[Certified Fund Certificate Cancellation Request Form]
                  [•]                                                   Your ref: $[] [FSB []]
                  Manager, [Appropriate Supervisory Unit]
                  Jersey Financial Services Commission                                                     Our ref: []
                  PO Box 267
                  14-18 Castle Street
                  St. Helier
                  JERSEY 
                  JE4 8TP                                                                                        []
                  Dear [•]
                  [] (Fund)
                  [] (Sub-Fund(s))]
                  Collective Investment Funds (Jersey) Law, 1988, as amended (CIF Law)
                  [Financial Services (Jersey) Law, 1998, as amended (FS(J)L)]
                  We, [],  the certificate holder (Certificate Holder), refer to the
                  certificate granted to us under Article 8B of the CIF Law (Certificate) in relation to the Fund [and the Sub-
                  Fund(s)] as a [[company issuing units] [trustee of a unit trust] [general partner of a limited partnership]] [and to
                  our fund services business (FSB) registration as a [[Class ZG trustee] [Class ZJ member of a partnership]] under
                  Article 2(10) of the FS(J)L (FSB Registration) and, specifically, to our appointment as [[trustee] [general partner]]
                  of the Fund [and the Sub-Fund(s)].
                  Please be advised that with effect from [], we ceased to carry on any business of the Fund [and
                  the Sub-Fund(s)].  The reason for our ceasing to act being that: [].  Accordingly, it is requested that the Commission cancel the Certificate pursuant
                  to Article 8B of the CIF Law.  
                  We confirm that the business of the Fund [and the Sub-Fund(s)] has been transferred to a new service provider
                  known as [] and that all necessary unitholder
                  notices and/or consents have been provided in connection with the same. 
                  It is noted that, under Article 8E of the CIF Law, any decision of the Commission to cancel a certificate cannot
                  take effect before the expiry of a period of written notice, but may, at the request of the relevant certificate
                  holder, take effect earlier.  On this basis, we hereby request that any decision of the Commission to cancel the
                  Certificate take effect on the date of that decision.
                  [We, the Certificate Holder, confirm as the outgoing company issuing units in relation to the Fund [and the Sub-
                  Fund(s)] that:-
                      1.   we are not in breach of any condition of the Certificate;
                      2.   we are not in breach of any requirement of the Code of Practice for Certified Funds (Certified Funds
                           Code);
                      3.   [we are not in breach of any requirement of the Code of Practice for Alternative Investment Funds and
                           AIF Services Business]; 
                      4.   we are not in breach of the constitutional document(s) constituting the Fund [or the Sub-Fund(s)];
                        5.   we are not in breach of any material contract entered into by the Fund in relation to it [or the Sub-
                             Fund(s)]; 
                        6.   any complaints in connection with the Fund [and/or the Sub-Fund(s)] have been resolved; 
                        7.   there are no outstanding issues in relation to the carrying on by ourselves of any business of the Fund
                             [or the Sub-Fund(s)] and we are not aware of any issues with the Fund [or the Sub-Fund(s)] generally;
                        8.   all reports and accounts that are obliged to be filed pursuant to a condition of the Certificate or the
                             Certified Funds Code have been submitted to the Commission;
                        9.   the requirements of the Proceeds of Crime (Jersey) Law 1999 as far as they relate to the Fund [,the
                             Sub-Fund(s)] and the investors in the Fund [and the Sub-Fund(s)], including but not limited to the files
                             evidencing full customer due diligence, have been met;
                        10. there are no material assets and liabilities remaining in the Fund [or the Sub-Fund(s)]; and 
                        11. all investors have been redeemed out of the Fund [and the Sub-Fund(s)].] 
                   [We, the Certificate Holder, confirm as the outgoing trustee in relation to the Fund [and the Sub-Fund(s)] that:-
                        1.   we are not in breach of any condition of the Certificate;
                        2.   we are not in breach of any requirement of the Code of Practice for Certified Funds (Certified Funds
                             Code);
                        3.   [we are not in breach of any requirement of the Code of Practice for Alternative Investment Funds and
                             AIF Services Business]; 
                        4.   we are not in breach of any condition of our FSB Registration;
                        5.   we are not in breach of any requirement of the Code of Practice for Fund Services Business;
                        6.   we are not in breach of the constitutional document(s) constituting the Fund [or the Sub-Fund(s)];
                        7.   we are not in breach of any material contract entered into by ourselves in our capacity as trustee of
                             the Fund [or the Sub-Fund(s)]; 
                        8.   any complaints in connection with ourselves in our capacity as trustee of the Fund [or the Sub-Fund(s)]
                             or in connection with the Fund [or the Sub-Fund(s)] have been resolved; 
                        9.   there are no outstanding issues in relation to the carrying on by ourselves of any business of the Fund
                             [or the Sub-Fund(s)] and we are not aware of any issues with the Fund [or the Sub-Fund(s)] generally;
                        10. all reports and accounts that are obliged to be filed pursuant to a condition of the Certificate or the
                             Certified Funds Code have been submitted to the Commission;
                        11. all reports and accounts that are obliged to be filed in respect of ourselves pursuant to the Financial
                             Services (Fund Services Business (Accounts, Audits and Reports)) (Jersey) Order 2007 have been
                             submitted to the Commission;
                        12. the requirements of the Proceeds of Crime (Jersey) Law 1999 as far as they relate to the Fund [,the
                             Sub-Fund(s)] and the investors in the Fund [and the Sub-Fund(s)], including but not limited to the files
                             evidencing full customer due diligence, have been met;
                        13. there are no material assets and liabilities remaining in the Fund [or the Sub-Fund(s)]; and
                        14. all investors have been redeemed out of the Fund [and the Sub-Fund(s)].]
                   [We, the Certificate Holder, confirm as the outgoing general partner in relation to the Fund that:-
                        1.   we are not in breach of any condition of the Certificate;
                        2.   we are not in breach of any requirement of the Code of Practice for Certified Funds (Certified Funds
                             Code);
                        3.   [we are not in breach of any requirement of the Code of Practice for Alternative Investment Funds and
                             AIF Services Business]; 
                        4.   we are not in breach of any condition of our FSB Registration;
                        5.   we are not in breach of any requirement of the Code of Practice for Fund Services Business;
                        6.   we are not in breach of the constitutional document(s) constituting the Fund;
                        7.   we are not in breach of any material contract entered into by ourselves in our capacity as general
                             partner of the Fund; 
                        8.   any complaints in connection with ourselves in our capacity as general partner of the Fund or in
                             connection with the Fund have been resolved; 
                        9.   there are no outstanding issues in relation to the carrying on by ourselves of any business of the Fund;
                        10. all reports and accounts that are obliged to be filed pursuant to a condition of the Certificate or the
                             Certified Funds Code have been submitted to the Commission;
                        11. all reports and accounts that are obliged to be filed in respect of ourselves pursuant to the Financial
                             Services (Fund Services Business (Accounts, Audits and Reports)) (Jersey) Order 2007 have been
                             submitted to the Commission;
                        12. the requirements of the Proceeds of Crime (Jersey) Law 1999 as far as they relate to the Fund and the
                             investors in the Fund, including but not limited to the files evidencing full customer due diligence, have
                             been met;
                        13. there are no material assets and liabilities remaining in the Fund; and
                        14. all investors have been redeemed out of the Fund.]
                   Yours sincerely
                   []
                   Director of the Certificate Holder