Company Registration Form

    Insert Passport Photo

    Insert Passport Photo

    Insert Passport Photo

    Type of Fund
    Income & Growth Fund Income Fund
    Income Plus Plan

    Investment Plans

    A. COMPANY/TRUST/GROUPS & ASSOCIATIONS INFORMATION
       
    Entity Name:
    Contact Person: Designation:
    Registration No: Tax Identification No:
    Postal Address: Email:
    Telephone No: Fax No:
    B. PURCHASE OF UNITS
    Fund Investment Plans Number of Units Value of Units [$]
    Income & Growth Fund n/a  
    Income Fund Children Investment Plan
      Income Plus Plan
    Source of Funds: Annual Income (Optional):
    Minimum initial application amount
    Income & Growth Fund: 100 units
    Income Fund:
    Children Investment Plan 20 units ($20.00)
    Income Plus Plan 50 units ($50.00)
    Reinvestment Plan: (Please Tick) YesNo Bank Direct Credit
    Bank Name:
    Account No:
    Branch:
    Cheque Payment: (applicable to Income & Growth Fund only with investment in excess of 1,000 units)(Please Tick) YesNo
    D. DECLARATION AND SIGNATURE
    I/We declare that I/We have seen and agree with the Declaration and Conditions that are outlined in on page 32 of this Prospectus.
    TRUSTEE SIGNATURE[S]
    Name Name: Name
    Signature Signature: Signature
    Date: Date: Date:
    Please affix Company seal here
    E. REFERRAL[S]
    FDB POST FIJI REPRESENTATIVE/AGENT
    F. Official Use Only Checklist
    No: Documents
    1 Photo I-D (Valid FNPF Card, Drivers License and Passport)
    2 Birth Certificate
    3 Passport Photo(s)
    4 Statutory Declaration (in the absence of a formal identification) with photo(s)
    5 Passport for overseas based investors (compulsory)
    6 Consent letter from Parents/guardians/custodians (applicable to Children Investment Plan)

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