This Application Form accompanies the Information Memorandum (IM) issued by Capital & Centric Funding Litigation Management Pty Ltd 98 665 486 135 (Issuer).
We have created an IM which contains key information and acknowledgments contained in this Application Form before applying for Units.
Unless otherwise defined, capitalised terms used in this Application Form have the same meaning given to them in the IM
Are you an existing investor in Capital & Centric Funding and wish to make an additional investment in the same name?:*
INFORMATION YOU'LL NEED TO COMPLETE YOUR APPLICATION
Before commencing the online application we suggest you have the following information handy to assist in completing the process.
PLEASE HAVE READY THE FOLLOWING DETAILS:
General information about each investor including full name, date of birth, residential address and Tax File Number
Bank account details for future distributions and withdrawals
If you are a sole trader or company:
I/We apply to invest in the Capital & Centric Funding Unit Trust.
INVESTMENT DETAILS: Source of investment funds: *Please identify the source of your investable assets or wealth (you can choose more than one)
What is the purpose of this investment?: *Please select the options that most aptly describe the purpose of your investment (you can choose more than one)
PAYMENT INSTRUCTIONS DISTRIBUTIONS AND WITHDRAWALS. Please indicate how you would like your distributions to be paid by ticking one box only. If this is a new investment and no nomination is made, distributions will be reinvested. A nomination in this section overrides any previous nominations. There may be periods in which no distribution is payable, or we may make interim distributions. We do not guarantee any particular level of distribution:*
Financial Institution Account Details (must be an Australian financial institution)Please provide account details for the credit of withdrawals and credit of distributions. Unless requested otherwise, this will be the bank account we credit any withdrawal proceeds. By providing your nominated account details in this section you authorise the Issuer to use these details for all future transaction requests that you make until written notice is provided otherwise. For additional investments, a nomination in this section overrides any previous nominations.
Notice: The name of your nominated bank account must be the same as the Investor’s name.
Please provide your Date of Birth:*
How many countries are you a resident for tax purposes?:*
I certify the tax residence countries provided represent all countries in which I am considered a tax resident.*
Residential Address (cannot be a PO Box):*
Primary Contact Number:*
Is this individual a Politically Exposed Person?:*
Is the account holder a U.S. person?:*
If you are applying as a Sole Trader or Company, please provide:*
I confirm that the supplied business name and ABN match according to ASIC's records.
Address of Principal Place of Business (cannot be a PO Box):*
Business Address (cannot be a PO Box):*
PRIVACY DISCLOSURE: Do you consent to your personal information being used and disclosed for marketing purposes as broadly described in the Privacy statement in this IM?*
EMAIL COMMUNICATION CONSENT: Please select the appropriate option(s) regarding communication relating to your investment in the Unit Trust:*
To comply with Australia’s Anti-Money Laundering and Counter-Terrorism Financing (AML/CTF) legislation, we must collect certain information from prospective investors and their beneficial owners supported by either ORIGINAL CERTIFIED COPIES of relevant identification documents or reliable and independent electronic data for all investors and their beneficial owners. Please refer to the directions in your completed application form on how to arrange certified copies. Please provide all documents in the proper format otherwise we may not be able to process your application for investment.
By selecting ‘I consent' below, you agree to Trust's Privacy Statement and Consent and agree to us running an online identity verification check using the supplied information (including for the supplied information and any documents referenced to be checked through the DVS with the document issuer or official record-holder).
I will attach a driver's licence that contains a photograph of the licence/permit holder, or I will attach a passport that contains a photograph and signature of the passport holder.
Drivers License Front:
Drivers License Back:
Please follow the link to view what a Sophisticated Investor is defined as before you complete this application.
Please upload the accountant's certificate confirming Sophisticated Investor Status.
When you complete this Application Form you make the following declarations:
I/we have read and understood the IM to which this Application Form applies, including any supplemental information;
I/we have received and accepted the offer to invest in Australia;
The information provided in my/our Application Form is true, correct and complete in all respects;
I/we agree to be bound by the provisions of the Constitution governing the Trust and the terms and conditions of the IM, each as amended from time to time;
I/we acknowledge that none of the Issuer, their related entities, directors or officers have guaranteed or made any representation as to the performance or success of the Trust, or the repayment of capital from the Trust. Investments in the Trust are subject to various risks, including delays in repayment and loss of income or principal invested. Investments in the Trust are not deposits with or other liabilities of the Issuer or any of its related bodies corporate or associates;
I/we acknowledge the Issuer reserves the right to reject any application or scale back an application in its absolute discretion;
If applicable, after assessing my/our circumstances, I/we have obtained my/our own independent financial advice prior to investing in the Trust;
If this Application Form is signed under Power of Attorney, each Attorney declares he/she has not received notice of revocation of that power (a certified copy of the Power of Attorney should be submitted with this Application Form);
I am/we are over 18 years of age and I/we are eligible to hold units/investment in the Trust;
I/we have all requisite power and authority to execute and perform the obligations under the IM and this Application Form;
I/we acknowledge that Application Monies will be held in a trust account until invested in the Trust or returned to me/us. Interest will not be paid to Applicants in respect of their Application Monies regardless of whether their monies are returned;
I/we have read the information on privacy and personal information contained in the IM and consent to my/our personal information being used and disclosed as set out in the IM;
I/we acknowledge that the Issuer may deliver and make reports, statements and other communications available in electronic form, such as e-mail or by posting on a website;
I/we indemnify the Issuer and each of its related bodies corporate, directors and other officers, shareholders, servants, employees, agents and permitted delegates (together, the Indemnified Parties) and to hold each of them harmless from and against any loss, damage, liability, cost or expense, including reasonable legal fees (collectively, a Loss) due to or arising out of a breach of representation, warranty, covenant or agreement by me/us contained in any document provided by me/us to the Issuer, its agents or other parties in connection with my/our investment in the Trust. The indemnification obligations provided herein survive the execution and delivery of this Application Form, any investigation at any time made by the Issuer and the issue and/or sale of the investment;
To the extent permitted by law, I/we release each of the Indemnified Parties from all claims, actions, suits or demands whatsoever and howsoever arising that I/we may have against any Indemnified Party in connection with the IM or my/our investment;
Other than as disclosed in this Application Form, no person or entity controlling, owning or otherwise holding an interest in me/us is a United States citizen or resident of the United States for taxation purposes (US Person);
I/we will promptly notify the Issuer of any change to the information I/we have previously provided to the Issuer, including any changes which result in a person or entity controlling, owning or otherwise holding an interest in me/us who is a US Person;
I/we consent to the Issuer disclosing any information it has in compliance with its obligations under the Inter-Governmental Agreement between the Government of Australia and the Government of the United States of America to improve International Tax Compliance and to implement FATCA and any related Australian law and guidance implementing the same (together, the IGA). This may include disclosing information to the Australian Taxation Office, who may in turn report that information to the US IRS;
I/we acknowledge that the collection of my/our personal information may be required by the Financial Transaction Reports Act 1988, the Corporations Act 2001, the Income Tax Assessment Act 1936, the Income Tax Assessment Act 1997, the Taxation Administration Act 1953, the IGA (which for these purposes includes any related Australian law and guidance) and the Anti-Money Laundering and Counter-Terrorism Financing Act 2006. Otherwise, the collection of information is not required by law, but I/we acknowledge that if I/we do not provide personal information, the Issuer may not allow me/us to invest in the Trust;
I am/we are not aware and have no reason to suspect that the monies used to fund my/our investment in the Trust have been or will be derived from or related to any money laundering, terrorism financing or similar or other activities illegal under applicable laws or regulations or otherwise prohibited under any international convention or agreement (AML/CTF Law);
I/we will provide the Issuer with all additional information and assistance that the Issuer may request in order for the Issuer to comply with any AML/CTF Law and the IGA;
I/we acknowledge that the Issuer may decide to delay or refuse any request or transaction, including by suspending the issue or redemption of investment in the Trust, if the Issuer is concerned that the request or transaction may breach any obligation of, or cause the Issuer to commit or participate in an offence, including under any AML/CTF Law.
Please confirm that the details entered above are correct.