What is your company name?

Company Registration

Date of Incorporation

Please provide an explaination of the industry that the company operates within:

What is the principals business address or registered office address?

Note: P.O. Boxes are not accepted.

What are the company tax details?

IRD Number What is my IRD number?

Prescribed Investor Rate

10.5% 17.5% 28%

What is my PIR?

Please note that if a PIR is not selected, a PIR of 28% will apply.

Are you a new investor?

New Investor Existing Investor

How do you intend to deposit to this account?

Regular Now and then One off lump sum

How do you intend to withdraw from this account?

Regular Now and then One off lump sum

Even if you are not planning to withdraw soon, please tell us how you might in the future.

Is the company a vehicle for holding personal assets or does the company have nominee shareholders, nominee directors or shares in bearer form?

No
Yes

Please provide a detailed explaination of the source of wealth and source of funds of the company:

Please supply a list of directors and those who own greater than 25% of the company

Person 1

Add another person

Contributions

I want to invest in the Elevation Capital Global Shares Fund with a

Single Lump Sum Regular Contribution

Contribution (NZ$)

The minimum contribution is $5,000.

Initial Contribution

A minimum initial contribution of NZ$5,000 applies.

Subsequent Contribution

A NZ$100 minimum contribution per month, quarter or annually applies.

Frequency

Monthly Quarterly Annually

Start date

Distribution Instructions

Reinvest distributions Payout distributions

Do you have an adviser?

Yes No

Principal business address or registered office address of the adviser

Note: P.O. Boxes are not accepted.

Is your address for service through your adviser?

Yes No

Acknowledgements

Acknowledgements relating to the Company

We confirm that we are authorised to complete this Application Form, invest in the Fund and to enter any related documentation on behalf of the company.

We confirm that any instructions provided by us are binding on the company.

Acknowledgements relating to the Fund

We confirm that we have read and understood the Elevation Capital Global Shares Fund - Product Disclosure Statement (PDS).

We confirm that we have read, understood and agree to be bound by the terms of the Trust Deed for the Fund.

We understand that the Fund is a vehicle for long term investments and as the Fund invests in shares, the value of my investment is liable to fluctuations, causing it to rise and fall from time to time.

We confirm that we understand how fees will be deducted from my investment.

We consent to the receipt of information and documents relating to my investment in the Fund by electronic communication.

Acknowledgements relating to personal information

We have read, understood and agree to the terms of your Privacy Policy.

I confirm that I am authorised to provide the personal details presented and have obtained the consent of the individuals to which the personal details relate for this information to be passed to and checked with the document issuer, official record holder, a credit bureau and authorised third parties for the purpose of verifying my identity and address. I also confirm that if required, evidence of this consent can be produced.

We acknowledge that you may need to disclose information about the investment in the Fund to the Financial Markets Authority and to your appointed Statutory Supervisor in order to comply with your obligations under the Financial Markets Conduct Act 2013 and other applicable laws. We agree to the disclosure of this information.

Acknowledgements relating to anti-money laundering and countering financing of terrorism

We are not aware, and do not have any reason to suspect, that any of the monies used to acquire unit(s) in the Fund are derived from money laundering or terrorism financing or any other illegal activity as defined by the laws of New Zealand.

We agree to provide to you with any further documents that you request from time to time to comply with your obligations under the AML/CFT Act (and related regulations and materials).

Acknowledgements relating to tax

We acknowledge that you may be obliged to share the information that I provide to you with relevant domestic and foreign tax authorities in accordance with applicable tax laws and regulations, including the Foreign Account Tax Compliance Act (FATCA) and Common Reporting Standard (CRS). We agree to the provision of this information.

We acknowledge that failure to advise a prescribed investor rate (PIR) or the provision of an incorrect PIR, will mean that we will be personally liable to pay any resulting shortfall and must also file a tax return.

Acknowledgements relating to this Application Form

We confirm that the information and documents that we have provided to you are accurate and complete, and that we will advise you of any changes to this information or the documents provided. We will comply with any requests for information or documents that you make in relation to the changes.

The Application Form and Direct Debit Authority (if applicable) have been properly signed by us in our capacity as directors of the company.

I understand that this Application Form cannot be withdrawn or reworked and that you reserve the right to reject any Application Form in whole, or in part, without giving any reason.