Investor Signals Fund - Company Client Application form

Initial Information Sheet

Company Client Application for Investor Signals Fund
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 account 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 enter amounts for Class A and B, minimum total is $50,000 AUD.
Amount Class A
Amount to invest in Class A of the Fund.
Amount Class B
Amount to invest in Class B of the Fund.
Source of Investment Funds
Please select all options applicable for the source of funds you are investing in the Fund.

Other
Company Details
Company Name
Company Type
Company ABN / ACN:
Country of Incorporation
Is the Company a foreign entity for tax purposes?
Company TFN
Country of domicile
ARBN or foreign registration number
Number of Directors
Nature of the business activity
Approval to perform Company search on your behalf to verify Company details, Directors and Owners
Principal place of office

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Registered Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is your postal address the same as the registered address?
Postal Address

Street Address / P O Box

Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mailing address you would like correspondence sent to for this account

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Officer Details
Number of Directors
Maximum of 4 Directors
Company Officer 1 (Sole Director, Director or Secretary)
Corporate Title
Company Officer 1 Full Name

TitleGiven NamesSurname
Any other name known by
Date of Birth

DayMonthYear
Country of birth
Country of citizenship or lawful permanent residency
Occupation
Mother’s Maiden Name
CO1 Are you a foreign citizen or resident for tax purposes?
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS OFFICER 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email address
(Where confirmation notes will be mailed)
Mobile Number

Country CodeArea CodePhone Number
Home or Business Number

Country CodeArea CodePhone Number
Company Officer 2 (Director or Secretary)
Corporate Title
Company Officer 2 Full Name

TitleGiven NamesSurname
Any other name known by
Date of Birth

DayMonthYear
Country of birth
Country of citizenship or lawful permanent residency
Occupation
Mother’s Maiden Name
CO2 Are you a foreign citizen or resident for tax purposes?
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS OFFICER 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email address
(Where confirmation notes will be mailed)
Mobile Number

Country CodeArea CodePhone Number
Home or Business Number

Country CodeArea CodePhone Number
Company Officer 3 (Director or Secretary)
Corporate Title
Company Officer 3 Full Name

TitleGiven NamesSurname
Any other name known by
Date of Birth

DayMonthYear
Country of birth
Country of citizenship or lawful permanent residency
Occupation
Mother’s Maiden Name
CO2 Are you a foreign citizen or resident for tax purposes?
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS OFFICER 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email address
(Where confirmation notes will be mailed)
Mobile Number
Format: 0000 000 000.
Home or Business Number

Country CodeArea CodePhone Number
Company Officer 4 (Director or Secretary)
Corporate Title
Company Officer 4 Full Name

TitleGiven NamesSurname
Any other name known by
Date of Birth

DayMonthYear
Country of birth
Country of citizenship or lawful permanent residency
Occupation
Mother’s Maiden Name
CO2 Are you a foreign citizen or resident for tax purposes?
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS OFFICER 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email address
(Where confirmation notes will be mailed)
Mobile Number
Format: (+00) 000 000 000.
Home or Business Number

Country CodeArea CodePhone Number
Beneficial Owners

List Individuals who whether directly or through other companies or trusts own more than 25% of the Company:-
Number of Owners
Maximum of 4 Owners
Owner 1
Owner 1 Full Name

TitleGiven NamesSurname
Any other name known by
Date of Birth

DayMonthYear
Country of birth
Country of Citizenship or lawful permanent residency
Occupation
Mother’s Maiden Name
01 Are you a foreign citizen or resident for tax purposes?
TFN
Country of residence
Residential Address Details Owner 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email address
(Where confirmation notes will be mailed)
Mobile Number
Format: (+00) 000 000 000.
Home or Business Number

Country CodeArea CodePhone Number
Owner 2
Owner 2 Full Name

TitleGiven NamesSurname
Any other name known by
Date of Birth

DayMonthYear
Country of birth
Country of citizenship or lawful permanent residency
Occupation
Mother’s Maiden Name
O2 Are you a foreign citizen or resident for tax purposes?
TFN
Country of residence
Residential Address Details Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email address
(Where confirmation notes will be mailed)
Mobile Number
Format: (+00) 000 000 000.
Home or Business Number

Country CodeArea CodePhone Number
Owner 3
Owner 3 Full Name

TitleGiven NamesSurname
Any other name known by
Date of Birth

DayMonthYear
Country of birth
Country of citizenship or lawful permanent residency
Occupation
Mother’s Maiden Name
O2 Are you a foreign citizen or resident for tax purposes?
TFN
Country of residence
Residential Address Details Address 3

Street Address

Street Address Line 3

CityState / Province

Postal / Zip CodeCountry
Email address
(Where confirmation notes will be mailed)
Mobile Number
Format: (+00) 000 000 000.
Home or Business Number

Country CodeArea CodePhone Number
Owner 4
Owner 4 Full Name

TitleGiven NamesSurname
Any other name known by
Date of Birth

DayMonthYear
Country of birth
Country of citizenship or lawful permanent residency
Occupation
Mother’s Maiden Name
O2 Are you a foreign citizen or resident for tax purposes?
TFN
Country of residence
Residential Address Details Address 4

Street Address

Street Address Line 4

CityState / Province

Postal / Zip CodeCountry
Email address
(Where confirmation notes will be mailed)
Mobile Number
Format: (+00) 000 000 000.
Home or Business Number

Country CodeArea CodePhone Number
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Initial Information Sheet

Investment Class

Source of Investment Funds

Company Details

Company Officer Details

Company Officer 1 (Sole Director, Director or Secretary)

Company Officer 2 (Director or Secretary)

Company Officer 3 (Director or Secretary)

Company Officer 4 (Director or Secretary)

Beneficial Owners

Owner 1

Owner 2

Owner 3

Owner 4