As part of our due diligence process, we kindly request that you provide us with more details regarding the source of your funds or wealth as per your option chosen above.
*This information is required to ensure compliance with regulatory requirements in New Zealand.
Note: By submitting this application you agree to receive all communication from Elevation Capital Management Limited via email.
This statement relates to the personal information you are providing to the Manager by way of the application and any subsequent personal information you may provide in the future. The personal information you have supplied maybe used by the Manager and Supervisor (and related entities thereof) for the purposes of enabling the Manager to arrange and manage your investment, and to contact you in relation to your investment. The Manager will provide you (on request) with the name and address of any entity to which information has been disclosed. You have the right to access all personal information held about you by the Manager. If any of the information is incorrect, you have the right to have it corrected. You acknowledged that you are authorised to provide personal information on behalf of the applicant and evidence of this authority is provided. You agree that your / each of your names and addresses maybe used by Elevation Capital Management Limited to provide you with newsletters and other information about the Fund/s and other products and services either via traditional mail or electronic communication.For the purpose of verifying my identity, I consent to the personal information that I have provided being used by Elevation Capital Management Limited and MMC Limited (the Administration Manager) with (and, where necessary, disclosed to) the following sources: (1) the NZTA for the purpose of checking the Driver Licence and MOTO databases; (2) the Department of Internal Affairs for the purpose of checking the Passport, Birth Certificate and Citizen Certificate databases; (3) Land Information New Zealand; (4) the Companies Office; (5) Centrix Group Limited (and I authorise Centrix to use any information that they hold in their credit reporting bureau about me to compare the information that I have provided); and (6) the White Pages.
The Foreign Account Tax Compliance Act ("FATCA") or any intergovernmental agreement ("IGA") entered into by New Zealand Government in respect of that Act requires Elevation Capital Management Limited to collect information on United States (US) citizens, US residents and entities controlled by US citizens and US residents from 1 July 2014. To help meet our legal obligation under FATCA or any IGA entered into by the New Zealand Government in respect of the Act, please answer the following question: Check the box if you are you a US citizen or US resident. If you are a US citizen or US resident we may require you to provide additional information to assist Elevation Capital Management Limited is complying with FATCA or any IGA entered into by the New Zealand Government in respect of the Act.
The Anti-Money Laundering and Countering Financing of Terrorism Act 2009 (AML/CFT Act) came into force on 30 June 2013. Elevation Capital Management Limited is required to identify and verify the identity of customers and associated persons of customers. Our application forms and online application process comply with the new requirements, however in certain circumstances we may need to collect extra information from you and anyone who is acting on your behalf for the purposes of the AML/CFT Act. The Parliament of New Zealand enacted the AML/CFT Act 2009 for the purposes: a) to detect and deter money laundering and the financing of terrorism; and b) to maintain and enhance New Zealand's international reputation; and c) To contribute to public confidence in the financial system. The AML/CFT Act applies to banks and most financial institutions, and it is essential that we comply. Sometimes this may mean that we won't be able to complete your investment instructions or meet your needs until all of the necessary information is obtained. We are committed to protecting the privacy of your information and we will continue to ensure all identity and other personal information you provide will be used and managed in accordance with the Privacy Act 1993. Check the box if you have read and understand the requirements under the AML/CFT Act and the possibility we may seek more information from you as a result of this application process to meet our legislative requirements.
I / We have read, understood and retained a copy of the attached Product Disclosure Statement and agree to be bound by the terms and conditions of the Trust Deed. I / We agree to the terms outlined above in relation to the Privacy Act and the supply of personal information. I / We understand that the Manager, Administration Manager or the Supervisor may disclose certain information to the New Zealand Government, Market Regulation or a Foreign Government due to either New Zealand or foreign laws. I / We consent to the receipt in electronic form of any information to be forwarded to me / us by Elevation Capital Management Limited or the Fund Administrator. I / We undertake to advise Elevation Capital Management Limited immediately should the Prescribed Investor Rate change at anytime. I / We acknowledge that failure to advise a Rate or the provision of an incorrect Rate will mean that I / We will be personally liable to pay any resulting shortfall and must also file a tax return. I / We understand that the Fund is a vehicle for long term investments and as the Fund invests in shares, the value of my / our investment is liable to fluctuations and may rise and fall from time to time. I / We understand the manner in which fees will be deducted from my / our investment. I / We understand that the application cannot be withdrawn or reworked by the applicant and that the Manager reserves the right to reject any application in whole or in part without giving any reason. This Product Disclosure Statement and the offer of securities has been made to me / us in New Zealand and the expressions defined in the Product Disclosure Statement have the same meaning in the Application Form.
