I confirm that I am 18 years of age or older and understand that in investing in the Fund, my capital is at risk.
I confirm that I have read and understood the Information Memorandum (and in particular the section headed Risk Factors on pages 7-10 and the Investor’s Agreement. I confirm that, in making my application, I am relying solely on the information contained in the Information Memorandum and the Investor’s Agreement, the Financial Intermediary & AML Certificate, or, as the case may be, the Investor & AML Certificate and my own enquiries, and not on any information or representation in relation to the proposal.
I agree and undertake, if my application is accepted, to observe, perform and be bound by the provisions of the Investor’s Agreement.
I confirm that I am not a client of Jenson for regulatory purposes and that consequently I may not be entitled to any compensation rights by participating in the Fund on this basis. I acknowledge that my investment in the Fund will only be accepted where either:
i) an FCA authorised adviser confirms to Jenson that i) an investment in the Fund is suitable for me on the basis of my investment objectives and financial circumstances; or
ii) that Jenson has certified that an investment in the Fund is appropriate for me on the basis that they deem me to be a person capable of making my own investment decisions and understanding the risks of investing in the Fund based on my answers to the questionnaire on pages 10-11.
I acknowledge that this Application Form is not transferable or assignable.
I confirm my agreement that this Application Form be governed by and construed in accordance with the laws of England and that the courts of England shall have exclusive jurisdiction to hear and determine any suit, action or proceedings and to settle any disputes which may arise out of or in connection with this Application Form and, for such purposes, I irrevocably submit to the jurisdiction of such courts. In addition, I irrevocably waive any objection which I might now or hereafter have to the courts of England being nominated as the forum to hear and determine any such suit, action or proceedings and to settle any such disputes, and agree not to claim that any such court is not a convenient or appropriate forum.
I agree that the foregoing representations, warranties, agreements and acknowledgments shall survive the date of my admission to the Fund and this Application Form shall be binding upon and inure to the benefit of all parties and their successors and permitted assignees.
I agree that any term or provision of this Application Form which is invalid or unenforceable in any jurisdiction shall, as to such jurisdiction, be ineffective to the extent of such invalidity or unenforceability without rendering invalid or unenforceable the remaining terms or provisions of this Application Form or affecting the validity or enforceability of any of the terms or provisions of this Application Form in any other jurisdiction.
I confirm, in relation to my investment in the Fund, that:
• I wish to seek SEIS Relief;
• I am applying on my own behalf;
• I will notify Jenson of any investment with which I am connected within section 163 and sections 166 to 177 of the Income Tax Act 2007 or part 5A of the Income Tax Act 2007; and
• I will notify Jenson if, within three years of the date of issue of shares by an SEIS Qualifying Company, I become connected with that SEIS Qualifying Company or receive value from it.
By signing this Application Form, you confirm that you have agreed to pay the financial adviser, detailed in the Adviser and Anti-Money Laundering Certificate in Section 3, the fees (if any) indicated in this section and you hereby instruct Jenson to set aside the amount in this section and to remit the fee to your adviser on your behalf as a one-off fee (including any VAT chargeable by the adviser) payable after the relevant Interim Closing Date in which your investment is made, for advice related to your investment in the Fund.
By signing this Application Form you also confirm that you understand that:
• the amount set aside from your Subscription in connection with the fees (if any) stated in this section will not be invested in the Fund and will not benefit from SEIS Relief; and
• all indications of possible returns stated in the Fund Documentation are based on amounts invested in the Fund after the setting aside of any such fees to financial advisers.
I hereby irrevocably and unconditionally confirm that I have not relied upon or been induced to make this application and participate in the investment as a result of any warranty, representation, assurance or otherwise from Jenson or any of their respective members, directors, employees, agents or advisers save as set out in the Information Memorandum and, with the exception of any fraudulent misrepresentation, any liability for such inducement is expressly disclaimed.
I will notify Jenson if any of the facts contained in this form change at any time.
I confirm that I am 18 years of age or older and understand that in investing in the Fund, my capital is at risk.
I confirm that I have read and understood the Information Memorandum (and in particular the section headed Risk Factors on pages 7-10 and the Investor’s Agreement. I confirm that, in making my application, I am relying solely on the information contained in the Information Memorandum and the Investor’s Agreement, the Financial Intermediary & AML Certificate, or, as the case may be, the Investor & AML Certificate and my own enquiries, and not on any information or representation in relation to the proposal.
I agree and undertake, if my application is accepted, to observe, perform and be bound by the provisions of the Investor’s Agreement.
I confirm that I am not a client of Jenson for regulatory purposes and that consequently I may not be entitled to any compensation rights by participating in the Fund on this basis. I acknowledge that my investment in the Fund will only be accepted where either:
i) an FCA authorised adviser confirms to Jenson that i) an investment in the Fund is suitable for me on the basis of my investment objectives and financial circumstances; or
ii) I am a certified high net worth, certified or self-certified sophisticated investor or a restricted investor (each as defined in COBS) and, additionally, my financial intermediary (or Jenson based on my answers to the questionnaire on pages 10-11) has made an assessment that an investment in the Fund is appropriate for me.
I acknowledge that this Application Form is not transferable or assignable.
I confirm my agreement that this Application Form be governed by and construed in accordance with the laws of England and that the courts of England shall have exclusive jurisdiction to hear and determine any suit, action or proceedings and to settle any disputes which may arise out of or in connection with this Application Form and, for such purposes, I irrevocably submit to the jurisdiction of such courts. In addition, I irrevocably waive any objection which I might now or hereafter have to the courts of England being nominated as the forum to hear and determine any such suit, action or proceedings and to settle any such disputes, and agree not to claim that any such court is not a convenient or appropriate forum.
I agree that the foregoing representations, warranties, agreements and acknowledgments shall survive the date of my admission to the Fund and this Application Form shall be binding upon and inure to the benefit of all parties and their successors and permitted assignees.
I agree that any term or provision of this Application Form which is invalid or unenforceable in any jurisdiction shall, as to such jurisdiction, be ineffective to the extent of such invalidity or unenforceability without rendering invalid or unenforceable the remaining terms or provisions of this Application Form or affecting the validity or enforceability of any of the terms or provisions of this Application Form in any other jurisdiction.
I confirm, in relation to my investment in the Fund, that:
• I wish to seek EIS Relief;
• I am applying on my own behalf;
• I will notify Jenson of any investment with which I am connected within section 163 and sections 166 to 177 of the Income Tax Act 2007 or part 5A of the Income Tax Act 2007; and
• I will notify Jenson if, within three years of the date of issue of shares by an EIS Qualifying Company, I become connected with that EIS Qualifying Company or receive value from it.
By signing this Application Form, you confirm that you have agreed to pay the financial adviser, detailed in the Adviser and Anti-Money Laundering Certificate in Section 3, the fees (if any) indicated in this section and you hereby instruct Jenson to set aside the amount in this section and to remit the fee to your adviser on your behalf as a one-off fee (including any VAT chargeable by the adviser) payable after the relevant Interim Closing Date in which your investment is made, for advice related to your investment in the Fund.
By signing this Application Form you also confirm that you understand that:
• the amount set aside from your Subscription in connection with the fees (if any) stated in this section will not be invested in the Fund and will not benefit from EIS Relief; and
• all indications of possible returns stated in the Fund Documentation are based on amounts invested in the Fund after the setting aside of any such fees to financial advisers.
I hereby irrevocably and unconditionally confirm that I have not relied upon or been induced to make this application and participate in the investment as a result of any warranty, representation, assurance or otherwise from Jenson or any of their respective members, directors, employees, agents or advisers save as set out in the Information Memorandum and, with the exception of any fraudulent misrepresentation, any liability for such inducement is expressly disclaimed.
I will notify Jenson if any of the facts contained in this form change at any time.
