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Application Form & Investor Certification

High Net Worth or Sophisticated Investor Declaration Form

My Details
Investor Declaration Statement

I declare that I am either a Certified High Net Worth Individual or a Self-Certified Sophisticated Investor under the Financial Services and Markets Act 2000 (Financial Promotion) Order 2005.

I understand that this means:
• (a) I can receive financial promotions that may not have been approved by an FCA-authorised person.
• (b) The content of such promotions may not conform to FCA rules.
• (c) By signing this statement, I may lose significant rights.
• (d) I may have no right to complain to:
• (i) the Financial Conduct Authority (FCA), or
• (ii) the Financial Ombudsman Service.
• (e) I may have no right to seek compensation from the Financial Services Compensation Scheme (FSCS).
I accept that I can lose my initial investment from making investment decisions based on financial promotions.
I am aware that I can seek advice from an investment specialist if I wish.

Investor Category

I confirm that I meet the criteria for at least one of the following investor categories (please tick one)

Certified High Net Worth Individual

• I had an annual income of £100,000 or more in the last financial year, OR
• I held net assets worth £250,000 or more throughout the last financial year.
(Net assets do NOT include primary residence, loans, insurance contracts, or pension benefits.)

Self-Certified Sophisticated Investor

• I am a member of a business angel syndicate/network for at least six months.
• I have made more than one investment in an unlisted company in the last two years.
• I work, or have worked, in a professional capacity in either:
• Private equity, or
• The provision of finance for SMEs, within the last two years.
• I am, or have been within the last two years, a director of a company with an annual turnover of at least £1 million.

Confirmation & Signature

I confirm that the information provided in this declaration is true and accurate.

Signature