For Individual Subscribers. For Subscribers that have one or more beneficial owners and to the extent that the beneficial owner’s information is not provided above, please complete the information below with respect to each such beneficial owner.
For Individual Subscribers. _______a. The Subscriber represents that he has an individual net worth, or together with his spouse a combined net worth in excess of $1,000,000. For purposes of this representation, "net worth" means the excess of total assets at fair market value, including home*, home furnishings and automobiles, over total liabilities. _______b. The Subscriber represents that he had an individual income of more than $200,000 in each of the last two calendar years or joint income with his spouse in excess of $300,000 in each of those years and reasonably expects to reach the same income level in the current calendar year.
For Individual Subscribers. For Subscribers that have one or more beneficial owners and to the extent that the beneficial owner’s information is not provided above, please complete the information below with respect to each such beneficial owner. Name Residential Address Date of Birth Occupation PEP¹ Y/N ¹ Is the Owner a Politically Exposed Person? If yes, please attach to this Subscription Agreement a Source of Wealth Letter. The Source of Wealth Letter must describe the economic activity that has generated the individual’s net worth. Subscriber's Bank Account Wire Details (for bank account from which amounts in respect of subscription proceeds will be paid to the Company and to which any amounts due from the Company to the Subscriber will be paid, unless the Company is notified otherwise): Bank Name: Bank Address: Bank Swift/ABA Number: IBAN Number or Sort Code (if applicable): Correspondent Bank Name: Correspondent Bank Address: Correspondent Bank Account# or swift#: Beneficiary Bank Account Name (should be the same as the Subscriber name above): Beneficiary Bank Account Number: I/We hereby certify that the Subscriber is a “Non-U.S. Person” that resides outside of the United States and that information given in this Schedule to the Subscription Agreement is true, accurate and complete. I/we confirm that I/we will, if requested to do so by the Company or the Administrator, provide further information and/or documents to verify this information. Individual Signature(s): Entity Signature: Name of Entity Authorized Signatory Subscription payments must be made by wire transfer, drawn on a bank account in the same name as that of the subscriber, and must accompany the Subscription Documents when submitted to the Sponsor. Please use the following wiring information: Correspondent Bank: Xxxxx Fargo Bank, NA, New York SWIFT: PNBPUS3NNYC Fedwire (ABA): 000000000 Beneficiary Bank: Royal Bank of Scotland International Limited Correspondent Bank A/C No.: 2000193009149 (CHIPS: 155424) Beneficiary: Belmont Commodity Trend Fund Ltd Beneficiary Bank BIC: XXXXXXXX Beneficiary Account No: 00000000 IBAN: XX00 XXXX 0000 0000 0000 00 Reference: “Name of Investor” “Reference” refers to the name of the Subscriber as it will be registered with the Fund.
For Individual Subscribers person whose individual net worth, or joint net worth with that person’s spouse or spousal equivalent, at the time of his purchase exceeds $1,000,000 (net worth includes total assets at fair market value, excluding one’s primary residence, less total liabilities); A natural person who had an individual income in excess of $200,000 in each of the two most recent calendar years or joint income with that person’s spouse or spousal equivalent in excess of $300,000 in each of those years and has a reasonable expectation of reaching the same income level in the current calendar year; A natural person presently in possession of certain professional certifications, credentials, or designations (e.g., FINRA Series 7 (General Securities Representative), 65 (Investment Adviser Representative), or 82 (Private Securities Offerings Representative) licenses) approved by the SEC from time to time; or A natural person who is a “knowledgeable employee” of a private fund, or of an investment adviser to such fund, or such person’s spouse (with respect to offerings of that fund’s securities).
For Individual Subscribers. A government issued form of picture identification (e.g., passport or drivers license) in English. ____ Proof of the individual’s current address (e.g., current utility xxxx), if not included in the form of picture identification. * As of the date hereof, countries that are members of the Financial Action Task Force on Money Laundering (“FATF Country”) are: Argentina, Australia, Austria, Belgium, Brazil, Canada, Denmark, Finland, France, Germany, Greece, Hong Kong, Iceland, Ireland, Italy, Japan, Luxembourg, Mexico, Kingdom of the Netherlands, New Zealand, Norway, Portugal, Russian Federation, Singapore, South Africa, Spain, Sweden, Switzerland, Turkey, United Kingdom and the United States of America. Regulation S Investor Questionnaire ___ A certificate of due formation and organization and continued authorization to conduct business in the jurisdiction of its organization (e.g., certificate of good standing). ___ A certificate of due formation and organization and continued authorization to conduct business in the jurisdiction of its organization (e.g., certificate of good standing). ___ An “incumbency certificate” attesting to the authority and title of the individual executing these subscription materials on behalf of the prospective investor. ___ A completed copy of a certification that the entity has adequate anti-money laundering policies and procedures (“AML Policies and Procedures”) in place that are consistent with the USA PATRIOT Act, OFAC and other relevant federal, state or non-U.S. anti-money laundering laws and regulations (with a copy of the entity’s current AML Policies and Procedures to which such certification relates). ___ A letter of reference any entity not located in the U.S. or other FATF Country, from the entity’s local office of a reputable bank or brokerage firm that is incorporated, or has its principal place of business located, in the U.S. or other FATF Country certifying that the prospective investor maintains an account at such bank/brokerage firm for a length of time and containing a statement affirming the prospective investor’s integrity.
For Individual Subscribers. Please check at least TWO boxes:
(a) The investor has carried out transactions, in significant size 6, on the relevant market at an average frequency of 10 per quarter over the previous four quarters;
(b) The size of the investor’s financial instrument portfolio, defined as including cash deposits and financial instruments exceeds EUR 500,000; or
(c) The investor works or has worked in the financial sector for at least one year in a professional position, which requires knowledge of the transactions or services envisaged.
For Individual Subscribers. Are you an Accredited Investor? Please check the box below as it relates to the subscribing person, if applicable.
☐ A person whose individual net worth, or joint net worth with a spouse or spousal equivalent (i.e., a cohabitant occupying a relationship generally equivalent to that of a spouse), is over $1,000,000. For purposes of this question 7(A), “net worth” means a person’s assets minus liabilities, provided that for purposes of calculating net worth:
(i) the person’s primary residence shall not be included as an asset,
(ii) indebtedness secured by the primary residence, up to the fair market value of the primary residence as of the date on which a Share is purchased, shall not be included as a liability (except that if the amount of such indebtedness outstanding as of the date on which a Share is purchased exceeds the amount outstanding 60 days before such date, other than as a result of the acquisition of the primary residence, the amount of such excess shall be included as a liability), and
(iii) indebtedness that is secured by the person’s primary residence in excess of the fair market value of the primary residence as of the date on which a Share is purchased shall be included as a liability.
