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Alternative Investment Fund Managers DirectiveReporting Template – C3: Self-Managed Small AIFMsVersion 3.1IF REPORTING FOR AN AIF STRUCTURED AS AN UMBRELLA PLEASE COMPLETE THIS FORM FOR EACH INVESTMENT COMPARTMENT/SUB-FUND/CELL OF THE AIFTHIS FORM ALSO SERVES AS AN EIF NOTIFICATION FORM, WHEN SMALL SELF MANAGED, AND DOES NOT REQUIRE A SEPARATE NOTIFICATION FORM TO BE FILEDReporting Templates: AIF(Article 3 (3)(d) and Article 24 of the AIFM Directive 2011/61/EU)AIF-SPECIFIC INFORMATION TO BE PROVIDED(Article 3(3 )(d) and Article 24(1) of Directive 2011/61 EU)Data TypeReported DataIdentification of the AIF1AIF nameClick here to enter text.EU AIF: Click here to enter text.2Fund manager(Legal name and standard code, where available)Click here to enter text.EU AIFM: Click here to enter text.3Fund identification codes,as applicable Click here to enter text. Click here to enter text.4Inception date of the AIFClick here to enter text.Click here to enter text.5Domicile and registered address of the AIFClick here to enter text.Click here to enter text.6Identification of prime broker(s) of the AIF(Legal name and standard code, where available)Click here to enter text.Click here to enter text.7Base currency of the AIF according to ISO 4217 and assets under management calculated as set out in Article 2CurrencyClick here to enter text.Total AuMClick here to enter text.8Jurisdictions of the three main funding sources (excluding units or shares of the AIF bought by investors)Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.9Predominant AIF type (select one)Hedge FundPrivate Equity FundReal Estate FundFund of FundsOtherNoneClick here to enter text.10Breakdown of investment strategies(Provide a breakdown of the investment strategies of the AIF depending on the predominant AIF type selected in question 1. See guidance notes for further information on how to complete this question.)Indicate the strategy that best describe the AIF's strategyShare in NAV(%)a) Hedge Fund Strategies(Complete this question if you selected 'Hedge Fund' as the predominant AIF type in question 1.)Click here to enter text.Click here to enter text.Indicate the hedge fund strategies that best describe the AIF’s strategiesEquity: Long BiasEquity: Long ShortEquity: Market NeutralEquity: Short BiasRelative Value: Fixed Income ArbitrageRelative Value: Convertible Bond ArbitrageRelative Value: Volatility ArbitrageEvent Driven: Distressed / RestructuringEvent Driven: Risk Arbitrage / Merger ArbitrageEvent Driven: Equity Special SituationsCredit Long / ShortCredit Asset Based LendingMacroManaged Futures / CTA: FundamentalManaged Futures / CTA: QuantitativeMulti-strategy hedge fundOther hedge fund strategyClick here to enter text.Click here to enter text.b) Private Equity Strategies(Complete this question if you selected 'Private Equity' as the predominant AIF type in question 1.)Indicate the private equity strategies that best describe the AIF’s strategiesVenture CapitalGrowth CapitalMezzanine CapitalMulti-strategy private equity fundOther private equity fund strategyClick here to enter text.Click here to enter text.c) Real Estate Strategies(Complete this question if you selected 'Real Estate' as the predominant AIF type in question 1.)Indicate the real estate strategies that best describe the AIF’s strategies Residential real estate Commercial real estate Industrial real estateMulti-strategy real estate fundOther real estate strategyClick here to enter text.Click here to enter text.d) Fund of Fund Strategies(Complete this question if you selected 'Fund of Funds' as the predominant AIF type in question 1.)Indicate the 'fund of fund' strategy that best describe the AIF’s strategies Fund of hedge funds Fund of private equity Other fund of fundsClick here to enter text.Click here to enter text.e) Other Strategies(Complete this question if you selected 'Other' as the predominant AIF type in question 1.)Indicate the 'other' strategy that best describe the AIF’s strategiesCommodity fundEquity fundFixed income fundInfrastructure fundOther fundClick here to enter text.Click here to enter text.Principal exposures and most important concentration11Main instruments in which the AIF is tradingType of instrument/instrument codeValue (as calculated under Article 3 AIFMD)Long / short positionMost important instrumentClick here to enter text.Click here to enter text.Click here to enter text.2nd most important instrumentClick here to enter text.Click here to enter text.Click here to enter text.3rd most important instrumentClick here to enter text.Click here to enter text.Click here to enter text.4th most important instrumentClick here to enter text.Click here to enter text.Click here to enter text.5th most important instrumentClick here to enter text.Click here to enter text.Click here to enter text.12Geographical focusProvide a geographical breakdown of the investments held by the AIF by percentage of the total net asset value of the AIF% of NAVAfricaClick here to enter text.Asia and Pacific (other than Middle East)Click here to enter text.Europe (EEA)Click here to enter text.Europe (other than EEA)Click here to enter text.Middle EastClick here to enter text.North AmericaClick here to enter text.South AmericaClick here to enter text.Supranational / multiple regionClick here to enter text.Click here to enter text.1310 principal exposures of the AIF at the reporting date (most valuable in absolute terms):Type of asset/liabilityName/description of the asset/liabilityValue (as calculated under Article 3)% of grossmarket valueLong/short positionCounterparty (where relevant)1st Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.2nd Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.3rd Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.4th Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.5th Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.6th Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.7th Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.8th Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.9th Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.10th Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.145 most important portfolio concentrations:Type of asset/liabilityName/description of the marketValue of aggregate exposure (as calculated under Article 3)% of grossmarket valueLong/short positionCounterparty (where relevant)1stClick here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.2nd Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.3rd Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.4th Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.5th Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.15Typical deal/position size(Complete this question if you selected as your predominant AIF type ‘private equity fund’ in question 1)[Select one]Very smallSmallLower mid-marketUpper mid-marketLarge CapMega CapClick here to enter text.16Principal markets in which AIF tradesPlease enter name and identifier (e.g. MIC code) where available, of market with greatest exposureClick here to enter text.Please enter name and identifier (e.g. MIC code) where available, of marker with second greatest exposureClick here to enter text.Please enter name and identifier (e.g. MIC code) where available, of marker with third greatest exposureClick here to enter text.17Investor ConcentrationSpecify the approximate percentage of the AIF’s equity that is beneficially owned by the five beneficial owners that have the largest equity interest in the AIF (as a percentage of outstanding units/shares of the AIF; look-through to the beneficial owners where known or possible)Click here to enter text.Breakdown of investor concentration by status of investors (estimate if no precise information available):%- Professional clients (as defined in Directive 2004/39/EC (MiFID):- Retail investors:Click here to enter text.DECLARATIONThis declaration must be signed for and on behalf of the AIFM by two directors.The AIFM warrants and undertakes that it has completed this notification form truthfully and fully and disclosed any other information which might reasonably be considered relevant for the purpose of this notification;SignedName of signatory in BLOCK CAPITALS: Click here to enter text. Position: Click here to enter text.SignedName of signatory in BLOCK CAPITALS:Click here to enter text. Position: Click here to enter text.THe following infomration should be completed where an eif is being notified to the fsc for the first timeFOR NEW eifs - Additional information required for Experienced Investor Funds(Financial Services (Experienced Investor Funds) Regulations 2012)(To be completed for each EIF)(Please note a separate EIF Notification form does not need to be filed in addition to this)Please confirm at which stage the notification is being sent:Before establishment of fund??Post establishment of fund?1.Legal form of fund:Click here to enter text.2.Provide details of investment restrictions, including the likely percentage of leverage applied to the fund:Click here to enter text.3.If the fund has been established as a company, including a protected cell company, please provide the name, date of birth and place of birth of all directors.If the fund has been established as for example a unit trust, please provide the name, date of birth and place of birth of the trustee(s). For corporate trustees, please include when incorporated and place of incorporation.If the fund has been established in another form, please provide the name, date of birth and place of birth of the persons managing and controlling the fund.Click here to enter text.4.Names of key service providers:Promoter:Click here to enter text.Ordinary shareholder:Click here to enter text.Administrator:Click here to enter text.Depositary:Click here to enter text.Investment manager/adviser:Click here to enter text.5.Details of the following key features:Auditor:Click here to enter text.Financial year-end of the fund:Click here to enter text.Currency of the fund:Click here to enter text.Open-ended or closed-end fund:Click here to enter text.Launch date (or expected launch):Click here to enter text.6.What is the structure of the fund (e.g. single class/multi class or protected cell company)?Click here to enter text.7.Name of key individual(s) upon whom the performance of the fund will depend, for example the investment director:Click here to enter text.8.Details of how the fund intends to attract clients and the types of clients it intends to attract:Click here to enter text.9.Please provide details of the arrangements made for the fund to pay initial set up fees (for example, will this be from seed capital) and have all fees due been paid up?Click here to enter text.The following documents must accompany this notificationA copy of the offering documents.A copy of the fund’s certificate of incorporation.An opinion of a lawyer of at least 5 years professional standing who is also a Barrister or Solicitor of the Supreme Court of Gibraltar, that the fund complies with the relevant provisions of the Financial Services (Collective Investment Scheme) Act 2011 and Financial Services (Experienced Investor Funds) Regulations pleted Offering Document Checklist.Signed declaration by directors of the fund (As per Appendix A).Initial fee.THE FOLLOWING DECLARATIONS ARE TO BE COMPLETED AS PART OF A NEW EIF NOTIFICATIONDECLARATIONThis declaration must be signed for and on behalf of the administrator by two resident directors of the administrator.The Administrator warrants and undertakes that it has completed this notification form truthfully and fully and disclosed any other information which might reasonably be considered relevant for the purpose of this notification;Name of administratorClick here to enter text. SignedClick here to enter text.Name of signatory in BLOCK CAPITALS Position: Click here to enter text.Click here to enter text. Director of the Fund AdministratorSignedClick here to enter text.Name of signatory in BLOCK CAPITALS Position: Click here to enter text.Click here to enter text. Director of the Fund AdministratorDirectors DeclarationWe confirm that we the proposed directors of the scheme are content with the disclosures in the schemes offer document meet the requirements of the Financial Services (Experienced Investor Funds) Regulations (EIF Regulations). I confirm that we the proposed director of the fund are content that the economic rationale for the fund and any attendant risks are clearly disclosed in the fund's scheme particulars/ offer document.We as the board of directors have considered the ability of the fund administrator to perform sufficient due diligence to be satisfied that the promoter of, and the associated parties to, the fund are fit and proper and that in this respect consideration has been given to all of the issues set out in the EIF Regulations and the AML/CFT Guidance Notes.We declare that we accept ultimate responsibility for the management and control of the fund in accordance with and subject to the constitutive documents and applicable law and the proper systems and procedures will be implemented in respect of the fund. SignedClick here to enter text.Name of signatory in BLOCK CAPITALSPosition: Click here to enter text.Click here to enter text. Director of the Fund SignedClick here to enter text.Name of signatory in BLOCK CAPITALSPosition: Click here to enter text.Click here to enter text. Director of the Fund SignedClick here to enter text.Name of signatory in BLOCK CAPITALSPosition: Click here to enter text.Click here to enter text. Director of the Fund SignedClick here to enter text.Name of signatory in BLOCK CAPITALSPosition: Click here to enter text.Click here to enter text. Director of the Fund This may be signed in counterpart. ................
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