You hereby declare that you are a current or prospective investor of Carmignac Fund(s) and that you will use the information to be provided pursuant to this form for the sole purpose of assessing your current or future investment(s) in the relevant Fund(s). Any information received pursuant to this form is strictly privileged and confidential and it is intended solely for the attention of the addressee. Any disclosure, use, dissemination or reproduction (either whole or partial) of the information other than specified in this form is strictly prohibited without prior consent of Carmignac. Any failure to comply with this provision may result in legal proceedings.