SUBSCRIPTION FORM NO. SUBSCRIPTION FORM Form of subscription to the Rules of Management of mutual fund Numerica Emerging Frontiers, delniški globalni sklad trgov v razvoju, managed by NUMERICA PARTNERJI družba za upravljanje d.o.o., Dalmatinova 7, Ljubljana, T: +386 (0)59 098 605, F: +386 (0)59 098 604, e-mail: [email protected], website: www.numerica-partners.si. Investor pays in the mutual fund by a bank transfer on the following bank account using the fund's reference number Numerica Emerging Frontiers, delniški globalni sklad trgov v razvoju ISIN CODE FUND'S ACCOUNT NO. SI0031401548 SI56 0510 0801 3743 437 REFERENCE NO. PLEASE USE CAPITAL LETTERS AND TICK WHERE NECESSARY! INVESTOR □Natural person POOBLAŠČENA OSEBA/ZAKONITI ZASTOPNIK □Legal Person □RS Resident □EU Resident □Non-resident Identification/Registration number: □Natural person □Legal person □RS Resident □EU Resident □Non-resident Identification/Registration number: Tax number: Tax office: Tax number: □ M Name and Surname / Firm: Permanent residence / Registered address: □ F Tax office: □ M Name and Surname / Firm: □ F Permanent residence / Registered address: ZIP code, City: Country: Date of birth: Place of birth: Personal identification document (type): Country: Date of birth: No.: Issued by: ZIP code, City: Valid until: Place of birth: Personal identification document (type): Issued by: No.: Valid until: Investor's activity: Investor's activity: Reason for establishment of a lasting business relationship: Reason for establishment of a lasting business relationship: Telephone no.: Telephone no.: E-mail: E-mail: □ Fiduciary Account (or IBAN) no.: Name of the bank: SWIFT: MAILING ADDRESS: Name and Surname / Firm: □ acting on my own behalf and on my own account □ acting on my own behalf and on other account Manager of the fund is NUMERICA PARTNERJI družba za upravljanje d.o.o. T: 059 098 605, F: 059 098 604, e-mail: [email protected] website: www.numerica-partners.si Address: ZIP code, City: STATEMENT/CONSENT/AUTHORIZATION BY INVESTOR I declare that I approach to the rules of management of the mutual fund, that I am aware of all risks associated with an investment in the mutual fund and that I was delivered the document containing key investor information prior to the accession. By signing I certify the accuracy of personal information provided on this Subscription Form (hereinafter: the data). I hereby expressly and irrevocably authorize NUMERICA PARTNERJI družba za upravljanje d.o.o. (hereinafter: the Management Company) to use all data provided for the exchange, storage and processing of personal data in accordance with the Personal Data Protection Act (Official Gazette of RS, No. 86/04, as amended), all in relation to the holding of units of assets and for the purposes of informing government and other competent authorities. I undertake that I will inform the Management Company of any change of the information provided promptly in writing. By providing my e-mail address, sending any prescribed and other documents to this e-mail address is considered a normal way of exchanging information between the Management Company and the investor, in accorda nce with regulations. By signing, I agree that the Management Company shall in this manner also provide all notices and documents for which direct informing of unit-holders is regulatory required. The undersigned investor as principal I hereby authorize the undersigned proxy to carry out on my behalf all transactions relating to the fund indicated in this Subscription Form until the cancellation of this power of attorney. □ I wish that the information provided apply to all previously signed subscription forms at NUMERICA PARTNERJI DZU d.o.o.. __________________________________ Place and Date __________________________________ Signature of Investor / Proxy Seal of a Legal Person __________________________________ Signature of Authorized Representative STATEMENT BY ADVISOR The undersigned adviser (person who has performed a review of the investor), declare that I have completed the identification and performed risk analysis of the indicated investor, and in accordance with the criteria of the Guidelines for the prevention of money laundering and terrorist financing, issued by the Securities Market Agency, made the following risk assessment (tick mark): □ Extremely high-risk client □ High-risk client □ Medium (average) risk client □ Negligible risk client and that prior to accession to the rules of management of the mutual fund an adequate review of the investor was carried out, in accordance with the Prevention of Money Laundering and Terrorist Financing Act (Official Gazette of RS, No. 60/07, as amended), the Securities Market Agency Guidelines for the prevention of money laundering and terrorist financing, and risk assessment (also applies to a proxy, representative and/or a fiduciary). □ Use of Statement of performed identification The undersigned adviser declare that the personal information of the investor (or his legal representative/proxy) which are indicated in their personal identification document, are identical to the information stated in this Subscription Form, and that the investor owns a personal bank account and account number as indicated in this Subscription Form, which I have found out by looking at his personal identification document, tax number certificate and bank certificate or his bank card. __________________________________ Subscription Site (Seal) __________________________________ Name and Surname of Adviser __________________________________ Signature of Adviser NUMERICA PARTNERJI DZU d.o.o.