually or longer

Please note:
1. Failure to complete the above questions may result in your application not being accepted;
2. Acceptance of your application should not be taken as a representation or confirmation that an investment in
the Fund is, or is likely to be, consistent with your intentions, objectives and needs as indicated in yourresponses to these questions; and3. For further information on the suitability of this product, please refer to your financial adviser and/or the
TMD

Equity Trustees Application Form – 2022

SECTION 1.2 – ARE YOU AN EXISTING INVESTOR IN THE FUND/TRUST AND
WISH TO ADD TO YOUR INVESTMENT?
Do you have an existing investment in the Fund/Trust and the information provided remains current andcorrect?

☐

Yes, if you can tick both of the boxes below, complete Sections 2 and 8☐

I/We confirm there are no changes to our identification documents previously provided and that theseremain current and valid.

☐

I/We confirm there have been no changes to our FATCA or CRS status

Existing investor number:If there have been changes in your identification documents or FATCA/CRS status since your last
application, please complete the full Application Form as indicated below.

☐

No, please complete sections relevant to you as indicated below:
Investor Type:☐

Individuals/Joint: complete section 2, 3, 6 (if applicable), 7, 8 & 9☐Companies: complete section 2, 4, 6 (if applicable), 7, 8 & 9☐Custodians on behalf of underlying clients: complete section 2, 4, 5, 5.1, 6 (if applicable), 7, 8 & 9☐

Trusts/superannuation funds:
with an individual trustee – complete sections 2, 3, 5, 6 (if applicable), 7, 8 & 9with a company as a trustee – complete sections 2, 4, 5, 6 (if applicable), 7, 8 & 9

If you are an Association, Co-operative, Partnership, Government Body or other type of entity not listed
above, please contact Equity Trustees.

Equity Trustees Application Form – 2022

SECTION 2 – INVESTMENT DETAILS
Investment to be held in the name(s) of (must include name(s) of investor(s))

Postal address

SuburbState

Email address

PostcodeCountry

Contact no.

FUND/TRUST NAMEAPIR CODEAPPLICATIONAMOUNT (AUD)

Artesian Corporate Bond Fund – Class A

ETL8268AU$

The minimum initial investment is $25,000.

Distribution Instructions
If you do not select a distribution option, we will automatically reinvest your distribution. If you select cash, please
ensure you provide your bank details below.

☐

Reinvest distributions if you select this option your distribution will be reinvested in the Fund/Trust☐Pay distributions to the bank if you select this option your distribution will be paid to the bank account below

Investor bank details
For withdrawals and distributions (if applicable), these must match the investor(s)’ name and must be an AUDdenominated bank account with an Australian domiciled bank.
Financial institution name and branch location

BSB number

Account number

Account name

Payment method☐ Cheque – payable to <Equity Trustees Limited as RE of the Artesian Corporate Bond Fund>☐ Direct credit – pay to:
Financial institution nameand branch location

National Australia Bank Limited, 105 Miller Street, North Sydney, NSW 2060

BSB number

082 401

Account number

71 533 1487

Account name

Equity Trustees Limited as RE of the Artesian Corporate Bond Fund

Reference<Investor Name>

Equity Trustees Application Form – 2022

Regular savings plan – please ensure you complete and sign the direct debit section below
Fund/Trust nameRegular savings planamount (AUD)

Regular savings plan start date*Artesian Corporate Bond Fund

$

15

/

/

*Funds will be deducted on or around the 15th of each month☐ Direct debit – complete below:
I/We request and authorise Mainstream Fund Services Pty Ltd (Direct Debit User ID 364011) to arrange, through its
own financial institution, a debit to my/our nominated account any amount Equity Trustees has deemed payable byme/us. This debit or charge will be made through the Bulk Electronic Clearing System (“BECS”) from my/our accountheld at the financial institution I/we have nominated below and will be subject to the “Direct Debit terms andconditions” (contained in the <PDS/IM>).
Financial institution name and branch location

BSB number

Account number

Account nameAcknowledgement
By signing and/or providing Equity Trustees with a valid instruction in respect to my/our direct debit request, I/wehave understood and agreed to the terms and conditions governing the debit arrangements between me/us andEquity Trustees as set out in the “Direct Debit terms and conditions” (contained in the <PDS/IM>).
Signature – Investor 1

Signature – Investor 2

Date
/

/

/

/

Date

If signing for a company please include full name and capacity for signing (e.g. director)

Source of investment
Please indicate the source of the investment amount (e.g. retirement savings, employment income):

Send your completed Application Form to:
Mainstream Fund Services Pty Ltd
GPO Box 4968 Sydney NSW 2001
Additional applications may be faxed to: +61 2 9251 3525

Please ensure you have completed all relevant sections and signed the Application Form

Equity Trustees Application Form – 2022

SECTION 3 – INVESTOR DETAILS – INDIVIDUALS/JOINT
Please complete if you are investing individually, jointly or you are an individual or joint trustee.
See Group A AML/CTF Identity Verification Requirements in Section 9
Investor 1
Title

First name(s)SurnameResidential address (not a PO Box/RMB/Locked Bag)

SuburbState

PostcodeCountry

Email address(Statements will be sent to this address, unless you elect otherwise in
Section 6)

Date of birth (DD/MM/YYYY)/

Contact no.

Tax File Number* – or exemption code/

Country of birthOccupation

Does the investor named above hold a prominent public position or function in a government body (local, state,
territory, national or foreign) or in an international organisation or are you an immediate family member or abusiness associate of such a person?

☐

☐

No

Yes, please give details:

Investor 2
Title

First name(s)SurnameResidential address (not a PO Box/RMB/Locked Bag)

SuburbState

PostcodeCountry

Email address(Statements will be sent to this address, unless you elect otherwise in
Section 6)

Date of birth (DD/MM/YYYY)/

Contact no.

Tax File Number* – or exemption code/

Country of birthOccupation

Does the investor named above hold a prominent public position or function in a government body (local, state,
territory, national or foreign) or in an international organisation or are you an immediate family member or abusiness associate of such a person?

☐

No

☐

Yes, please give details:

Equity Trustees Application Form – 2022

SECTION 4 – INVESTOR DETAILS – COMPANIES/CORPORATE TRUSTEE
Please complete if you are investing for a company or where the company is acting as trustee.
See Group B AML/CTF Identity Verification Requirements in Section 9
Full company name (as registered with ASIC or relevant foreign registered body)

Registered office address (not a PO Box/RMB/Locked Bag)

SuburbState

PostcodeCountryTax File Number* – or exemption code

Australian Company Number

Australian Business Number* (if registered in Australia) or equivalent foreign company identifier

Contact Person
Title

First name(s)Surname

Email address(Statements will be sent to this address, unless you elect otherwise in
Section 6)

Contact no.

Principal place of business: If the principal place of business is the same as the registered office street address,
state ‘As above’ below. Otherwise provide address details. For foreign companies registered with ASIC pleaseprovide a local agent name and address if you do not have a principal place of business in Australia.
Principal Place of Business Address (not a PO Box/RMB/Locked Bag)

SuburbState

PostcodeCountry

Registration details
Name of regulatory body

Identification number (e.g. ARBN)

Controlling Persons, Directors and Beneficial Owners
All beneficial owners who own, hold or control either directly or indirectly 25% or more of the issued capital of a
proprietary or private company that is not regulated i.e. does not have an AFSL or ACLN etc., will need toprovide Group A AML/CTF Identity Verification Requirements specified in Section 9. In the case of an
unregulated public company not listed on a securities exchange, provide the details of the senior managing
official(s) as controlling person(s) (e.g. managing director, senior executive(s) etc. who is/are authorised to signon the company’s behalf, and make policy, operational and financial decisions) in the following sections. All
proprietary and private companies, whether regulated or unregulated, must provide the names of all of thedirectors.

Equity Trustees Application Form – 2022

Names of the Directors of a Proprietary or Private Company whether regulated or
unregulated
1

2

3

4

If there are more than 4 directors, please write the other names below.
Names of the Beneficial Owners or Senior Managing Official(s)Select:☐Beneficial owner 1 of an unregulated proprietary or private company; OR☐

Senior Managing Official of an unregulated, unlisted, public (e.g. Limited) company

Title

First name(s)SurnameResidential address (not a PO Box/RMB/Locked Bag)

SuburbState

PostcodeCountry

Date of birth (DD/MM/YYYY)//

Does the beneficial owner named above hold a prominent public position or function in a government body (local,
state, territory, national or foreign) or in an international organisation or are you an immediate family member or abusiness associate of such a person?

☐

☐

No

Yes, please give details:

Select:☐Beneficial owner 2 of an unregulated proprietary or private company; OR☐

Senior Managing Official of an unregulated, unlisted, public (e.g. Limited) company

Title

First name(s)SurnameResidential address (not a PO Box/RMB/Locked Bag)

SuburbState

PostcodeCountry

Date of birth (DD/MM/YYYY)//

Does the beneficial owner named above hold a prominent public position or function in a government body (local,
state, territory, national or foreign) or in an international organisation or are you an immediate family member or abusiness associate of such a person?

☐

No

☐

Yes, please give details:

If there are more than 2 beneficial owners or managing officials, please copy and complete this page forthe other persons or alternatively, provide the additional details as an attachment.

Equity Trustees Application Form – 2022

SECTION 5 – INVESTOR DETAILS – TRUSTS/SUPERANNUATION FUNDS
Please complete if you are investing for a trust or superannuation fund.
See Group C AML/CTF Identity Verification Requirements in section 9
Full name of trust or superannuation fundFull name of business (if any)Country where established

Australian Business Number* (if obtained)

Tax File Number* – or exemption code

Trustee details – How many trustees are there?

☐

Individual trustee(s) – complete Section 3 – Investor details – Individuals/Joint☐

Company trustee(s) – complete Section 4 – Investor details – Companies/Corporate Trustee☐

Combination – trustee(s) to complete each relevant section

Type of Trust☐

Registered Managed Investment Scheme
Australian Registered Scheme Number (ARSN)☐

Regulated Trust (including self-managed superannuation funds and registered charities that are trusts)
Name of Regulator (e.g. ASIC, APRA, ATO, ACNC)

Registration/Licence details or ABN☐

Other Trust (unregulated)
Please describe

Beneficiaries of an unregulated trust
Please provide details below of any beneficiaries who directly or indirectly are entitled to an interest of 25% ormore of the trust.
1

2

3

4

If there are no beneficiaries of the trust, describe the class of beneficiary (e.g. the name of the family group,class of unit holders, the charitable purpose or charity name):Equity Trustees Application Form – 2022

Other Trust (unregulated) Continued
Settlor details
Please provide the full name and last known address of the settlor of the trust where the initial asset
contribution to the trust was greater than $10,000.

☐

This information is not required if the initial asset contribution was less than $10,000, and/or☐This information is not required if the settlor is deceased

Settlor’s full name and last known address

Beneficial owners of an unregulated trust
Please provide details below of any beneficial owner of the trust. A beneficial owner is any individual who
directly or indirectly has a 25% or greater interest in the trust or is a person who exerts control over the trust.
This includes the appointer of the trust who holds the power to appoint or remove the trustees of the trust.
All beneficial owners will need to provide Group A AML/CTF Identity Verification Requirements in Section 9
Beneficial owner 1 or Controlling Person 1
Select:☐Beneficial owner 1; OR☐

Controlling Person – What is the role e.g. Appointer:

Title

First name(s)SurnameResidential address (not a PO Box/RMB/Locked Bag)

SuburbState

Date of birth (DD/MM/YYYY)

Postcode/Country/

Does the beneficial owner named above hold a prominent public position or function in a government body (local,
state, territory, national or foreign) or in an international organisation or are you an immediate family member or abusiness associate of such a person?

☐

No

☐

Yes, please give details:

Beneficial owner 2 or Controlling Person 2
Select:☐Beneficial owner 2; OR☐

Controlling Person – What is the role e.g. Appointer:

Title

First name(s)SurnameResidential address (not a PO Box/RMB/Locked Bag)

SuburbDate of birth (DD/MM/YYYY)

State

Postcode//CountryEquity Trustees Application Form – 2022

Does the beneficial owner named above hold a prominent public position or function in a government body (local,
state, territory, national or foreign) or in an international organisation or are you an immediate family member or abusiness associate of such a person?

☐

No

☐

Yes, please give details:

If there are more than 2 beneficial owners or controlling persons, please copy and complete this page forthe other persons or alternatively, provide the additional details as an attachment.

SECTION 5.1 – CUSTODIAN ATTESTATION: CHAPTER 4, PARTS 4.4.18 AND
4.4.19 OF THE AML/CTF RULES
If you are a Company completing this Application Form on behalf of an individual, another company, atrust or other entity, in a Custodial capacity, please complete this section.
In accordance with Chapter 4, part 4.4.19 (1)(a) to (d) of the AML/CTF Rules, does the Custodian meet thedefinition (see ‘Section 10 – Glossary’) of a Custodian?

☐

No

☐

Yes

In accordance with Chapter 4, part 4.4.19 (e) of the AML/CTF Rules, do you, in your capacity as Custodian attest
that prior to requesting this designated service from Equity Trustees, it has carried out and will continue to carryout, all applicable customer identification procedures on the underlying account holder named or to be named in
the Fund’s register, including conducting ongoing customer due diligence requirements in accordance with Chapter
15 of the AML/CTF Rules?

☐

No

☐

Yes

If you answered YES to all of the above questions, then Equity Trustees is able to apply the Chapter 4, part 4.4
Custodian rules to this account and will rely upon the customer due diligence conducted by the Custodian on theunderlying account holder named or to be named in the Fund’s register.
If requested to do so at any time after the provision of this designated service, the Custodian agrees to honour any
reasonable request made by Equity Trustees for information or evidence about the underlying account holder inorder to allow Equity Trustees to meet its obligations under the AML/CTF Act.

☐

No

☐

Yes

Excepting the below circumstances where the custodian answered NO or did not complete any of the above
questions, no other information about the underlying account holder is required to be collected. However, further
information about you as the Custodian and as a company is required to be collected and verified as required by
the AML/CTF rules. Please complete the rest of this form for the Custodian.
Excepting circumstances:If you answered NO or did not complete any of the above questions, then we are unable to apply the Chapter 4,part 4.4 Custodian rules to this application. We are therefore obligated to conduct full Know Your Client procedureson the underlying account holder named or to be named in the Fund’s register including any named nominee, as
well as the trustees, beneficial owners and controlling persons of the underlying named account in addition to theCustodian. Therefore, please complete the relevant forms and provide identity documents for all parties connectedto this account.

Equity Trustees Application Form – 2022

SECTION 6 – AUTHORISED REPRESENTATIVE, AGENT AND/OR FINANCIAL
ADVISER
Please complete if you are appointing an authorised representative, agent and/or financial adviser.
See Group D AML/CTF Identity Verification Requirements in Section 9☐

I am an authorised representative or agent as nominated by the investor(s)You must attach a valid authority such as Power of Attorney, guardianship order, grant of probate,appointment of bankruptcy etc. that is a certified copy. The document must be current and complete, signedby the investor or a court official and permits the authorised representative or agent to transact on behalf of
the investor.
Full name of authorised representative or agent

Role held with investor(s)Signature☐

Date

I am a financial adviser as nominated by the investor
Name of adviser

AFSL number

Dealer group

Name of advisory firm

Postage address

SuburbState

Email address

PostcodeCountry

Contact no.

Financial Advice (only complete if applicable)☐

The investor has received personal financial product advice in relation to this investment from a licensed
financial adviser and that advice is current.

Financial Adviser Declaration☐

I/We hereby declare that I/we are not a US Person as defined in the PDS/IM.

☐

I/We hereby declare that the investor is not a US Person as defined in the PDS/IM.

☐

I/We have attached the relevant CIP documents;

Signature

DateEquity Trustees Application Form – 2022

Access to information
Unless you elect otherwise, your authorised representative, agent and/or financial adviser will also be provided
access to your investment information and/or receive copies of statements and transaction confirmations. By
appointing an authorised representative, agent and/or financial adviser you acknowledge that you have read andagreed to the terms and conditions in the PDS/IM relating to such appointment.

☐

Please tick this box if you DO NOT want your authorised representative, agent and/or financial adviser tohave access to information about your investment.

☐

Please tick this box if you DO NOT want copies of statements and transaction confirmations sent to yourauthorised representative, agent and/or financial adviser.

☐

Please tick this box if you want statements and transaction confirmations sent ONLY to your authorised
representative, agent and/or financial adviser.

Equity Trustees Application Form – 2022

SECTION 7 – FOREIGN ACCOUNT TAX COMPLIANCE ACT (FATCA), COMMONREPORTING STANDARD (CRS) SELF-CERTIFICATION FORM – ALL INVESTORSMUST COMPLETE
Sub-Section I – Individuals
Please fill this Sub-Section I only if you are an individual. If you are an entity, please fill Sub-Section II.
1. Are you a US tax resident (e.g. US citizen or US resident)?

☐

Yes: provide your US Taxpayer Identification Number (TIN) and continue to question 2
Investor 1
Investor 2☐

No: continue to question 2

2. Are you a tax resident of any other country outside of Australia?

☐

Yes: state each country and provide your TIN or equivalent (or Reason Code if no TIN is provided) for eachjurisdiction below and skip to question 12
Investor 1
Country/Jurisdiction of tax
residence

TIN

If no TIN available enter Reason
A, B or C

TIN

If no TIN available enter Reason
A, B or C

1
2
Investor 2Country/Jurisdiction of tax
residence
1
2
If more space is needed please provide details as an attachment.

☐

No: skip to question 12

Reason Code:If TIN or equivalent is not provided, please provide reason from the following options:Reason A: The country/jurisdiction where the investor is resident does not issue TINs to its residents.
Reason B: The investor is otherwise unable to obtain a TIN or equivalent number (Please explain why theinvestor is unable to obtain a TIN in the below table if you have selected this reason).
Reason C: No TIN is required. (Note. Only select this reason if the domestic law of the relevant jurisdiction does
not require the collection of the TIN issued by such jurisdiction).
If Reason B has been selected above, explain why you are not required to obtain a TIN:
Reason B explanation
Investor 1
Investor 2

Equity Trustees Application Form – 2022

Sub-Section II – Entities
Please fill this Sub-Section II only if you are an entity. If you are an individual, please fill Sub-Section I.
3. Are you an Australian complying superannuation fund?

☐Yes: skip to question 12☐

No: continue to question 4

FATCA
4. Are you a US Person?

☐

Yes: continue to question 5☐

No: skip to question 6

5. Are you a Specified US Person?

☐

Yes: provide your TIN below and skip to question 7☐

No: indicate exemption type and skip to question 7

6. Are you a Financial Institution for the purposes of FATCA?

☐

Yes: provide your Global Intermediary Identification Number (GIIN)

If you do not have a GIIN, please provide your FATCA status below and then continue to question 7. If you
are a sponsored entity, please provide your GIIN above and your sponsor’s details below and then continue
to question 7.

☐☐

Exempt Beneficial Owner, provide type below:☐

Deemed-Compliant FFI (other than a Sponsored Investment Entity or a Trustee Documented Trust),
provide type below:☐

Non-Participating FFI, provide type below:☐

Sponsored Entity. Please provide the Sponsoring Entity’s name and GIIN:☐

Trustee Documented Trust. Please provide your Trustee’s name and GIIN:☐

Other, provide details:

No: continue to question 7

Equity Trustees Application Form – 2022

CRS
7. Are you a tax resident of any country outside of Australia and the US?

☐

Yes: state each country and provide your TIN or equivalent (or Reason Code if no TIN is provided) for eachjurisdiction below and continue to question 8
Investor 1
Country/Jurisdiction of tax
residence

TIN

If no TIN available enter Reason
A, B or C

TIN

If no TIN available enter Reason
A, B or C

1
2
Investor 2Country/Jurisdiction of tax
residence
1
2
If more space is needed please provide details as an attachment.
Reason Code:If TIN or equivalent is not provided, please provide reason from the following options:Reason A: The country/jurisdiction where the investor is resident does not issue TINs to its residents.
Reason B: The investor is otherwise unable to obtain a TIN or equivalent number (Please explain why theinvestor is unable to obtain a TIN in the below table if you have selected this reason).
Reason C: No TIN is required. (Note. Only select this reason if the domestic law of the relevant
jurisdiction does not require the collection of the TIN issued by such jurisdiction).
If Reason B has been selected above, explain why you are not required to obtain a TIN:
Reason B explanation
Investor 1
Investor 2☐

No: continue to question 8

8. Are you a Financial Institution for the purpose of CRS?

☐☐

Yes: specify the type of Financial Institution below and continue to question 9☐

Reporting Financial Institution☐

Non-Reporting Financial Institution:☐

Trustee Documented Trust☐

Other: please specify:

No: skip to question 10

9. Are you an investment entity resident in a non-participating jurisdiction for CRS purposes and managed
by another financial Institution?

☐

Yes: skip to question 11☐

No: skip to question 12

Equity Trustees Application Form – 2022

Non-Financial Entities
10. Are you an Active Non-Financial Entity (Active NFE)?

☐

Yes: specify the type of Active NFE below and skip to question 12:☐

Less than 50% of the entity’s gross income from the preceding calendar year is passive income (e.g.
dividends, distribution, interests, royalties and rental income) and less than 50% of its assets during thepreceding calendar year are assets held for the production of passive income☐

Corporation that is regularly traded or a related entity of a regularly traded corporation
Provide name of Listed Entity:and exchange on which traded:☐☐

Governmental Entity, International Organisation or Central Bank☐

Other: please specify:

No: you are a Passive Non-Financial Entity (Passive NFE). Continue to question 11

Controlling Persons
11. Does one or more of the following apply to you:
Is any natural person that exercises control over you (for corporations, this would include directors or
beneficial owners who ultimately own 25% or more of the share capital) a tax resident of any country outsideof Australia?
If you are a trust, is any natural person including trustee, protector, beneficiary, settlor or any other natural
person exercising ultimate effective control over the trust a tax resident of any country outside of Australia?
Where no natural person is identified as exercising control of the entity, the controlling person will be thenatural person(s) who holds the position of senior managing official.

☐Yes. provide controlling person information below:
Controlling person 1
Title

First name(s)SurnameResidential address (not a PO Box/RMB/Locked Bag)

SuburbState

Date of birth (DD/MM/YYYY)Country/Jurisdiction of tax
residence1
2

Postcode/
TIN

Country/
If no TIN available enter Reason
A, B or C

Equity Trustees Application Form – 2022

Controlling person 2
Title

First name(s)SurnameResidential address (not a PO Box/RMB/Locked Bag)

SuburbState

Date of birth (DD/MM/YYYY)Country/Jurisdiction of tax
residence

Postcode/Country/

TIN

If no TIN available enter Reason
A, B or C

1
2
If there are more than 2 controlling persons, please provide details as an attachment.
Reason Code:If TIN or equivalent is not provided, please provide reason from the following options:Reason A: The country/jurisdiction where the investor is resident does not issue TINs to its residents.
Reason B: The investor is otherwise unable to obtain a TIN or equivalent number (Please explain why theinvestor is unable to obtain a TIN in the below table if you have selected this reason).
Reason C: No TIN is required. (Note. Only select this reason if the domestic law of the relevant
jurisdiction does not require the collection of the TIN issued by such jurisdiction).
If Reason B has been selected above, explain why you are not required to obtain a TIN:
Reason B explanation
Investor 1
Investor 2☐

No: continue to question 12

12. Signature and Declaration – ALL investors must sign☐

I undertake to provide a suitably updated self-certification within 30 days of any change in circumstances
which causes the information contained herein to become incorrect.

☐

I declare the information above to be true and correct.

Investor 1

Investor 2

Name of individual/entity

Name of individual/entity

Name of authorised representative

Name of authorised representative

Signature

Signature

Date

Date

Equity Trustees Application Form – 2022

SECTION 8 – DECLARATIONS – ALL INVESTORS MUST COMPLETE
In most cases the information that you provide in this form will satisfy the AML/CTF Act, the US Foreign AccountTax Compliance Act (FATCA) and the Common Reporting Standard (CRS). However, in some instances the
Responsible Entity may contact you to request further information. It may also be necessary for the Responsible
Entity to collect information (including sensitive information) about you from third parties in order to meet its
obligations under the AML/CTF Act, FATCA and CRS.
When you complete this Application Form you make the following declarations:
I/We have received the PDS/IM and made this application in Australia (and/or New Zealand for those offers
made in New Zealand).
I/We have read the PDS/IM to which this Application Form applies and agree to be bound by the terms andconditions of the PDS/IM and the Constitution of the relevant Fund/Trust in which I/we have chosen to invest.
I/we have carefully considered the features of Fund/Trust as described in the PDS (including its investment
objectives, minimum suggested investment timeframe, risk level, withdrawal arrangements and investor
suitability) and, after obtaining any financial and/or tax advice that I/we deemed appropriate, am/are satisfied
that my/our proposed investment in the Fund/Trust is consistent with my/our investment objectives, financial
circumstances and needs.*
I/We have considered our personal circumstances and, where appropriate, obtained investment and/or taxation
advice.
I/We hereby declare that I/we are not a US Person as defined in the PDS/IM.
I/We acknowledge that (if a natural person) I am/we are 18 years of age or over and I am/we are eligible to holdunits in the Fund/Trust in which I/We have chosen to invest.
I/We acknowledge and agree that Equity Trustees has outlined in the PDS/IM provided to me/us how andwhere I/we can obtain a copy of the Equity Trustees Group Privacy Statement.
I/We consent to the transfer of any of my/our personal information to external third parties including but notlimited to fund administrators, fund investment manager(s) and related bodies corporate who are locatedoutside Australia for the purpose of administering the products and services for which I/we have engaged theservices of Equity Trustees or its related bodies corporate and to foreign government agencies for reporting
purposes (if necessary).
I/we hereby confirm that the personal information that I/we have provided to Equity Trustees is correct andcurrent in every detail, and should these details change, I/we shall promptly advise Equity Trustees in writing of
the change(s).
I/We agree to provide further information or personal details to the Responsible Entity if required to meet its
obligations under anti-money laundering and counter-terrorism legislation, US tax legislation or reporting
legislation and acknowledge that processing of my/our application may be delayed and will be processed at theunit price applicable for the Business Day as at which all required information has been received and verified.
If I/we have provided an email address, I/we consent to receive ongoing investor information including PDS/IM
information, confirmations of transactions and additional information as applicable via email.
I/We acknowledge that Equity Trustees does not guarantee the repayment of capital or the performance of theFund/Trust or any particular rate of return from the Fund/Trust.
I/We acknowledge that an investment in the Fund/Trust is not a deposit with or liability of Equity Trustees and issubject to investment risk including possible delays in repayment and loss of income or capital invested.
I/We acknowledge that Equity Trustees is not responsible for the delays in receipt of monies caused by the
postal service or the investor’s bank.
If I/we lodge a fax application request, I/we acknowledge and agree to release, discharge and agree toindemnify Equity Trustees from and against any and all losses, liabilities, actions, proceedings, account claims
and demands arising from any fax application.
If I/we have completed and lodged the relevant sections on authorised representatives, agents and/or financial
advisers on the Application Form then I/we agree to release, discharge and indemnify Equity Trustees from andagainst any and all losses, liabilities, actions, proceedings, account claims and demands arising from Equity
Trustees acting on the instructions of my/our authorised representatives, agents and/or financial advisers.
If this is a joint application each of us agrees that our investment is held as joint tenants.
I/We acknowledge and agree that where the Responsible Entity, in its sole discretion, determines that:
I/we are ineligible to hold units in a Fund/Trust or have provided misleading information in my/our
Application Form; orI/we owe any amounts to Equity Trustees, then I/we appoint the Responsible Entity as my/our agent tosubmit a withdrawal request on my/our behalf in respect of all or part of my/our units, as the case requires,in the Fund/Trust.
For Wholesale Clients* – I/We acknowledge that I am/we are a Wholesale Client (as defined in Section 761Gof the Corporations Act 2001 (Cth)) and are therefore eligible to hold units in the Fund/Trust.
For New Zealand applicants* – I/we have read the terms of the offer relating to New Zealand investors,
including the New Zealand warning statement.
For New Zealand Wholesale Investors* – I/We acknowledge and agree that:
I/We have read the “New Zealand Wholesale Investor Fact Sheet” and PDS/IM or “New ZealandInvestors: Selling Restriction” for the Fund/Trust;I am/We are a Wholesale Investor and am/are therefore eligible to hold units in the Fund/Trust; andI/We have not:

Equity Trustees Application Form – 2022▪

Offered, sold, or transferred, and will not offer, sell, or transfer, directly or indirectly, any units in theFund/Trust;▪ Granted, issued, or transferred, and will not grant, issue, or transfer, any interests in or options over,directly or indirectly, any units in the Fund/Trust; and▪ Distributed and will not distribute, directly or indirectly, the PDS/IM or any other offering materials or
advertisement in relation to any offer of units in the Fund/Trust, in each case in New Zealand, otherthan to a person who is a Wholesale Investor; andI/We will notify Equity Trustees if I/we cease to be a Wholesale Investor; andI/We have separately provided a signed Wholesale Investor Certification located at the end of thisApplication Form.
All references to Wholesale Investor in this Declaration are a reference to Wholesale Investor in terms of clause
3(2) of Schedule 1 of the Financial Markets Conduct Act 2013 (New Zealand).
* Disregard if not applicable.
*Terms and conditions for collection of Tax File Numbers (TFN) and Australian Business Numbers (ABN)
Collection of TFN and ABN information is authorised and its use and disclosure strictly regulated by tax laws andthe Privacy Act. Investors must only provide an ABN instead of a TFN when the investment is made in the courseof their enterprise. You are not obliged to provide either your TFN or ABN, but if you do not provide either or claim
an exemption, we are required to deduct tax from your distribution at the highest marginal tax rate plus Medicare
levy to meet Australian taxation law requirements.
For more information about the use of TFNs for investments, contact the enquiries section of your local branch of
the ATO. Once provided, your TFN will be applied automatically to any future investments in the Fund/Trust whereformal application procedures are not required (e.g. distribution reinvestments), unless you indicate, at any time,that you do not wish to quote a TFN for a particular investment. Exempt investors should attach a copy of thecertificate of exemption. For super funds or trusts list only the applicable ABN or TFN for the super fund or trust.
When you sign this Application Form you declare that you have read, agree to and make the declarations
above
Investor 1

Investor 2

Name of individual/entity

Name of individual/entity

Capacity (e.g. Director, Secretary, Authorised
signatory)

Capacity (e.g. Director, Secretary, Authorised
signatory)

Signature

Signature

Date

Date

Company Seal (if applicable)

Equity Trustees Application Form – 2022

SECTION 9 – AML/CTF IDENTITY VERIFICATION REQUIREMENTS
The AML/CTF Act requires the Responsible Entity to adopt and maintain an Anti-Money Laundering andCounter-Terrorism Financing (AML/CTF) Program. The AML/CTF Program includes ongoing customer due
diligence, which may require the Responsible Entity to collect further information.
Identification documentation provided must be in the name of the investor.
Non-English language documents must be translated by an accredited translator. Provide both the foreign
language document and the accredited English translation.
Applications made without providing this information cannot be processed until all the necessary information
has been provided.
If you are unable to provide the identification documents described please contact Equity Trustees.
These documents should be provided as an original or a CERTIFIED COPY of the original.

Who can certify?
Below is an example of who can certify proof of ID documents under the AML/CTF requirements:
Bailiff
Bank officer with 5 or more years of continuous
service
Building society officer with 5 or more years ofcontinuous service
Chiropractor (licensed or registered)Clerk of court
Commissioner for Affidavits
Commissioner for Declarations
Credit union officer with 5 or more years ofcontinuous service
Dentist (licensed or registered)
Fellow of the National Tax Accountant's Association
Finance company officer with 5 or more years ofcontinuous service
Judge of a court
Justice of the peace
Legal practitioner (licensed or registered)
Magistrate
Marriage celebrant licensed or registered under
Subdivision C of Division 1 of Part IV of the Marriage
Act 1961
Master of a court
Medical practitioner (licensed or registered)
Member of Chartered Secretaries Australia
Member of Engineers Australia, other than at thegrade of student
Member of the Association of Taxation andManagement Accountants

Member of the Australian Defence Force with 5 ormore years of continuous service
Member of the Institute of Chartered Accountants inAustralia, the Australian Society of Certified
Practicing Accountants or the Institute of Public
Accountants
Member of the Parliament of the Commonwealth, aState, a Territory Legislature, or a local government
authority of a State or Territory
Minister of religion licensed or registered under
Subdivision A of Division 1 of Part IV of the Marriage
Act 1961
Nurse (licensed or registered)
Optometrist (licensed or registered)
Permanent employee of Commonwealth, State or
local government authority with at least 5 or more
years of continuous service.
Permanent employee of the Australian Postal
Corporation with 5 or more years of continuous
service
Pharmacist (licensed or registered)
Physiotherapist (licensed or registered)
Police officer
Psychologist (licensed or registered)
Registrar, or Deputy Registrar, of a court
Sheriff
Teacher employed on a full-time basis at a school or
tertiary education institution
Veterinary surgeon (licensed or registered)

When certifying documents, the following process must be followed:
All copied pages of original proof of ID documents must be certified and the certification must not be older than
2 years.
The authorised individual must ensure that the original and the copy are identical; then write or stamp on the
copied document “certified true copy”. This must be followed by the date and signature, printed name andqualification of the authorised individual.
In cases where an extract of a document is photocopied to verify customer ID, the authorised individual should
write or stamp “certified true extract”.

Equity Trustees Application Form – 2022

GROUP A – Individuals/Joint
Each individual investor, individual trustee, beneficial owner, or individual agent or authorised representative must
provide one of the following primary photographic ID:☐

A current Australian driver’s licence (or foreign equivalent) that includes a photo and signature.

☐

An Australian passport (not expired more than 2 years previously).

☐

A foreign passport or international travel document (must not be expired)☐

An identity card issued by a State or Territory Government that includes a photo.

If you do NOT own one of the above ID documents, please provide one valid option from Column A and one valid
option from Column B.
Column A

Column B☐

Australian birth certificate.

☐☐

Australian citizenship certificate.

☐

Pension card issued by Department of Human
Services.

A document issued by the Commonwealth or a
State or Territory within the preceding 12 months
that records the provision of financial benefits tothe individual and which contains the individual’s
name and residential address.

☐

A document issued by the Australian Taxation
Office within the preceding 12 months that records
a debt payable by the individual to the
Commonwealth (or by the Commonwealth to theindividual), which contains the individual’s nameand residential address. Block out the TFN before
scanning, copying or storing this document.

☐

A document issued by a local government body orutilities provider within the preceding 3 months
which records the provision of services to that
address or to that person (the document must
contain the individual’s name and residential
address).

☐

If under the age of 18, a notice that: was issued tothe individual by a school principal within thepreceding 3 months; and contains the name andresidential address; and records the period of timethat the individual attended that school.

Equity Trustees Application Form – 2022

GROUP B – Companies
For Australian Registered Companies, provide one of the following (must clearly show the Company’s full name, type(private or public) and ACN):☐

A certified copy of the company’s Certificate of Registration or incorporation issued by ASIC.

☐

A copy of information regarding the company’s licence or other information held by the relevant Commonwealth,State or Territory regulatory body e.g. AFSL, RSE, ACL etc.

☐

A full company search issued in the previous 3 months or the company’s last annual statement issued by ASIC.

☐

If the company is listed on an Australian securities exchange, provide details of the exchange and the ticker(issuer) code.

☐

If the company is a majority owned subsidiary of a company listed on an Australian securities exchange, provide
details of the holding company name, its registration number e.g. ACN, the securities exchange and the ticker(issuer) code.

All of the above must clearly show the company’s full name, its type (i.e. public or private) and the ACN issued byASIC.
For Foreign Companies, provide one of the following:☐

A certified copy of the company’s Certificate of Registration or incorporation issued by the foreign jurisdiction(s)in which the company was incorporated, established or formed.

☐

A certified copy of the company’s articles of association or constitution.

☐

A copy of a company search on the ASIC database or relevant foreign registration body.

☐

A copy of the last annual statement issued by the company regulator.

All of the above must clearly show the company’s full name, its type (i.e. public or private) and the ARBN issued by
ASIC, or the identification number issued to the company by the foreign regulator.
In addition, please provide verification documents for each beneficial owner or controlling person (senior
managing official and shareholder) as listed under Group A.
A beneficial owner of a company is any person entitled (either directly or indirectly) to exercise 25% or more of thevoting rights, including a power of veto, or who holds the position of senior managing official (or equivalent) and isthus the controlling person.

Equity Trustees Application Form – 2022

GROUP C – Trusts
For a Registered Managed Investment Scheme, Government Superannuation Fund or a trust registered with theAustralian Charities and Not-for-Profit Commission (ACNC), or a regulated, complying Superannuation Fund,retirement or pension fund (including a self-managed super fund), provide one of the following:☐

A copy of the company search of the relevant regulator’s website e.g. APRA, ASIC or ATO.

☐

A copy or relevant extract of the legislation establishing the government superannuation fund sourced from agovernment website.

☐

A copy from the ACNC of information registered about the trust as a charity☐

Annual report or audited financial statements.

☐

A certified copy of a notice issued by the ATO within the previous 12 months.

☐

A certified copy of an extract of the Trust Deed (i.e. cover page and signing page and first two pages that
describes the trust, its purpose, appointer details and settlor details etc.)

For all other Unregulated trust (including a Foreign trust), provide the following:☐

A certified copy of an extract of the Trust Deed (i.e. cover page and signing page and first two pages that
describes the trust, its purpose, appointer details and settlor details etc.)
If the trustee is an individual, please also provide verification documents for one trustee as listed underGroup A.
If the trustee is a company, please also provide verification documents for a company as listed underGroup B.

GROUP D – Authorised Representatives and Agents
In addition to the above entity groups:☐

If you are an Individual Authorised Representative or Agent – please also provide the identification
documents listed under Group A.

☐

If you are a Corporate Authorised Representative or Agent – please also provide the identification documents
listed under Group B.

All Authorised Representatives and Agents must also provide a certified copy of their authority to act for the investor
e.g. the POA, guardianship order, Executor or Administrator of a deceased estate, authority granted to a bankruptcy
trustee, authority granted to the State or Public Trustee etc.

Equity Trustees Application Form – 2022

SECTION 10 – GLOSSARY
Custodian – means a company that:a) is acting in the capacity of a trustee; andb) is providing a custodial or depository service of the kind described in item 46 of table 1 in subsection 6(2) ofthe Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (AML/CTF Act); andc) either:i. holds an Australian financial services licence authorising it to provide custodial or depository services
under the Corporations Act 2001; orii. is exempt under the Corporations Act 2001 from the requirement to hold such a licence; andd) either:i. satisfies one of the ‘geographical link’ tests in subsection 6(6) of the AML/CTF Act; orii. has certified in writing to the relevant reporting entity that its name and enrolment details are entered on
the Reporting Entities Roll; ande) has certified in writing to the relevant reporting entity that it has carried out all applicable customer
identification procedures and ongoing customer due diligence requirements in accordance with Chapter 15 of
the AML/CTF Rules in relation to its underlying customers prior to, or at the time of, becoming a customer ofthe reporting entity.