Individual Investor Application Form

 Income & Growth Fund:

Insert Passport Photo

A. INVESTOR[S] INFORMATION
Full Name: (Mr/Mrs/Ms)
Residential Address:
Postal Address:
Occupation:
Date of Birth:
Tax Identification No:
Telephone No:
Email:
Valid Passport No:
Non-residence:
FNPF No:
(If applicable, state country of residence)
MINORS - (Managed by Parents/Guardians and Custodians)
Name:
Relationship with Minor:
Tax Identification No:
Date of Birth:
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)
C. DIVIDEND DISTRIBUTION
Reinvestment Plan: (Please Tick)  Yes No 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)  Yes No
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{1}: Name:{2} Name:{3}
Signature: Signature Signature:
Date: Date: Date:
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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