Melchior Selected Trust - Banque Privée Edmond de Rothschild ...

Melchior Selected Trust – Global ConservativeFund – Class A2USDor46200Ed : May 2013ISIN: LU0467767983Melchior Selected Trust – Global ConservativeFund – Class CGBPorISIN: LU0467768288Melchior Selected Trust – Global ConservativeFund – Class I1EURorISIN: LU0340436806Melchior Selected Trust – Global ConservativeFund – Class I2USDorISIN: LU0467768106Melchior Selected Trust – Global ConservativeFund – Class I7GBPorISIN: LU0467768445Melchior Selected Trust – European AbsoluteReturn Fund – Class A1EURorISIN: LU0476438485Melchior Selected Trust – European AbsoluteReturn Fund – Class A2USDorISIN: LU0476438568Melchior Selected Trust – European AbsoluteReturn Fund - Class C (hedged)GBPorISIN: LU0476438998Melchior Selected Trust – European AbsoluteReturn Fund – Class HGBPorISIN: LU0572597879Melchior Selected Trust – European AbsoluteReturn Fund - Class I1EURorISIN: LU0476438642Melchior Selected Trust – European AbsoluteReturn Fund - Class I2 (hedged)USDorISIN: LU0476438725Melchior Selected Trust – European AbsoluteReturn Fund – Class I3 (hedged)YenorISIN: LU0706247375Melchior Selected Trust – European AbsoluteReturn Fund – Class I7 (hedged)GBPorISIN: LU0476439020Melchior Selected Trust – EuropeanOpportunities Fund – Class A1EURorISIN: LU0289522954Melchior Selected Trust – EuropeanOpportunities Fund – Class A2USDorISIN: LU0289527599Melchior Selected Trust – EuropeanOpportunities Fund – Class CGBPorISIN: LU0289524224Melchior Selected Trust – EuropeanOpportunities Fund – Class I1EURorISIN: LU02895232594

Melchior Selected Trust – EuropeanOpportunities Fund – Class I2USDor46200Ed : May 2013ISIN: LU0289527912Melchior Selected Trust – EuropeanOpportunities Fund – Class I7GBPorISIN: LU0289524653Melchior Selected Trust – Indian AbsoluteReturn Fund – Class I1EURorISIN: LU0689628385Melchior Selected Trust – Indian AbsoluteReturn Fund – Class I2USDorISIN: LU0689628542Melchior Selected Trust – Indian AbsoluteReturn Fund – Class I7GBPorISIN: LU0689628625* Delivery of registered sharesBy selecting R from the table above, I understand that physical certificates shall not be issued for registered shares. Instead,the Agent shall enter an order confirmation in the shareholders’ register, which is held at the registered office of the Agent.Confirmation of shares recorded in the shareholders register shall be sent to the shareholder within the time limit specified inthe prospectus.** Delivery via a clearing systemBy selecting C from the table above, I request the delivery of my shares via a clearing system and the registration of thesubscription in the name of the clearing system or its custodian according to the details below:Name of clearing establishment: __________________________________________________________________________Country: ____________________ Account name: ____________________ Account number: ________________________In this case, the name of the shareholder shall not appear on the register.5

3. Payment Instructions46200Ed : May 2013Subscription monies should be paid as follows, reference MELCHIOR SELECTED TRUST. Please refer to theprospectus for the relevant payment deadlines.CurrencyUSDBPERE’s Correspondent Name andAddressCash Account NbrSWIFT AddressBANK OF NEW YORK MELLON, NYABA N° 021 000 018 8900691069 IRVTUS3NEURO TARGET 2 LU93999000117204200E PRIBLULLREGGBPJPYHSBC10 Lower Thames StreetLondon EC3R 6AEGreat BritainBANK OF TOKYO MITSUBISHI1-1 Nihombashi Muromachi2 Chome, Chuo-Ku, Tokyo 103Japan58059280 MIDLGB22XXXSort code:40-05-15653-0412—082 BOTKJPJTXXX4. Authorised Signature(s)Date: _____________________Signature: _________________________________________________________________________________________________________________________________________________Full name (in capital letters)Signature: _________________________________________________________________________________________________________________________________________________Full name (in capital letters)6