Welcome
The following is a guide to help complete the Application Form for Units in The Gemi Fund (Fund).
| Type of Investor | Details | Correct Form | Signature Required |
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| Individual | Use full legal names only | Mary Jane Smith |
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| Company | Use full company name | Smith Corporation Pty Ltd |
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| Minor | Use name of parent/guardian with the name of the minor in brackets | Mary Jane Smith <Mary Jane Smith> |
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| Trusts | Use names of trustees with the trust name in brackets | Smith Corporation Pty Ltd <Smith Family Trust> |
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| Superannuation Funds | Use names of trustees with the fund name in brackets | Smith Corporation Pty Ltd <Super Fund A/C> |
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| Partnerships | Use all full partner names with preferred account name in brackets | Mary Smith and Sally Smith <Smith Sisters A/C> |
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| Deceased Estates | Use executor(s) personal names, do not use name of deceased | John Smith <Est Jane Smith A/c> |
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| Type of Investor | Details |
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| Individual |
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| Minor |
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| Trusts |
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| Superannuation Funds |
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| Partnerships |
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| Deceased Estates |
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If you are an association, foreign investor or government body, kindly complete this form to include name and type of investor, identification documents and contact details. If required we will contact you to obtain further information necessary to meet our compliance obligations.
Payment
Transfers may be made directly into the Applications bank account of the Fund. Details of this bank account are available later on this form. Applications will not be processed by the Trustee without confirmation that payment has been received in the Trust account.
Before You Begin
| Are you already an investor in The GEMI Fund or The Gemi First Mortgage Fund and wish to make an additional investment with the same investing entity? | |
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By ticking each of the below boxes, you acknowledge and agree that:
*Electronic signature with respect to this application is in the form of entering your name and ticking a box to confirm you are the authorised person to execute this form.
Application Form
This Application Form relates to the application for Units in The Gemi Fund (Fund) under the Information Memorandum dated 12 December 2019 (IM) issued by Gemi Asset Management Pty Ltd (Issuer) as the Trustee of the Fund.
Unless otherwise defined, capitalised terms in this Application Form have the meaning given to them in the IM.
It is important that you read the IM in full and the acknowledgments contained in this application form before applying for units.
Please provide details of key contact person for correspondence for all applicants and other authorised parties. Correspondence regarding investment in the Fund will be sent to the email address provided.
Applications must only be in the name of a natural person or persons, companies or other entities acceptable to the Trustee. All account designations are to use "<>" notations.
Unless otherwise defined, capitalised terms in this Application Form have the meaning given to them in the IM.
It is important that you read the IM in full and the acknowledgments contained in this application form before applying for units.
Please provide details of key contact person for correspondence for all applicants and other authorised parties. Correspondence regarding investment in the Fund will be sent to the email address provided.
Applications must only be in the name of a natural person or persons, companies or other entities acceptable to the Trustee. All account designations are to use "<>" notations.
Applicant Contact Details
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We will send relevant information, updates, disclosure documents, forms and reports to your email address nominated above. Should you wish to opt out of our electronic disclosure, please contact us on (02) 91570719.
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Applicant Postal Address
Investment Details
Source of Investment Funds
Please identify the source of your investable assets or wealth:
What is the purpose of this investment?
Wholesale Clients
| Are you a Wholesale Client under Section 761G(7) of the Corporations Act? |
I acknowledge that one of the following circumstances apply to me (please indicate):
If (b) or (c) applies, please provide an Accountant’s Certificate with your Application Form
- Download Here
* If you consider yourself a ‘professional investor’ please contact the Registrar on the number provided in order to complete the appropriate forms.
* If you consider yourself a ‘professional investor’ please contact the Registrar on the number provided in order to complete the appropriate forms.
Investor Details
What type of investor are you?
Individual Investor Details
Tax Residency
| Are you an Australian resident for tax purposes? | |
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| Are you a US person? | |
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Please specify your countries of tax residence and associated tax identification numbers (TIN).
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| Are you a tax resident of any other country? | |
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| If you don't have a TIN, please tick one of the following: | |
Political Exposure
| Are you a Politically Exposed Person? | |||
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Individual Investor Details
Tax Residency
| Are you an Australian resident for tax purposes? | |
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| Are you a US person? | |
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Please specify your countries of tax residence and associated tax identification numbers (TIN).
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| Are you a tax resident of any other country? | |
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| If you don't have a TIN, please tick one of the following: | |
Political Exposure
| Are you a Politically Exposed Person? | |||
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Individual Investor Details
Tax Residency
| Are you an Australian resident for tax purposes? | |
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| Are you a US person? | |
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Please specify your countries of tax residence and associated tax identification numbers (TIN).
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| Are you a tax resident of any other country? | |
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| If you don't have a TIN, please tick one of the following: | |
Political Exposure
| Are you a Politically Exposed Person? | |||
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Individual Investor Details
Tax Residency
| Are you an Australian resident for tax purposes? | |
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| Are you a US person? | |
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Please specify your countries of tax residence and associated tax identification numbers (TIN).
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| Are you a tax resident of any other country? | |
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| If you don't have a TIN, please tick one of the following: | |
Political Exposure
| Are you a Politically Exposed Person? | |||
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Company Details
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If there are more than four directors, please contact us.
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Tax Residency
| Is the Company an Australian resident for tax purposes? | |
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| Is the Company a US company? | |||
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| Foreign Account Tax Compliance Act (FATCA) Status | |||
| Select a classification that matches the company's FATCA status: | |||
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| Common Reporting Standard (CRS) Status | |||
| Is the Investment Entity managed by another Financial Institution? | |||
| If the Company is a Non-Financial Entity ('NFE'), select a classification that matches its CRS status: | |||
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Please specify the countries of tax residence and associated tax identification numbers (TIN).
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| Are you a tax resident of any other country? | |||
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| If the company doesn't have a TIN, please tick one of the following: | |||
Registered Business Address
Principal place of business address
(Not a PO Box Address)
Trust Details
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Additional Unregulated Trust Details
| Do the terms of the trust identify the beneficiaries by reference to membership of a class? | |
| Describe the class of beneficiaries (e.g. Unit Holders, Family Members, Charitable purposes) | |
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| Please provide the full name of each beneficiary | |
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Settlor Details |
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| Full name of settlor of trust? | |
Tax Residency
| Is the Trust an Australian resident for tax purposes? | |||
| Is the Trust a US Trust? | |||
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| Foreign Account Tax Compliance Act (FATCA) Status | |||
| Select a classification that matches the Trust's FATCA status: | |||
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| Common Reporting Standard (CRS) Status | |||
| If the Trust is a Non-Financial Entity ('NFE'), select a classification that matches its CRS status: | |||
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Please specify the countries of tax residence and associated tax identification numbers (TIN).
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| Are you a tax resident of any other country? | |||
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| If the company doesn't have a TIN, please tick one of the following: | |||
Beneficial Owner Details
| Is this Beneficial Owner also a Controlling Person? |
Beneficial Owner Tax Residency
| Are you an Australian resident for tax purposes? | |||
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| Are you a US person? | |||
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Please specify your countries of tax residence and associated tax identification numbers (TIN).
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| Are you a tax resident of any other country? | |||
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| If you don't have a TIN, please tick one of the following: | |||
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Beneficial Owner Political Exposure
| Are you a Politically Exposed Person? | |||
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Beneficial Owner Details
| Is this Beneficial Owner also a Controlling Person? |
Beneficial Owner Tax Residency
| Are you an Australian resident for tax purposes? | |||
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| Are you a US person? | |||
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Please specify your countries of tax residence and associated tax identification numbers (TIN).
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| Are you a tax resident of any other country? | |||
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| If you don't have a TIN, please tick one of the following: | |||
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Beneficial Owner Political Exposure
| Are you a Politically Exposed Person? | |||
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Beneficial Owner Details
| Is this Beneficial Owner also a Controlling Person? |
Beneficial Owner Tax Residency
| Are you an Australian resident for tax purposes? | |||
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| Are you a US person? | |||
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Please specify your countries of tax residence and associated tax identification numbers (TIN).
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| Are you a tax resident of any other country? | |||
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| If you don't have a TIN, please tick one of the following: | |||
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Beneficial Owner Political Exposure
| Are you a Politically Exposed Person? | |||
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Beneficial Owner Details
| Is this Beneficial Owner also a Controlling Person? |
Beneficial Owner Tax Residency
| Are you an Australian resident for tax purposes? | |||
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| Are you a US person? | |||
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Please specify your countries of tax residence and associated tax identification numbers (TIN).
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| Are you a tax resident of any other country? | |||
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| If you don't have a TIN, please tick one of the following: | |||
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Beneficial Owner Political Exposure
| Are you a Politically Exposed Person? | |||
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Controlling Person Details
Controlling Person Tax Residency
| Are you an Australian resident for tax purposes? | |||
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| Are you a US person? | |||
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Please specify your countries of tax residence and associated tax identification numbers (TIN).
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| If you don't have a TIN, please tick one of the following: | |||
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Controlling Person Political Exposure
| Are you a Politically Exposed Person? | |||
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Controlling Person Details
Controlling Person Tax Residency
| Are you an Australian resident for tax purposes? | |||
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| Are you a US person? | |||
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Please specify your countries of tax residence and associated tax identification numbers (TIN).
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| If you don't have a TIN, please tick one of the following: | |||
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Controlling Person Political Exposure
| Are you a Politically Exposed Person? | |||
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How we make payments to you - payment of distributions and withdrawals
| Do you want us to reinvest your income distributions back into the Fund? If you choose to reinvest, you will receive additional units in the fund instead of cash. | |||||||
| Refer to the Offer Document for more details on reinvestment. | |||||||
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How to pay application money to us
Please transfer funds electronically to the following account:| Bank | STG | ||
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| Account Name | GEMI REGISTRY PTY LTD - THE GEMI FUND APPLICATION A/C | ||
| BSB | 112-879 | ||
| Account Number | 426 235 288 | ||
| Reference | Please specify your Surname or Investing Entity Name | ||
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AML/CTF Checklist
Please tick the boxes to confirm where docs have been provided.
Select one of the following options to verify the Trust:
Select one of the following options to verify the Trust:
For any Trustee(s) who are natural persons, ID in accordance with the individual verification requirements below.
If any of the Trustee(s) is a company, ID in accordance with the company verification requirements below.
If the Trustees comprise of individuals and companies, then ID in accordance with the individual and company verification requirements below.
ID will be in accordance with the individual verification requirements below. This will only be required if the amount used to establish the Trust (settlement amount) was greater than $10,000.
You must provide ID of each individual who (directly or indirectly):
- Owns more than 25% of the Trust; or
- Controls the Trust.
ID will be in accordance with the individual verification requirements below.
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You must provide ID of each individual who (directly or indirectly):
- Owns more than 25% of the issued capital of a company; or
- Controls the Company.
ID will be in accordance with the individual verification requirements below.
Please provide at least one of the following Certified ID documents in relation to each applicant.
Personal Information Collection Notification Statement: Personal information about you is held on a register in accordance with the Corporations Act 2001. In addition, the Anti-Money Laundering & Counter-Terrorism Financing Act 2006 (“AML/CTF Act”) requires that personal information about you be collected and verified before a designated service is provided to you. For details about Gemi Investment's privacy policy or to request a copy of our privacy policy, contact our Client Services team on michaelg@gemi.com.au or call (02) 91570719.
Declaration
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Please read the IM before signing the Application Form. Note that company Applicants usually require two signatures.
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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;
- I/we am/are a wholesale client as defined in Section 761G of the Corporations Act 2001 (Cth) and provide all supporting documents required to evidence this. I/we am/are therefore eligible to invest in the Fund;
- The information provided in my/our Application Form is true, correct and complete in all respects;
- I confirm that the Issuer is authorised to treat this Application Form as an original of the Application Form which I have sent to the Issuer by an electronic transmission, either in my personal capacity or as an authorized representative of the investor;
- I also acknowledge that if an electronic copy or printout of the Application Form is introduced as evidence in any judicial proceeding, it will be admissible as any original Application Form record;
- I/we agree to be bound by the provisions of the Constitution governing the Fund 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 Fund, or the repayment of capital from the Fund. Investments in the Fund are subject to various risks, including delays in repayment and loss of income or principal invested. Investments in the Fund 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 Fund;
- 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 Fund;
- 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 Fund 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. Specifically, I confirm the following:
- I have the legal capacity to understand and communicate any personal information required under this application;
- I have read and understood the privacy disclosure as detailed in the IM and in this Application Form;
- I consent to my personal information being collected, held, used and disclosed in accordance with the privacy disclosure voluntarily;
- I consent to the Issuer disclosing my personal information to any Issuer's service providers, in relation to any identification and verification that the Issuer is required to undertake on me, as required under the AML/CTF Act.
- This shall include any information:
- required by any third party document verification service provider; and/or
- provided to any third party document verification service provider.
- 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 Fund. 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 or any other country for taxation purposes;
- 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;
- I/we consent to the Issuer disclosing any information it has in compliance with its obligations under the U.S. Foreign Account Tax Compliance Act (FATCA) and the OECD Common Reporting Standards for Automatic Exchange of Financial Account Information (CRS) and any related Australian law and guidance implementing the same. This may include disclosing information to the Australian Taxation Office, who may in turn report that information to the relevant tax authorities as required;
- 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 FATCA and CRS (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 Fund;
- I am/we are not aware and have no reason to suspect that the monies used to fund my/our investment in the Fund 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 the AML/CTF Law, FATCA and CRS; and
- 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 Fund, 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 the AML/CTF Law, FATCA and CRS).
- I/We acknowledge and agree that information contained in this form and information regarding the account(s) set out above may be reported to the Australian Taxation Office (ATO) as required under the relevant laws and the ATO may provide the information to the country or countries in which I/We/Account Holder am/are/is resident for tax purposes.
- I/We undertake to advise the relevant trustee/responsible entity and/or their relevant agent of any change in circumstances which causes the information contained herein to become incorrect and to provide them with a suitably updated certification within 30 days of such change in circumstances.
- I/We certify that I am/We are the Account Holder (or I am/We are authorised to sign for the Account Holder) of all the account(s) to which this form relates.
- I/We declare that all statements made on this form/in this declaration are, to the best of my/our knowledge and belief, true correct and complete.
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