EIS Fund Information Request

High Net Worth Investor Statement - EIS Funds

I make this statement so that I can receive promotional communications which are exempt from the restriction on promotion of non-readily realisable securities, and/or non-mainstream pooled investments. The exemption relates to certified high net worth investors and I declare that I qualify as such because at least one of the following applies to me:

Please confirm whether you qualify as a high-net worth investor on the basis that A or B apply to you.

In the last financial year, did you have:

A. An annual income of £100,000 or more? Income does NOT include any one-off pension withdrawals. [required]

No

Yes

B. Net assets of £250,000 or more? Net assets do NOT include: your home (primary residence), your pension (or any pension withdrawals) or any rights under qualifying contracts of insurance. [required]

No

Yes

OR

Investment Professional statement - EIS Funds

I, the undersigned, declare that I am an investment professional for the purposes of the Financial Services and Markets Act 2000 (Financial Promotion) Order 2005. I am an investment professional because at least one of the following applies:

1. I am an 'authorised person' for the purposes of FSMA;
2. I am a person who is 'exempt', as a result of an exemption order made under section 38(1) of FSMA, in relation to one of more relevant scheme activities;
3. I am a person:
   1. whose ordinary activities involve him in participating in unregulated schemes for the purposes of a b usiness carried on by him; or
   2. who it is reasonable to expect will so participate for the purposes of a business carried on by him;
4. the individual is a government, local authority (whether in the United Kingdom or elsewhere) or an international organisation;
5. the individual is a person ("A") who is a director, officer, or employee of a person ("B") falling within any of sub-paragraphs (1) to (4) above, when the communication is made to A in that capacity and where A's responsibilities when acting in that capacity involve him in B's participation in unregulated schemes.

I accept that the investments to which the promotions will relate may expose me to a significant risk of losing all of the money or other property invested. I am aware that it is open to me to seek advice from an authorised person who specialises in advising on (1) non-readily realisable securities and/or non-mainstream pooled investments.

Self-certified sophisticated investor statement - EIS Funds

Please confirm whether you qualify as a self-certified sophisticated investor on the basis the A, B, C, or D apply to you.

In the last two years have you:

A. Worked in private equity or in the provision of finance for small and medium enterprises? [required]

No

Yes

If yes, what is/was the name of the business or organisation? [required]

B. Been the director of a company with an annual turnover of at least £1 million? [required]

No

Yes

If yes, what is/was the name of the company? [required]

C. Made two or more investments in an unlisted company? [required]

No

Yes

If yes, how many investments in unlisted companies have you made in the last two years? [required]

D. Been a member of a network or syndicate of business angels for more than six months? [required]

No

Yes

If yes, what is the name of the network or syndicate? [required]

OR

E. None of these applies to me

I accept that being a self-certified sophisticated investor will expose me to promotions for investment where there is a significant risk of losing all the money I invest.

I am aware that it is open to me to seek advice from an authorised person who specialises in advising on (1) non-readily realisable securities and/or (2) non-mainstream pooled investments.

I accept that I could lose all of the money I invest.