Hedge Fund Subscription Procedure (Page 18 of 23) in pdf

SCHEDULE “C”

INDIVIDUAL TAX SELF-CERTIFICATION FORM

Instructions

You may also complete a U.S. Internal Revenue Service (IRS) W8 or W9 tax form as an alternative to this Individual Tax Self-Certification

form. Please visit the IRS website: to obtain the latest IRS W tax form.

Please use this form for a non-registered account held by a natural person or sole proprietor (for both account opening or updating the tax

status of a natural person or sole proprietor of an existing account). Registered account holders are exempt from completing this Tax Self-

Certification form or the IRS W8 or W9 tax form.

Please use the Entity Tax Self-Certification form for an account held by an entity such as a corporation, partnership, a formal trust or any

other corporate forms/organizations.

For joint accounts, please complete a Tax Self-Certification form for each joint account holder.

For any informal trusts, such as an “in-trust-for” account, please complete a Tax Self-Certification form for the account holder.

Please send completed form to AGF Investments Inc. at TD Bank Tower, 66 Wellington Street West, 31

Floor, Toronto, ON M5K

1E9.

Under Section 265(2) of the Income Tax Act (Canada), a Canadian financial institution is required to collect information to determine whether

individuals opening a non-registered account are a U.S. citizen or a U.S. resident for U.S. tax purposes. For further information, please visit the

Canada Revenue Agency (CRA) website at or the IRS website at

Name of the account holder:

_______________________

Account Number(s):

________________

Yes

No

1a) Are you a U.S. citizen or a U.S. resident for U.S. tax purposes?

1b) If you answered “yes”, please provide your U.S. taxpayer identification number (TIN)

For U.S. citizens or U.S. residents for U.S. tax purposes, your TIN is the same as your Social Security Number (SSN).

__ __ __ - __ __ - __ __ __ __ (U.S. TIN)

Optional and only if applicable, such as in the case of certain Canadian individuals, who are not considered a U.S. citizen or a resident for

U.S. tax purposes, such as students who are receiving an education in the U.S., retirees or “snowbirds” who spend considerable time

vacationing in the U.S.

I certify that I am a resident of Canada. I further certify that any U.S. address, U.S. telephone number or standing instructions to transfer

funds to an account maintained in the U.S. associated with this account exists or will arise only in the context of temporary visits that I make

to the U.S. while I remain a resident of Canada and not, at any time, because I am a resident of the U.S. for tax purposes or a U.S. citizen. I

agree to notify AGF Investments Inc. if events cause this certification to become false or misleading.



check if making this declaration

Note: The optional certification in (2) expires at the end of the calendar year that ends 7 years after the date of the original certification.

Account holder certification

I declare that the information I have provided on this form is, to the best of my knowledge and belief, correct and complete. I agree to notify AGF

Investments Inc. within 30 days if there are any changes in circumstances that cause any information provided on this certification to become

incomplete, inaccurate, false or misleading, and to provide AGF Investments Inc. with a new Tax Self-Certification form upon request. I

acknowledge that information contained in this form and information regarding my account(s) with AGF Investments Inc. (including information

on account balances and payments received) may be reported to the CRA, and that the CRA may provide this information to the IRS.

Name:

________________________________________

Signature: ________________________________________

Date:

________________________________

Please note that the information contained in this form should not be construed as tax or legal advice. Please consult with your own tax or legal advisors for

information regarding your own circumstances.

Why am I being asked whether I am a U.S. citizen or a U.S. tax resident?

(“Canadian IGA”), Canadian financial

Under the Intergovernmental Agreement between Canada and the United States of America

institutions are required to collect and report information on their non-registered account holders who are U.S. citizens and/or U.S. residents

for U.S. tax purposes to the Canada Revenue Agency (CRA). Under the Canadian IGA, the CRA would exchange this information with the

Hedge Fund Subscription Procedure Page 18

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