Subscription Form - Meltemi

Subscription form (‘application’) 

For the subscription of 

Investor Shares in 

the LTRIP Fund (the ‘Fund’) 

a distinct sub-fund of (and constituted by the ordinary non-voting no par value shares referred to herein) 

issued by 

TRIPS SICAV plc (the ‘Company’) 

a multi-fund public limited liability investment company with variable share capital registered under the laws of 

Malta with registration number SV 234 and with its registered office situated at 6th Floor, Airways House, Gaiety 

Lane, Sliema SLM 1549, Malta, and which is licensed by the Malta Financial Services Authority (‘MFSA’) under the 

Investment Services Act (Chapter 370 of the Laws of Malta) to carry out the activities of a collective investment 

scheme as a Professional Investor Fund promoted to Qualifying Investors in respect of such Fund. 

Unless otherwise expressly defined herein or the context otherwise requires, capitalised terms used herein and 

defined in the current general Offering Memorandum and Fund-specific Offering Supplement issued by the 

Company in respect of Fund Shares in the Fund (hereinafter together referred to as the ‘Offering Memorandum’) 

and/or in the current Memorandum and Articles of Association of the Company (the ‘Articles’) shall have the 

same meanings herein as therein. 

To: 

The Directors, TRIPS SICAV plc 

c/o Apex Fund Services (Malta) Limited 

6th Floor, Airways House, 

Gaiety Lane, Sliema SLM 1549, Malta 

T: +356 2131 1330 | F: +356 2131 2880 

E: info@apexfunds.com.mt 

Note: This Subscription Form and accompanying documents and information will be processed by Apex Fund Services (Malta) Limited, 

as Administrator of the Fund. 

Dear Sirs, 

I/We hereby apply to subscribe to shares in the Fund (‘Fund Shares’) which are being offered on a 

private placement basis by the Company, as per the following details and instructions and subject 

to the terms and conditions hereof and of the Offering Memorandum and the Articles: 

Registration details of applicant(s) 

In cases where the Fund Shares in respect of which this Application is being submitted are to be held jointly by more than one person and they 

are to be registered as joint holders in the Register of Fund Shares (if this Application is accepted by the Company), the details requested below 

should be given in respect of each joint applicant (on separate sheets to be attached hereto as may be necessary). This will be undertaken on 

the understanding that the Company will not be obliged to register more than four (4) persons as joint holders of any Fund Share and subject to 

the provisions of the Offering Memorandum and the Articles dealing with the entitlement of the Company to treat the joint holder first named 

on the Register as the single registered holder of such Fund Share for such purposes as mentioned therein. You might find it convenient to ask 

your financial institution to apply on your behalf. In such cases, kindly take this form as well as the LTRIP order form to your financial institution. 

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Applicant (name in full) 

Address (residential address 

for individuals, or registered address 

for legal persons) 

Correspondence address 

(If different from the above) 

Telephone number 

Fax number 

Email address 

Name and address of duly 

authorised agent 

(where this Application is being made 

and signed on behalf of the Applicant 

by a duly authorised agent) 

Send contract note by Email Mail Fax 

Country of residence 

Tax country 

Tax identification number 

(if EU resident) 

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Subscription details 

Class of Fund Shares Currency ISIN and Lipper Amount* 

LTRIPF Shares 

USD 

MT7000008884 

LP68226421 

USD 

* Minimum investment in respect of initial investments is USD 100,000 for LTRIPF Shares, net of allowable deductible expenses as 

per the terms of the Offering Memorandum. 

The Company will be entitled to reject this Subscription Form in whole or in part, in the circumstances set out in the Offering Memorandum, and 

(save where otherwise expressly set out in the Offering Memorandum) without being obliged to give any reason and without being held liable 

for any loss arising as a result of such rejection. This Subscription Form may be partially accepted by the Company and shall then be binding on 

the applicant for a part only of the Fund Shares applied for (subject to the minimum investment amount indicated above). In case of total or 

partial refusal of the Subscription Form, the applicant will only be entitled to a reimbursement of the amounts paid by him/her/it (if any) to the 

Company together with or in connection with the Application (or to the balance of the amount paid but not allocated, as the case may be) as 

provided for in the Offering Memorandum. 

Payment details 

Pay to 

Account name 

Bank Julius Baer, Zurich 

TRIPS SICAV plc 

Account number 310.3683.2120.333.02 

IBAN CH39 0851 5031 0368 3200 6 

SWIFT/BIC code 

Reference 

BAERCHZZ 

LTRIP Fund 

For value date** 

* Bank or other transfer charges and expenses shall be at the charge of the applicant, and the applicant shall give clear instructions to this 

effect (‘all charges for remitter’) to the bank or financial institution wiring or transferring the funds, and in any case any such charges and expenses 

otherwise incurred by the Company shall be deducted from such funds or will be payable separately by the applicant upon request of the Company. 

** This should not be later than 17:00 hours CET of the last day of the Initial Offer Period for Fund Shares applied for during such period and 

not later than 17:00 hours CET five (5) Business Days prior to the relevant Subscription Day in case of subsequent subscription applications. 

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Details of remitting bank and source of funds 

Name and address of bank 

with which account(s) is/are 

held 

Bank code (BIC or SWIFT code) 

Name(s) of the account(s) from 

which the funds originated 

Account number(s) 

IBAN 

Contact person (name and 

telephone number or email address) 

SOURCE OF FUNDS: 

I/We also authorise you to apply for a reference from the above mentioned bank. 

I/We consent and agree that the Company, the Administrator and any other authorised Service Provider 

of the Fund shall be entitled and is hereby unconditionally and irrevocably authorised by me/us to 

contact such bank to obtain information regarding the origin of the subscription monies or to request 

a reference and I/we hereby undertake to give, sign and deliver such separate authorisations to this 

effect as may be requested by the Company, the Administrator or any such other authorised Service 

Provider or by the bank. 

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Due diligence documents 

Unless otherwise accepted by the Company, its officers, the Administrator and/or other authorised 

Service Providers of the Fund or intermediaries receiving or processing this Subscription Form or 

otherwise delegated by the Company with such function (in cases where a detailed identification 

procedure may not be required in terms of the applicable anti-money laundering laws and, in any such 

cases, subject to such confirmations, identification and verification requirements as may be prescribed 

by the Company and/or such persons mentioned above) I/we hereby attach, or will shortly provide the 

documents as indicated below. 

Please indicate the type of the subscriber and provide the required information accordingly. 

Section 1. 

Section 2. 

Section 3. 

Section 4. 

Section 5. 

Section 6. 

Section 7. 

Individuals 

Corporate Entity 

Corporate Entity listed on a Recognised Exchange 

Partnerships or Other Unincorporated Businesses 

Trusts 

Designated Body acting as Principal 

Designated Body e.g. a Financial Institution acting as Nominee 

In most cases when a financial institution or a bank subscribes on behalf of a client they may already have most 

of the information listed in sections 1–7. By signing the order form you agree for them to pass on this 

information to the Fund Administrator when required. 

(Please use additional space provided at the end of this document if needed.) 

1. Individual person Enclosed 

To be 

forwarded 

N/A 

1.1 A copy of Passport/Drivers Licence or other form of identification with 

photograph included, notarised or certified by a bank, attorney, accountant or 

Meltemi Investment Management Limited (Meltemi); 

1.2 One recent confirmation of address in your name (original, notarised or 

certified as above) – for example a utility bill, which must be dated within 

the last 6 months; (if a utility bill is not available then please provide some 

alternative proof of residence, for example a bank statement or a credit card 

statement, etc.); 

1.3 Details and evidence of any business ownership or directorship(s) or proof of 

employment or self-employment; 

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Enclosed 

To be 

forwarded 

N/A 

1.4 In respect of EU residents only, a notarised (or certified by a bank, attorney, 

accountant or Meltemi) copy of your Tax Identification Number (‘TIN’) or 

equivalent. 

Note that, in all instances where bank details are required, if the bank is from a country that is not a full 

member of the FATF group or the EU, information may be required concerning the bank, or the subscription 

may be rejected. 

2. Corporate Entity (excluding Entities in Sections 3, 6 and 7 below) 

2.1 Notarised (or certified by the relevant company registrar or as per 1.1) copy of, 

or original Certificate of Incorporation and any Change of Name Certificate; 

2.2 Notarised or certified (as per 1.1) copy of, or original Memorandum and Articles 

of Association; 

2.3 A list, giving all directors, beneficial owners of 10% or more of the share 

capital, all authorised signatories and copies of signatures; 

2.4 Personal information on at least two directors and anyone authorised as a 

signatory for this application (as per 1.1 and 1.2), plus copies of signatures; 

2.5 Personal information on any beneficial owners* holding 10% or more of the 

share capital (as per 1.1 and 1.2); 

2.6 Minutes, resolutions or declaration confirming the power to invest; 

2.7 Copy of the Certificate of Registration, company number and country of 

registration, certified as per 1.1; 

2.8 Most recent audited accounts, or written details on the nature of business 

conducted, signed by at least two directors; 

2.9 Corporate structure showing ownership and control. 

3. Corporate Entities listed on a Recognised Exchange in the EU or in a 

reputable jurisdiction 

3.1 The original or notarised copy of the Certificate of Incorporation or the 

Certificate to Trade (copies may alternatively be certified as per 1.1); 

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Enclosed 

To be 

forwarded 

N/A 

3.2 A list of Directors; 

3.3 A properly authorised mandate of the Directors to open/operate an account or 

establish the business relationship; and 

3.4 A list of authorised signatories; 

4. Partnerships or Other Unincorporated Businesses 

4.1 A list, giving all directors, or partners, beneficial owners of 10% or more of the 

business and all authorised signatories plus copies of the signatures; 

4.2 Personal information on at least two directors, or partners, and anyone 

authorised as a signatory for this transaction (as per 1.1 and 1.2); 

4.3 Personal information on the beneficial owners as per 4.1 (as per 1.1, 1.2 

and 1.4); 

4.4 Copy of partnership agreement (if any), or other agreement establishing 

the unincorporated business; 

4.5 All information required for a Corporate Entity, as per 2.6 to 2.10 above; 

4.6 Corporate structure showing ownership and control. 

5. Trusts 

5.1 Certified true copy of Authorisation or Licence of Trust from an EEA Country; 

5.2 Personal details of the Trustee (as per 1.1 and 1.2); 

5.3 AML Comfort Letter from the Trustee confirming that the Trust carries out its 

own due diligence on the beneficiaries and settler of the Trust; 

5.4 Relevant section of the Trust deed; 

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Enclosed 

To be 

forwarded 

N/A 

5.5 Minutes, resolutions or declaration confirming the power to invest. 

6. Designated Body (‘DB’)** acting as principal 

6.1 Confirmation that the DB is a ‘Designated Body’, to include confirmation 

of membership or association with appropriate regulatory body; 

6.2 Contact name and details at regulatory body, or web address to confirm 

regulatory status; 

6.3 Confirmation that the DB is investing and is allowed to invest as principal 

for its own account; 

6.4 Authorised signatories list, plus copies of signatures. 

7. Designated Body** acting as Nominee (e.g. a bank) 

7.1 Same information as requested under 6.1 and 6.2 above; 

7.2 Written confirmation that the DB complies with appropriate anti-money 

laundering regulations with regard to verifying identity and residence of 

investor(s); 

7.3 Details of anti-money laundering regulations that DB complies with; 

7.4 Undertaking that DB will provide its anti-money laundering due diligence files 

to the Administrator and/or other authorised Service Providers of the Fund 

or intermediaries receiving or processing this Subscription Form on demand; 

7.5 Authorised signatories list, plus copies of signatures; 

7.6 The identity of the applicant of the Designated Body and/or beneficial owners 

and purpose of the business relationship. 

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I/We understand and agree that the Company, its officers, the Administrator and/or other 

authorised Service Providers of the Fund or intermediaries receiving or processing this Subscription 

Form or otherwise delegated by the Company with such function, have the right to request further 

documentation or information as provided and for the purposes specified in the Offering Memorandum, 

and I/we undertake to provide the same upon request. 

* For the purposes hereof, ‘beneficial owner(s)’ means the natural person(s) who ultimately own or control the applicant or on whose behalf this 

Application is being made and includes, in the case of (i) an applicant which is a body corporate or a body of persons (other than a listed company 

which is subject to disclosure requirements consistent with EU law), individuals who ultimately own or control, directly or indirectly, more than 

10% of the shares or voting rights in that body corporate or body of persons or who otherwise exercise control over the management of that body 

corporate or body of persons; or (ii) an applicant which is any other legal entity or legal arrangement which administers and distributes funds, 

individuals who are the beneficiaries (where these are determined) of at least 10% of the property of the legal entity or arrangement or (where 

the beneficiaries are not yet determined) the class of persons in whose main interest the legal entity or arrangement is set up or operates and 

individuals who control at least 10% of the legal entity or arrangement. 

** A ‘Designated Body’ means, in the context of this Application, a financial institution that is regulated by an appropriate regulator in an 

acceptable jurisdiction and meets certain regulatory standards regarding anti-money laundering procedures, in accordance with EU or FATF laws 

and regulations, as may be determined by the Company, its officers, the Administrator and/or other authorised Service Providers of the Fund or 

intermediaries receiving or processing this Subscription Form or otherwise delegated by the Company with such function. 

Furthermore by ticking the first box below, I/we explicitly consent to the receipt of unsolicited communications 

(including by fax or electronic mail) for the purpose of direct marketing by or on behalf of the Company. 

[Note: The applicant may at any time, oppose such processing for the purposes of direct marketing and request that the unsolicited 

communications cease, at no cost, by giving notice to the Company.] 

I/We consent to the receipt of unsolicited communications (including by fax or electronic mail), 

for the purpose of direct marketing by or on behalf of the Company. 

Page 9 of 17


Declaration and signature(s) of applicant(s) 

I/We hereby confirm that I/we have read, understood and accepted the full contents of this Application, 

the Articles and the Offering Memorandum (including the risk warnings included therein) which, I/ 

we hereby acknowledge and agree, exhaustively set out and contain and constitute the terms and 

conditions of offering, issue, subscription, resale, transfer, acquisition, holding and redemption (where 

applicable) of Fund Shares which may eventually be issued pursuant hereto, and I/we hereby declare 

and agree that I am/we are making this Application solely on the basis of, and shall at all times be 

bound by and comply with, and shall be subscribing and holding the relevant Fund Shares issued 

pursuant hereto on the basis of and subject to, such contents, terms and conditions. I/we hereby 

represent and warrant that I am/we each are eligible to hold the Fund Shares in terms of the Articles 

and the Offering Memorandum and am/are hereby attaching a Qualifying Investor Declaration Form 

signed and submitted by me/each of us or on my/our behalf as required in the Offering Memorandum 

and that I am/we are able to subscribe for and hold Fund Shares without violating applicable laws, 

regulations and requirements of any country or governmental or other competent authority. I/We 

understand that the price of Fund Shares may go down as well as up and that past performance cannot 

guarantee future results. 

Name 

(name(s) of the individual(s)) 

or 

if applying through a bank the name, address and contact details of the bank 

Signature(s) 

Date 

Individual signatories must be over 18 years of age. Where there are joint applicants, and there must not be more than four, this Application 

must be signed by or on behalf of each of them. 

Applications from a corporation or other legal entity must be signed by an authorised officer or representative thereof or be completed 

otherwise in accordance with its constitution on behalf of and binding the applicant. In each case where this Application is signed on behalf of 

the applicant (or, as the case may be, on behalf of any joint applicant), by a duly authorised agent thereof, the original or a duly certified copy 

(certified by a licensed Bank in a reputable jurisdiction or by a professional person such as a lawyer, notary, accountant or Meltemi or official entity 

such as an embassy or government ministry) of the relevant power of attorney, resolution or other instrument granting such authority must 

accompany this Application. 

Where this Application is made and signed on behalf of any applicant or (as the case may be) any of the joint applicants by its duly authorised 

agent, such duly authorised agent, by signing this Application, hereby personally represents and warrants to the Company that it has been 

properly appointed as an agent of the applicant or, as the case may be, of the respective joint applicant (the ‘Principal’) with full powers and 

authority to act on its Principal’s behalf and to bind him/her/it on this Application and the transactions contemplated hereby, including (without 

limitation) all agreements, declarations, representations, warranties and undertakings contained (or deemed to be contained) herein or made 

(or deemed to be made) pursuant hereto which have been made or given by such agent in the name of and on behalf of its Principal. 

Page 10 of 17


Qualifying investor declaration form 

Scheme/Company 

Fund 

TRIPS SICAV plc 

LTRIP Fund 

This section should be completed by the Qualifying Investor or his/her/its duly authorised agent. 

Tick the boxes below as appropriate 

The investment is being made directly by the investor (not through a duly authorised agent) 

I hereby confirm that I am eligible to be treated as a ‘Qualifying Investor’, since I satisfy the 

definition thereof in light of the positive response(s) that I have given to the question(s) below. 

I certify that I have read and understood the general Offering Memorandum and the Fund-specific 

Offering Supplement issued by the Company (together the ‘Offering Document’) including the 

mandatory risk warnings. 

The investment is not being made directly by the investor but through a duly authorised agent 

I hereby confirm that I have been properly appointed as a duly authorised agent of a prospective 

investor in the Fund described above. I certify that my principal is eligible to be treated as a 

‘Qualifying Investor’ since my principal satisfies the definition thereof in light of the positive 

response(s) that I have given to the question(s) below in respect of my principal. I certify that my 

principal has read and understood the Offering Document including the mandatory risk warnings 

I qualify/my principal qualifies [delete as applicable] as a ‘Qualifying Investor’, as I am/he/she/it is: 

(please tick the appropriate boxes) 

i. a body corporate which has net assets in excess of EUR750,000 or USD750,000 

(or equivalent in another currency) which is part of a group which has net assets 

in excess of EUR750,000 USD750,000 (or equivalent in another currency); 

Yes 

No 

ii. 

an unincorporated body of persons or association which has net assets in excess 

of EUR750,000 or USD750,000 (or equivalent in another currency); 

iii. 

a trust where the net value of the trust’s assets is in excess of EUR750,000 

or USD750,000 (or equivalent in another currency); 

iv. 

an individual, or in the case of a body corporate, the majority of its board of 

directors or in the case of a partnership its general partner, who has reasonable 

experience in the acquisition and/or disposal of funds of a similar nature or risk 

profile, or property of the same kind as the property, or a substantial part of the 

property, to which the Fund relates; 

v. an individual whose net worth or joint net worth with that person’s spouse, 

exceeds EUR750,000 or USD750,000 (or equivalent in another currency); 

vi. 

a senior employee or director of Service Providers to the Fund; 

Page 11 of 17


vii. a relation or a close friend of the promoters of the Fund; 

Yes 

No 

viii. an entity with (or which is part of a group with) EUR3.75 million or USD3.75 million 

(or equivalent in another currency); or more under discretionary management 

investing on its own account; 

ix. 

a Professional Investor Fund promoted to Qualifying Investors or Extraordinary 

Investors (all such terms as defined in the Investment Services Rules for 

Professional Investor Funds issued by the Malta Financial Services Authority 

(MFSA) and in the Offering Document); 

x. an entity (body corporate or partnership) wholly owned by persons or entities 

satisfying any of the criteria listed above which is used as an investment vehicle 

by such persons or entities. 

Name of investor or 

Name of the registered 

shareholder or 

Name of duly authorised 

agent (where applicable) 

Signature 

Title/Capacity in which 

signed 

Date 

In the case where the applicant is a company or partnership, the Qualifying Investor Declaration Form is required from the directors or general 

partners of the applicant, or in the case of a trust, by the trustee. In the case of joint applicants, all applicants should individually satisfy the 

eligibility criteria to be treated as Qualifying Investors and the Qualifying Investor Declaration Form should be completed and signed by (or on 

behalf of) all of them (subject to the exception relating to spouses as provided in the Offering Document). 

Page 12 of 17


Fund Intermediaries 

Details of fund intermediary receiving this application or of licensed bank, financial institution, 

investment firm or other person through which this application and/or payment thereon is 

submitted and made to the company 

This section is to be completed and signed by: 

(a) 

(b) 

the authorised agent, distributor or other intermediary of the Fund (including the Investment Manager of the Fund, where appropriate), 

receiving this Subscription Form from the respective applicant(s) (hereinafter referred to as the ‘Fund Intermediary’); or 

where the applicant does/applicants do not submit the same through an appointed Intermediary of the Fund, by the licensed bank, financial 

institution, investment firm, collective investment scheme or other person qualifying as ‘subject person’ or ‘third party’ under and for the 

purposes of Regulation 12 of the Maltese Prevention of Money Laundering and Funding of Terrorism Regulations, 2008 (Legal Notice 

180 of 2008, as amended) (namely a ‘subject person’ (natural or legal person)) carrying out either ‘relevant financial business’ or ‘relevant 

activity’ as defined in the said Regulations and who is subject to such Regulations, or a ‘third party’ undertaking activities equivalent 

to such ‘relevant financial business’ or ‘relevant activities’ (as defined in the said Regulations) and who is situated in an EU or EEA 

State other than Malta or in a reputable jurisdiction (as defined in the said Regulations and a jurisdiction having appropriate legislative 

measures for the prevention of money laundering and the funding of terrorism) and who is subject to authorisation or mandatory 

professional registration recognised by law, in both cases (whether a ‘subject person’ or a ‘third party’ ) to the extent that the Company 

can rely on customer due diligence carried out by such person in terms of the said Regulation 12 of such Regulations) through which this 

Application Form and payment thereon is submitted and made to the Company (hereinafter referred to as ‘Independent Intermediary’). 

Name and address of fund 

intermediary/independent intermediary 

Reference/identification number of fund intermediary 

(this information to be given only in the case of a fund intermediary, not in 

the case of an independent intermediary) 

Details of regulatory status/authorisation/mandatory 

professional registration recognised by law of fund 

intermediary/independent intermediary (including contact 

name and details at regulatory body and/or web address to confirm the 

above and intermediary’s authorisation, membership or association number, 

code or identification)* 

Details of business or activities undertaken by fund 

intermediary/independent intermediary in respect of 

which it is subject to such regulation/authorisation/ 

registration** 

We hereby represent and warrant to the Company that we have not issued any advertisement and have 

not given any information or made any representations in connection with the promotion of the Fund 

or the offering or sale of Fund Shares to the applicant(s) submitting this Application other than those 

contained herein and/or in the Offering Memorandum and in the documents attached to therewith. 

Page 13 of 17


We hereby also give assurance and confirm to the Company that: 

(i) we are situated in (being an EU or EEA Member State)/(being a 

reputable jurisdiction, namely a country which has appropriate legislative measures for the 

prevention of money laundering and the funding of terrorism)** and are subject to authorisation 

or mandatory professional registration recognised by law and are so authorised or registered, as 

the case may be, in accordance with applicable law to undertake the above-mentioned business 

and activities and that our main business is not currency exchange or money transmission or 

remittance services; 

(ii) we have established and verified the identity of the applicant(s) appearing hereon on the basis 

of documents, data or information obtained from a reliable and independent source; 

(iii) we have identified the beneficial owner(s) (as defined under the section entitled ‘Due Diligence 

Documents’ above under this Application), if any, and have taken reasonable measures to verify 

its/their identity so that we are satisfied of knowing who the beneficial owner(s) is/are, including, 

in the case of a body corporate, trusts and similar legal arrangement, reasonable measures to 

understand its/their ownership and control structure; 

(iv) we have obtained information on the purpose and intended nature of the business relationship 

with the applicant(s) appearing hereon, which enables us to establish the business and risk profile 

of the applicant(s); 

(v) 

we will immediately make available to the Company, the relevant Service Providers of the Fund 

and/or other persons delegated by the Company with this function, the information referred to in 

points (ii), (iii) and (iv) as well as any changes therein, (certified, if so requested), and we will, upon 

request, immediately forward to the Company, the relevant Service Providers of the Fund and/ 

or other persons delegated by the Company with this function, copies (which shall be certified, if 

so requested) of the identification and verification data and other relevant documentation of the 

applicant(s) and/or the beneficial owner(s) thereof; 

(vi) we have carried out and obtained appropriate verifications of the source of funds being paid 

pursuant hereto; 

(vii) all necessary records in relation to points (ii), (iii) and (iv) as well as the records relating to the 

source of funds to ensure a proper audit trail in relation to the applicant(s) appearing hereon are 

maintained at our office and will be so maintained at least for the prescribed period required by 

applicable laws and that we will make available such records to the Company, the relevant Service 

Providers of the Fund or other persons delegated by the Company with this function, and to the 

relevant authorities, promptly when requested by them; and 

(viii) we have taken all other action as required by and in accordance with the applicable prevention 

of money laundering and funding of terrorism laws and regulations to which we are subject: 

it being acknowledged that this assurance and confirmation shall be without prejudice to our 

obligation to obtain from the applicant(s) and to submit and supply to the Company, the relevant 

Service Providers of the Fund or other persons delegated by the Company with this function such 

information and documentation necessary to verify the identity of the applicant(s) and the source of 

funds and, generally, to meet any other requirements in relation to the prevention of money laundering 

and funding of terrorism under applicable law, as the Company or such Service Providers or delegated 

persons may request. 

Page 14 of 17


(the Fund Intermediary/for and on behalf of and as duly authorised by the Fund Intermediary**) 

(name, address, email and other contact details) 

Signed by 

Signature 

(the Independent Intermediary/for and on behalf of and as duly authorised by the Independent Intermediary**) 

(name, address, email and other contact details) 

Signed by 

Signature 

Date 

* The Company, the Administrator and/or other authorised Service Providers of the Fund or persons delegated by the Company with such function may 

request other details, information and verifications as appropriate. 

** Delete as appropriate. 

FOR OFFICIAL USE ONLY 

Accepted as of 201 

Signature 

Name 

Title 

Page 15 of 17


Please use these pages to provide any additional information 

Page 16 of 17


Please use these pages to provide any additional information 

Page 17 of 17 

Meltemi Investment Management Ltd No. 2 Eaton Gate London SW1W 9BJ T+44 (0)20 3427 3202 

Meltemi Investment Management Limited is authorised and regulated by the Financial Conduct Authority in the United Kingdom.

Subscription Form - Meltemi

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