Investment Verification Form

An Investment Verification Form needs to be completed to verify investments placed or anticipated into the Mansard Funds. The completion of this form allows us to match up subscriptions made by your client and to process commission payments in a timely manner. Failure to complete the form accurately may result in delay in verifying subscriptions attributable to you and/or your company.

1. Investor Details

Investment Date *

Investor Name *

Date of Birth *

Address *

Direct Investment

Has all relevant KYC been included with completed subscription?

Yes

Investment via 3rd Party

Name of 3rd Party

3rd Part Policy Reference Number/ Fund-settle Number

2. Subscription Instructions

I/We wish to subscribe in the following Share Classes of the Sub-Fund, in the Cash Amounts indicated

Sub-fund Name/Share Class *

ISIN

Sales
Load (1-5%) *

Deferred Sales
Charge (%) **

Cash Amount
Invested ***

Distribution or Accumulation Option

Select Distribution or Accumulation Option

3. Investment Verifiers Details

Verifiers Company Name

Verifiers Name

Verifiers Email

If you are human, leave this field blank.

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I Agree