Update of Senior Trust Capital

Are you currently a Senior Trust Capital investor?

YesNo

First Name*

Last Name*

Email

example@example.com

Phone Number*

Area CodePhone Number

Address*

Suburb*

City*

Post Code*

Country*

Date of Birth*

What type of Application is this*

In your individual nameA joint applicationA Trust or Company

Type a Name of Trust/Company

Registration number (if applicable)

Please be aware that STC is required to collect certain information to ensure compliance with NZ Legislation. In the case of a Trust this will include:

A copy of the Trust Deed
Beneficiaries names and date’s of birth
Settlors and Trustees names, addresses and dates of birth
Documents verifying the Trust’s “source of wealth”
Description of the trust's "source of wealth”
Bank statements of the Trust

Once your application has been submitted, one of our staff will be in touch to clarify the information required.

First Name (Applicant 2)*

Last Name (Applicant 2)*

Email (Applicant 2)

example@example.com

Phone Number (Applicant 2)*

Area CodePhone Number

Address (Applicant 2)*

Suburb (Applicant 2)*

City (Applicant 2)*

Post Code (Applicant 2)*

Country (Applicant 2)*

Date of Birth (Applicant 2)

IRD Number*

IRD Number - (Applicant 2)

Please note your PIR tax rate in the box below, that being either 0%, 10.5%, 17.5% or 28%.

0%10.5%17.5%28%

Please note your PIR tax rate in the box below, that being either 0%, 10.5%, 17.5% or 28% (2nd Applicant)

0%10.5%17.5%28%

Do you have RWT exemption?

Please tick this box if you hold an RWT exemption certificate from the IRD and attach a copy of your RWT exemption certificate.

Do you have RWT exemption? (Applicant 2)

Please tick this box if you hold an RWT exemption certificate from the IRD and attach a copy of your RWT exemption certificate.

Attach RWT exemption certificate

Browse Files

Attach RWT exemption certificate (2nd Applicant)

Browse Files

Please tick this box if you are a non - resident for NZ tax purposes. Under the Income Tax Act 2007 you will be treated as a NZ tax resident and be subject to the 28% PIR rate unless this box is ticked.

I am a non NZ resident

Please tick this box if you are a non- resident for NZ tax purposes. Under the Income Tax Act 2007 you will be treated as a NZ tax resident and be subject to the 28% PIR rate unless this box is ticked.

I am a non NZ resident (Applicant 2)

Please tick this box if you are a non- resident for NZ tax purposes. Under the Income Tax Act 2007 you will be treated as a NZ tax resident and be subject to the 28% PIR rate unless this box is ticked.

Are you a US resident, citizen or taxpayer?

Please tick this box if you are a US resident, citizen or taxpayer.

Are you a US resident, citizen or taxpayer? (Applicant 2)

Please tick this box if you are a US resident, citizen or taxpayer.

Verification of your identity

All applicants must provide details of their drivers licence which will be used for AML/CFT Act verification purposes along with your DOB and Street address provided earlier in this application form.

If you do not have a driving licence please contact John Jackson (0800 609 600). If you do not provide these details your application form cannot be processed.

Licence Number*

Licence Version*

Licence Number (Applicant 2)

Licence Version (Applicant 2)

COMMON SHAREHOLDER NUMBER (CSN) (NOT MANDATORY)

Previous CSN to enter.

I have a previous CSN to enter.

COMMON SHAREHOLDER NUMBER (CSN) of your current Investment in Senior Trust

If you have a Common Shareholder Number (CSN) for any other securities you hold please enter it here:

If you do not have a CSN, leave the space blank and you will be allocated a CSN and Authorisation Code (FIN) when your Units are allotted.

I wish to purchase shares for the following NZ$ amount*

I agree that the Registrar is authorised to withdraw from the bank account associated with my current investment in Senior Trust Capital, the full dollar amount of Units applied for on the terms and conditions for one-time direct debit.*

Yes

Bank Account Details

Please provide New Zealand dollar bank account details for direct debit and/or direct credit of your quarterly distribution payments If you wish to have your distribution paid into a different bank account than the one provided below for direct debit purposes, you need to advise Link Market Services of the account details in writing.
Please Note: No distribution payments will be made to Unit holders by cheque. Payments will be withheld until such time a bank account is provided to the Registrar, Link Market Services.

Name Of Bank*

Name Of Account*

Account Number*

I agree that the Registrar is authorised to withdraw from this account the full dollar amount of Units applied for on the terms and conditions for one-time direct debit.*

Yes

CASH MANAGEMENT ACCOUNT (NOT MANDATORY)

CASH MANAGEMENT ACCOUNT (If you wish your distribution payments to be direct credited to your Cash Management Account held with an NZX Firm, please provide the following details: Direct credit to my Cash Management Account)

Name of NZX Firm where Cash Management Account is held:

Cash Management Account Number:

Signature(s) of Applicants

By ticking the box below, I/we hereby acknowledge that I/we have and read the Product Disclosure Statement including the application instructions, and apply for the dollar amount of shares as set out above and agree to accept such Shares (or such lesser number as may be allotted to me/us) on, and subject to, the terms and conditions set out in the Product Disclosure Statement and application instructions. I/We consent to the Registrar verifying my/our identity electronically using my/our details provided by providing those details to a credit reporting agency or any other person or entity for the sole purpose of identity verification. The Application Form must be signed by, or on behalf of, each Applicant. If the Applicant is a company or other entity, it should be signed by a duly authorised person in accordance with any applicable constitution or governing document. If the Applicant is a minor (under the age of 18) the parent or legal guardian should sign the Application Form on the Applicant's behalf. If you elect to pay by one time direct debit, you should ensure that the signatories are consistent with your bank authorities.

I understand & agree*

Yes

I understand & agree (Applicant 2)

Yes

Terms and Conditions

By submitting this application form:
a) I/ We agree to subscribe for shares upon and subject to the terms and conditions of the Product Disclosure Statement and this Application Form and I/ we agree to be bound by the provisions thereof.
b) I/ We confirm that I/ we have received, read and understood the Product Disclosure Statement.
c) I/ We declare that all details and statements made by me/ us in this Application Form are complete and accurate.
d) I/ We certify that, where information is provided by me/ us in this Application Form about another person, I/ we are authorised by such person to disclose the information to you and to give authorisation.
e) I/We consent to the Registrar verifying my/our identity electronically using my/our details provided above and below by providing those details to a credit reporting agency or any other person or entity for the sole purpose of identity verification.
f) I / We acknowledge that an application cannot be withdrawn or revoked by me/ us once it has been submitted.
g) I/ We acknowledge that the Offer is only made in New Zealand, and by applying for Shares , I/ we agree to indemnify the Company and its respective directors, officers, employees and agents in respect of any liability incurred by the Company as a result of my/ our breach of securities laws in any jurisdiction other than New Zealand. The information in this Application Form is provided to enable the the Registrar to process your application, and to administer your investment. By submitting this Application Form, you authorise Senior Trust Capital Limited and the Registrar to disclose information in situations where the Senior Trust Capital Limited or the Registrar are required or permitted to do so by any applicable law or by a governmental, judicial or regulatory entity or authority in any jurisdiction. If you are an individual under the Privacy Act 1993, you have the right to access and correct any of your personal information.

Personal Details

Application and Payment

Bank Account Details