Second Applicant

First Applicant

Please ensure all fields are completed to avoid delays in processing © Capital Treasury Services Limited 2011 Page 2

1 Account Name

Account Name

Please complete this section indicating how you wish to have the account registered/recorded for future reference

2 Applicant Details

Surname Forename(s)

3 Investment Details

No. of transactions per year Investment Amount Please indicate number of transactions

Reporting Currency Average transaction value Please indicate average transaction value

Portfolios may choose to have distributions and income Paid out or Retained for investment

Account Reference (for internal use only)

Trust Name

Company Name

Title

Surname Forename(s) Title

5 Source of Wealth

Business Profits

Life Savings

Please indicate the underlying source of your wealth, e.g. if your wealth is derived from salary/bonus please give an indication of your annualised salary

I/We confirm that the source of my/our wealth represented by the funds to be held in this account derive from:

Salary/Bonus

Business Share/Sale

House/Property Sale

Pension Settlement

Inheritance

Other

Description Details Amount / Value

The funds to be invested with Capital Treasury Services Limited are to originate from: (please state bank or building society name and address)

Source of Funds

4 Source of Funds

6 On-line Access - Registration Process

Visit www.capital-cts.com and click on Online Services in the top menu bar, the page will redirect you to a secure site where you will need to ‘Click here’ to register where you will need to complete and submit the form.

You will be sent a confirmation email to the email address you specified - just follow the instructions on the email which provides a link back to the website (please note this link is only valid for 24 hours) which will redirect you to the website, where you will need to confirm your registration details and allow application for services.

NOTE: You will be asked for a password during the registration process - an access password should be a memorable name or word which is typically 7 or 8 characters long.

Would you like online access to your account? Yes No If ‘Yes’ then please refer to the notes below.

Please ensure all fields are completed to avoid delays in processing © Capital Treasury Services Limited 2011 Page 3

Investment Minimums:

The investment vehicles listed have a minimum investment of:

£10,000, $20,000 or €20,000

Apart from the Capital Liquidity Account which has a minimum of:

£50,000, $100,000 or €100,000

Please indicate below your investment amount - space has been provided if you are wishing to invest in multiple currencies.

Portfolio Base Currency

%

Foreign Exchange Services * %

Capital Platinum Fixed Term Bond %

%

Discretionary Treasury Management

Capital Liquidity Account

Gold Bullion & Precious Metals %

7 Investment Details

Investment 1

Investment 2

Investment 3

* Foreign Exchange: Please indicate below the

proposed currencies you wish

to trade using our Foreign

Exchange Services

Money Market & Cash Investments %

Pre-Paid Debit Card Services

8 Treasury Services Please indicate the Treasury Service you require by ticking the relevant box and answer the relevant questions where possible - for help or further information please contact Capital Treasury Services on +44 (0) 1624 654290

Structured Products %

Number of Transactions per month

Indicative Load Value

Sterling US Dollars Euro Other

Number of Cards Sterling US Dollars Euro Other

Capital Treasury Services Limited is not the product provider but acts as an Introducer and Payment Service Provider for this third party service on behalf of Conister Bank Limited and Tuxedo Money Solutions Limited

Nature of Card Business

Registered Address

This section should only be completed by Intermediaries. Please enter the appropriate details here and avoid supplying information on separate sheets.

I / we confirm that I / we am / are registered with / regulated by the following body to conduct investment business:

I am/am not registered for VAT:

Please tick the relevant commission structure:

If ‘Other’ is selected please specify the terms required on this application form; all terms must be agreed with Capital Treasury Services Limited in advance.

Intermediary Stamp/Details:

X X X A B C D Other: .

9 Intermediary Details

Intermediary Name

Contact Name

Telephone Number

E-mail Address

Postcode

Firm Ref No

Volume of Turnover per day/week Sterling US Dollars Euro Other

International & Domestic Payment Services

Number of Payments per day/week

Size of Payments

Volume of Turnover per day/week

Sterling US Dollars Euro Other

Sterling US Dollars Euro Other

Expected Total Card Volumes Year 1 Year 2 Year 3

Nature of Payments

Any sums received do not constitute a deposit as defined in Regulated Activities Order 2011, as amended and are not covered by any compensation scheme.

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10 Declaration & Signature You must sign and date the form below

Capital Treasury Services Limited may use your personal information to tell you about products and services which we believe may be of

interest to you. If you do not wish your personal information to be used in this way, please put an X in this box.

Signatures of ALL Applicants

(YOU MUST SIGN HERE - Please ensure all relevant sections are completed as per the instructions on this form)

PLEASE SIGN HERE

M M 2 0 Y Y D

Date

D Print Name

First Signature

PLEASE SIGN HERE

M M 2 0 Y Y D

Date

D Print Name

Second Signature

Delete as appropriate - Signing Together / Signing Alone _______________________________ Please indicate who Signing Authority (Joint Accounts)

I/We understand that the information I/we provide on this application form, and any additional information supplied, will be processed in accordance with

Capital Treasury Services Limited’s Data Protection statement contained in the Terms of Business referred to below, and for the Pre-Paid Debit Card

Service where your data will be passed on to the Product Provider notice should be made of the Data Protection statement contained within Conister

Bank Limited’s and Tuxedo Money Solutions Limited’s Terms & Conditions. By signing below, I/we confirm that I/we have received the relevant

documentation and advice relating to this Investment and/or Treasury Service, and Terms which I/we accept. I/We declare that: I/We am/are 18 years of age or over.

I/We agree that the information contained within this application form is true and accurate.

I/We have received, read and understood the Capital Treasury Services Limited product brochures (please indicate where appropriate):

CTS - Bullion & Precious Metals Brochure - V1.01-08.10

and/or CTS - CLA Brochure - V1.01-01.12

and/or CTS - CLMA Brochure - V1.01-08.10

and/or CTS - Foreign Exchange Brochure - V1.01-08.10

and/or CTS - Bridge: International Payment & Cash Management Brochure - V1.01-01.12

and/or CTS - Money Market Investments Brochure - V1.01-08.10

and/or CTS - Platinum Bond Brochure - V1.01-08.10

and/or CTS - Pre-Paid Debit Card Services Brochure - V1.01-08.10

and/or CTS - Treasury Management Brochure - V1.01-08.10

I/We have received, read, understood and agree to be bound by the following document as given to me:

CTS - Retail Terms of Business V1.01-01.12

or CTS - Terms of Business V1.01-01.12

or CIL - Capital Liquidity Account Terms of Business V1.01-08.10

In the case of the Capital Treasury Services Limited Pre-Paid Debit Card Services, I/we am/are aware that this is a third party service

with Conister Bank Limited and Tuxedo Money Solutions Limited and agree with the relevant Terms & Conditions as supplied by them. If you have not received all of the aforementioned documentation relating to your Capital Treasury Services Investment and/or Service, or do

not fully understand the Investments and/or Treasury Service offerings then please contact your Financial Adviser or us immediately.

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Internal Use Only Received Date: Application Processed: Client Notification Sent:

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