Investor Signals Fund - SMSF Client Application form

Initial Information Sheet

SMSF 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
Salary/WagesBusiness income, earnings or profitsInvestment income/earnings/saleInheritance/giftOther
Investor Details
Name of Superfund
Superfund ABN
Superfund TFN
Mailing address you would like correspondence sent to for this account

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of beneficial owners of the Superfund*
Maximum of 5 Beneficial Owners
Beneficial Owner 1
Full Name 1

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
If Director, please specify the industry & nature of business
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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 Owner 2
Full Name 2

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
If Director, please specify the industry & nature of business
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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 Owner 3
Full Name 3

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
If Director, please specify the industry & nature of business
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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 Owner 4
Full Name 4

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
If Director, please specify the industry & nature of business
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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 Owner 5
Full Name 5

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
If Director, please specify the industry & nature of business
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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
Trustees
IndividualCorporate or Company
Number of Individual Trustees*
Maximum of 4 Individual Trustees
Individual Trustee 1 details:
Trustees Full Name 1

TitleGiven NamesSurname
Any other name known by
Date of Birth

DayMonthYear
Country of birth
Occupation
Mother’s Maiden Name
If Director, please specify the industry & nature of business
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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
Individual Trustee 2 details:
Trustees Full Name 2

TitleGiven NamesSurname
Any other name known by
Date of Birth

DayMonthYear
Country of birth
Occupation
Mother’s Maiden Name
If Director, please specify the industry & nature of business
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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
Individual Trustee 3 details:
Trustees Full Name 3

TitleGiven NamesSurname
Any other name known by
Date of Birth

DayMonthYear
Country of birth
Occupation
Mother’s Maiden Name
If Director, please specify the industry & nature of business
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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
Individual Trustee 4 details:
Trustees Full Name 4

TitleGiven NamesSurname
Any other name known by
Date of Birth

DayMonthYear
Country of birth
Occupation
Mother’s Maiden Name
If Director, please specify the industry & nature of business
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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
Company Details
Company Name
ProprietaryPublicOther
Company ABN / ACN:
Company TFN
Country of Incorporation
Number of Directors
Nature of the business activity
YesNo
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
YesNo
Postal Address

Street Address / P O Box

Address Line 2

CityState / Province

Postal / Zip CodeCountry
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
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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
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
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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
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
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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
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
No - Enter TFN belowYes - Enter country of residence below
TFN
Country of residence
RESIDENTIAL ADDRESS DETAILS

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
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Should be Empty:

Initial Information Sheet

Investment Class

Source of Investment Funds

Investor Details

Beneficial Owner 1

Beneficial Owner 2

Beneficial Owner 3

Beneficial Owner 4

Beneficial Owner 5

Trustees

Individual Trustee 1 details:

Individual Trustee 2 details:

Individual Trustee 3 details:

Individual Trustee 4 details:

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)