Joint Investor Application Form

    Insert Passport Photo

    Insert Passport Photo

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