HELIO SECURED INCOME FUND APPLICATION FORM


* Indicates required field

Is this application from a new investor or an existing investor in HELIO SECURED INCOME FUND? *

Do you have a 708 Sophisticated Investor Certificate?


PART A: INVESTOR & INVESTMENT DETAILS

If you are a new investor please complete both PART A: Investor & Investment Details and PART B: Investor Identification, and send all documents to First Guardian Capital (FGC) via this online form or at the address below. If your investor type does not fall into any of the four investor categories, please request a customised application form from FGC.

Type of Investor: *


A1 - Investor Information

A1.1 - Investor Details

*

A1.2 - Contact Details



A2 - Taxation Details

Where the investment in the fund is held jointly by 2 or more unitholders taxation details for each unitholder need to be provided.

A2.1 - Investor

  


A3 - Distribution and Redemption Details

I/we wish to have my/our income distributions (please tick one):

I/we wish to have my/our proceeds from redemption :

Complete bank account details below if applicable:

IMPORTANT NOTE: If this section is not completed it may cause a delay in processing of your redemption proceeds. Additional security checks to verify bank account changes will be performed at the time of payment of your redemption proceeds.

If you reside in Australia distributions and withdrawal proceeds can only be paid to an Australian bank account in the name of the unitholder and cannot be paid by cheque or to third party accounts. By completing this section, you confirm that any distributions and withdrawal proceeds sent by EFT to a designated bank account are sent at your risk insofar as the onus to provide bank account details rests solely on you.



A4 - Investment Details

Source of funds being invested (please tick one):

  

* Once your application has been approved, we will notify you of the payment method.



PART B: INVESTOR IDENTIFICATION

* If you have not selected a type of investor, please select one in PART A.


B1 - Investor Type: All Trusts (Including Superannuation Funds)

B1.1 - General Information

B1.2 - Type of Trust


B1.3 - Beneficiary Details

(Complete this section if “Other trust type” is selected in the previous section)

Do the terms of the trust identify the beneficiaries by reference to membership of a class?

Provide full name of each beneficiary below:

If there are more beneficiaries, provide details on a separate sheet of paper and attached it to your Application Form.


B1.4 - Beneficial Ownership

Individual Trustee(s) and/or the beneficial owners of any corporate Trustee previously provided will be considered to be the beneficial owners of the trust. If different, please provide details below.


B1.5 - Identification Documents

For each individual listed on this application, please provide a certified copy of identification as listed below:

  • Australian Driver’s License
  • Australian Passport (that has not expired more than 2 years ago)
  • International Travel Document – Foreign Passport (that has not expired more than 2 years ago)
  • Australian Proof of Age Card
  • Australian National Identity Card
    (1) Primary certified non-photographic identity document; AND
  • Australian Birth Certificate or Extract of Birth
  • Australian Citizenship Certificate
  • Foreign Citizenship Certificate
  • Foreign Birth Certificate
  • A Centrelink Pension Card or Centrelink Healthcare Card
    (2) Secondary certified non-photographic identity document
  • A financial benefit notice issued by the Commonwealth,
  • State or Territory within the last 12 months
  • An income tax assessment notice issued within the last 12 months
  • A local government notice (e.g. council rates) or utilities notice issued within the last 3 months

Primary Non-Photographic Identification Documents:

Secondary Identification Documents:


B1 - Investor Type: Australian & Foreign Company

B1.1 - General Information

  
  
  

Registered office address (PO Box is not acceptable)

Principal place of business (if any, PO Box is not acceptable)


B1.2 -Regulatory and Listing Details (Select the following categories which apply to the company and provide the information requested)

Select the following categories which apply to the company and provide the information requested:


B1.3 - Company Type (Select only one of the following categories)

  

B1.4 - Directors (only needs to be completed for proprietary, private and other companies)

This section does NOT need to be completed for public and listed companies.

Provide full name of each director below:

If the company is a regulated company (as selected in above) section B1 is now competed, continue to Section B2.

If there are more directors, please provide details on a separate sheet of paper and attach it to your Application Form.


B1.5 - Shareholder Beneficial Owners (only needs to be completed for proprietary, private or other companies that are not regulated companies as selected in section above)

Provide details of ALL individuals who ultimately own 25% or more of the company’s issued share capital (through direct or indirect shareholdings).

Shareholder 1

Residential address (PO Box is not acceptable)

Shareholder 2

Residential address (PO Box is not acceptable)

Shareholder 3

Residential address (PO Box is not acceptable)


Other beneficial owners

If there are no individuals who meet the requirements of shareholder beneficial owners, provide the names of the individuals who directly or indirectly control the company.

* includes exercising control through the capacity to determine decisions about financial or operating policies; or by means of trusts, agreements, arrangements, understanding & practices; voting rights of 25% or more; or power of veto. If no such person can be identified then the most senior managing official/s of the company (such as the managing director or directors who are authorised to sign on the company’s behalf).

Beneficial Owner 1

Residential address (PO Box is not acceptable)

Beneficial Owner 2

Residential address (PO Box is not acceptable)

Beneficial Owner 3

Residential address (PO Box is not acceptable)

* If the company is a FOREIGN company NOT registered with ASIC please also attach certified copy of the certification of registration issued by the relevant foreign registration body.


B1.6 - Identification Documents

For each individual listed on this application, please provide a certified copy of identification as listed below:

  • Australian Driver’s License
  • Australian Passport (that has not expired more than 2 years ago)
  • International Travel Document – Foreign Passport (that has not expired more than 2 years ago)
  • Australian Proof of Age Card
  • Australian National Identity Card
    (1) Primary certified non-photographic identity document; AND
  • Australian Birth Certificate or Extract of Birth
  • Australian Citizenship Certificate
  • Foreign Citizenship Certificate
  • Foreign Birth Certificate
  • A Centrelink Pension Card or Centrelink Healthcare Card
    (2) Secondary certified non-photographic identity document
  • A financial benefit notice issued by the Commonwealth,
  • State or Territory within the last 12 months
  • An income tax assessment notice issued within the last 12 months
  • A local government notice (e.g. council rates) or utilities notice issued within the last 3 months

Primary Non-Photographic Identification Documents:

Secondary Identification Documents:


B1 - Investor Type: Individual

B1.1 - Investor 1

Residential address (PO Box is not acceptable)

Complete this part if individual is a sole trader

Principal place of business (if any, PO Box is not acceptable)


B1.2 - Investor 2

Residential address (PO Box is not acceptable)

Complete this part if individual is a sole trader

Principal place of business (if any, PO Box is not acceptable)


B1.3 - Identification Documents

For each individual listed on this application, please provide a certified copy of identification as listed below:

  • Australian Driver’s License
  • Australian Passport (that has not expired more than 2 years ago)
  • International Travel Document – Foreign Passport (that has not expired more than 2 years ago)
  • Australian Proof of Age Card
  • Australian National Identity Card
    (1) Primary certified non-photographic identity document; AND
  • Australian Birth Certificate or Extract of Birth
  • Australian Citizenship Certificate
  • Foreign Citizenship Certificate
  • Foreign Birth Certificate
  • A Centrelink Pension Card or Centrelink Healthcare Card
    (2) Secondary certified non-photographic identity document
  • A financial benefit notice issued by the Commonwealth,
  • State or Territory within the last 12 months
  • An income tax assessment notice issued within the last 12 months
  • A local government notice (e.g. council rates) or utilities notice issued within the last 3 months

Primary Non-Photographic Identification Documents:

Secondary Identification Documents:



B2 - Declaration and Signature

I/we have received the complete and unaltered Information Memorandum dated 31 December 2018 (as amended by the Trustee from time to time) to which this Application Form relates. I/we have read and understood the entire Information Memorandum to which this Application Form applies. I/we agree to be bound by:

  • the provisions of the information Memorandum (as amended from time to time); and
  • the Constitution (as amended from time to time) governing the Fund.

I/we declare that in making this application and investing in the Fund.

  • all statements made by me/us are complete and accurate and this application complies with the terms of the Information Memorandum;
  • I/we have legal power to invest in accordance with this Application Form;
  • I/we am/are a "wholesale client" within the meaning of the Corporations Act 2001 or I/we am/are an investor/s in a jurisdiction to who it is lawful to make an offer or invitation to purchase Units;
  • I/we received the Information Memorandum and made this application in Australia;
  • if this Application Form is signed under Power of Attorney, the Attorney declares that he/she has not received notice of revocation of that power and that under the terms of the Power of Attorney, the Attorney is authorised to grant an irrevocable Power of Attorney in respect of the applicant under the terms of Section 5 of the Application Form. (A certified copy of the Power of Attorney must be submitted with this application unless we have already sighted it);
  • by their signature hereto, applicants on behalf of companies or trustees for superannuation, provident or other funds or trusts warrant that the company or trustee, as the case may be, has the power of invest in Units and that the applicant is duly authorised to apply for such Units;
  • that the Trustee is authorised to apply the TFN or ABN provided above to all future applications for units, including reinvestments, unless I notify the Trustee otherwise;
  • I/we will notify FGC of any changes in the information provided in this Application Form (including on any of these declarations);
  • I/we authorise FGC, its officers or agents, to do anything on our behalf necessary for Units to be issued to us;
  • I/we release and indemnify FGC against any liabilities whatsoever arising out of FGC acting on any communications received phone, fax, or other electronic means in respect of my/our investments.
  • Investments in the Fund is subject to investment and other risks, including possible delays in repayment and the loss of income and principal invested;
  • neither the Trustee, FGC nor any other member company of the First Guardian Group of companies guarantees the repayment of capital or the performance of the Fund or any particular rate of return from the Fund;
  • FGC may disclose to any service provider to the Fund or to any regulatory body in any applicable jurisdicition copies of my/our Application Form and any information concerning me/us provided by me/us to FGC and any such disclosure shall not be treated as a breach of any restriction upon the disclosure of information imposed by law or otherwise;
  • I acknowledge that the Trustee may be required to pass on information about me or my investment to the relevant regulatory authority in compliance with the AML Act. I will provide such information and assistance that may be requested by the Trustee to comply with its obligations under the AML Act and I indemnify it against any loss caused by my failure to provide such information or assistance;
  • I acknowledge that the Trustee may be required to pass on information about me or my investment to the relevant regulatory authority in compliance with the US Foreign Account Tax Compliance Act (“FATCA”). I will provide such information and assistance that may be requested by the Trustee to comply with its obligations under the FATCA Act and I indemnify it against any loss caused by my failure to provide such information or assistance;
  • The monies used to fund my investment in the Fund are not derived from or related to any money laundering, terrorism financing or other illegal activities, whether prohibited under Australian law, international law or convention (‘illegal activity’) and the proceeds of my investment in the Fund will not be used to finance any illegal activities;
  • I am not a ‘politically exposed’ person or organisation for the purpose of any AML law;
  • I acknowledge that any personal information I provide to FGC will be collected and handled in accordance with FGC’s privacy policy, a copy of which can be posted / emailed to me if I contact FGC on +61 3 9988 7753 or info@frstguardiancapital.com. By submitting this form or any other paperwork relating to my investment I consent to my/our personal information being collected and handled by the unit registry in accordance with that policy;
  • I/we declare that the Trustee, FGC and/or its related entities will not be liable to me/us or other persons for any loss suffered (including consequential loss in circumstances where transactions are delayed, blocked, frozen or where the Trustee or FGC refuses to process a transaction);
  • I/we acknowledge that the return of this Application Form will constitute my/our acceptance of the offer contained in the IM to purchase Units;
  • I/we acknowledge that if this Application Form is not completed correctly it may still be treated as valid;
  • I/we acknowledge that FGC may accept or reject this application in whole or in part;
  • I/we acknowledge that once FGC receives this Application Form, I/we may not withdraw it;
  • I/we acknowledge that the decision of the Trustee on the number of Units allocated to me/us will be final, but I/we will not be treated as having applied to purchase more Units than is indicated on this Application Form;
  • I/we acknowledge that investments in the Fund are not investments, deposits or other liabilities of FGC or any other member company of the First Guardian Group of companies;
  • I/we acknowledge that the information in the IM contains general information only, does not constitute investment advice, and does not take into account the investment objectives, financial situation or investment needs of any particular investor;
  • I/we acknowledge that I/we have not relied on any statement or representation of the Trustee or FGC except as set out in the IM; and
  • I/we acknowledge that I/we have had the opportunity to seek independent professional advice concerning the legal, tax and financial implications of investing in the Fund, and have made my/our own enquiries, in particular in relation to the potential returns from and the risks associated with an investment in the Fund.


Investor Details


Contact Details



Additional Investment

Please note the minimum additional investment amount is A$100,000.

Please tick the box to advise how your payment will be made:

IMPORTANT: All EFT payments must be accompanied by a notification email to invest@firstguardiancapital.com in order to ensure that the investor account is properly credited.


Declaration and Authorisation


Please make sure you have completed the section above.

In signing, I/we authorise that these instructions be made on my/our behalf and acknowledge that this form is provided on the basis that the Trustee will affect it according to the terms and conditions of the current IM.


For Individuals



For Company/Trust/Superannuation Fund