Managed Fund Application Form

Initial Information Sheet

Managed Fund Application Form
Please Note: The following is a data collection form. Please complete the required details below and hit submit at the bottom of the page. Your data collection form will be emailed through to myself for review, if you’ve missed any required data I’ll call you to obtain the extra details. Otherwise, our back office will complete your fund application forms and we will send a hard copy by post to you for your review and signature. Thank you for your interest and I look forward to working with you as an Investor Signals’ client.

Regards Leon Hinde
Investment Class
Please select whether you wish to invest Class A Units, Class B Units or both Classes. If no selection is made, you will be deemed to have selected Class A Units.

Class A UnitsClass B Units
The minimum investment amount for each class is $100,000 and subsequently in increments of $50,000 (unless agreed otherwise by the Trustee)
Please indicate dollar amount you wish to invest in Class A Units
Please indicate dollar amount you wish to invest in Class B Units
Is this for a new investor to the fund?

YesNo
If this is for a new investor - please provide the name of the holding (in a format you want to appear on the unit holder register)
Contact Details
Name

Full Given Name(s)Last Name
Company name/Trustee Name
ACN or ABN
Address

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Email
example@example.com
Telephone
Taxation Details

For the fund applicant. (e.g. the SMSF)
Are you a resident of Australia for taxation purposes?

YesNo
Country of Residence
If you answered no to the above
Tax File Number or ABN
If you answered yes to the above.
TIN or Foreign Tax ID
If you answered no to the above
TFN or ABN belongs to:

IndividualCompanyTrust/Superfund
Source of Investment Funds
Please select all options applicable for the source of funds you are investing in the Fund:

Salary/WagesBusiness Income, earnings or profitsInvestment income/earnings Sale of AssetInheritance/giftOther

Complete if a Trust (including Superannuation Funds). Corporate Trustee's must also fill in the Company Section.
All Trusts (Including Superannuation Funds)

If you have a Company Trustee, please also complete the section at the bottom of this form for the Company.
Full name of trust
Full name of the Trustee of the trust
Trust's ABN or registration details
If this a regulated trust. (SMSF's are regulated trusts)
Other trust type?
Trust description (e.g. unregistered, fixed, family, unit)

Complete if a Other Trust Type (Unregulated - Not SMSF)
Other Trust Types

Please complete the following if your trust is not a regulated trust.
Do not complete, if your trust is an SMSF.
Beneficiary Details
Do the terms of the trust identify the beneficiaries by reference to membership of a class?

YesNo
If Yes, provide details of the membership classes.
If No, provide the full name of each substantial trust beneficiary below.
Trustee Details
Trustee 1

Full Given Name(s)Last Name
Date of Birth

DayMonthYear
Date
Address (PO Box is NOT acceptable)

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Email
example@example.com
Telephone
Trustee 2

Full Given Name(s)Last Name
Date of Birth

DayMonthYear
Date
Address (PO Box is NOT acceptable)

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Email
example@example.com
Telephone

Complete If a Company or Company/Corporate Trustee
Investor Identification

Australian or Foreign Company including Company Trustee's of a Fund
If the applicant is a trust, with a corporate trustee, please fill in this section and the trust section above. (e.g. if the applicant is an SMSF with a corporate trustee)
Full Registered Name
ACN
If applicable
ARBN
If applicable
Foreign body registration number
If applicable
Country of formation
If applicable
Registered office address (PO Box is NOT acceptable)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Principal place of business (if any) (PO Box is NOT acceptable)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Directors
Please enter one director per line
Shareholders

Provide details of shareholders who own 25% or more of the company’s issued capital.
Shareholder 1

Full Given Name(s)Last Name
Date of Birth

DayMonthYear
Date
Address (PO Box is NOT acceptable)

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Email
example@example.com
Telephone
Shareholder 2

Full Given Name(s)Last Name
Date of Birth

DayMonthYear
Date
Address (PO Box is NOT acceptable)

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Email
example@example.com
Telephone
Shareholder 3

Full Given Name(s)Last Name
Date of Birth

DayMonthYear
Date
Address (PO Box is NOT acceptable)

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Email
example@example.com
Telephone
Beneficial Holders

Only complete if different to the individual shareholders described above.
A beneficial owner is any individual who ultimately “owns” or “controls” (directly or indirectly) the applicant. “Control” includes control as a result of, or by means of, trusts, agreements, arrangements, understandings and practices, including exercising control through the capacity to determine decisions about financial and operating policies of the investor. “Owns” means ownership (either directly or indirectly) of 25% or more of the applicant.
Beneficial Holder 1

Full Given Name(s)Last Name
Date of Birth

DayMonthYear
Date
Address (PO Box is NOT acceptable)

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Email
example@example.com
Telephone
Beneficial Holder 2

Full Given Name(s)Last Name
Date of Birth

DayMonthYear
Date
Address (PO Box is NOT acceptable)

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Email
example@example.com
Telephone
Beneficial Holder 3

Full Given Name(s)Last Name
Date of Birth

DayMonthYear
Date
Address (PO Box is NOT acceptable)

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Email
example@example.com
Telephone

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Initial Information Sheet

Investment Class

Contact Details

Taxation Details

Source of Investment Funds

All Trusts (Including Superannuation Funds)

Other Trust Types

Beneficiary Details

Trustee Details

Investor Identification

Shareholders

Beneficial Holders