Subscription Form and Power of Attorney

{{company_name}}

{{company_address}}

Phone: {{phone}} | Email: {{email}} | Web: {{website}}

Subscription Form and Power of Attorney

Subscription Form and Power of Attorney

Subscriber Information

Full Name: {{subscriber_full_name}}

Date of Birth: {{subscriber_dob}}

National ID/Passport Number: {{subscriber_id_number}}

Nationality: {{subscriber_nationality}}

Residential Address: {{subscriber_address}}

Phone Number: {{subscriber_phone}}

Email Address: {{subscriber_email}}

Subscription Details

Fund Name: {{fund_name}}

Class of Shares/Units: {{share_class}}

Number of Shares/Units Subscribed: {{number_of_shares}}

Subscription Amount: {{currency}} {{subscription_amount}}

Payment Method: {{payment_method}}

Source of Funds: {{source_of_funds}}

Bank Account Details for Redemptions

Bank Name: {{bank_name}}

Account Name: {{account_name}}

Account Number: {{account_number}}

SWIFT/BIC Code: {{swift_code}}

Power of Attorney Grant

I, {{subscriber_full_name}}, hereby irrevocably appoint {{attorney_name}} of {{attorney_address}} as my true and lawful attorney to act in my name and on my behalf to do all acts, deeds, and things necessary or incidental to my subscription in the {{fund_name}} Fund, including but not limited to:

1. Completing and submitting all necessary forms and documents.

2. Communicating with the fund administrator, registrar, and other relevant parties.

3. Receiving and acknowledging statements, notices, and other communications.

4. Effecting redemptions and transfers of shares/units, and receiving redemption proceeds into the bank account specified above.

This Power of Attorney shall remain in full force and effect until expressly revoked by me in writing.

Declarations and Warranties

I declare that all information provided in this form is true and accurate.

I understand and accept the terms and conditions of the {{fund_name}} Fund as described in the {{prospectus_document_name}}.

I confirm that I have received, read, and understood the {{prospectus_document_name}} and any other relevant offering documents.

Indemnification

I agree to indemnify and hold harmless the {{fund_name}} Fund, its directors, officers, agents, and administrators from and against any and all claims, liabilities, losses, and expenses arising out of or in connection with this subscription and the exercise of the Power of Attorney, except in cases of gross negligence or willful misconduct.

Governing Law and Jurisdiction

This Subscription Form and Power of Attorney shall be governed by and construed in accordance with the laws of {{country_name}}. Any disputes arising hereunder shall be subject to the exclusive jurisdiction of the courts of {{country_name}}.

Signature

Subscriber's Signature: _____________________________

Date: {{signature_date}}

Printed Name: {{subscriber_full_name}}

Witness Name: _____________________________

Witness Signature: _____________________________

Date: {{witness_signature_date}}