Jenson Seed EIS Fund - Clubfinance

ClubfinancePage 2 of 3ELECTIVE PROFESSIONAL CLIENTDECLARATION & QUESTIONNAIRE6ASSESSMENTFor the investments for which you are seeking classification as an Elective Professional Client, Clubfinancemust assess your expertise, experience and knowledge, to gain reasonable assurance that you are capableof making your own investment decisions and understanding the risks involved. Clubfinance will rely on theinformation you supply below, and, using this and any other information held about you as a Clubfinancecustomer, will determine whether to classify you as an Elective Professional Client for some or all theinvestments listed at the top of this document.Investing Experience(An investment may fall into more than one categoryand should be included in all applicable categories.)Shares on London Stock Exchange (e.g. FTSE 100,250) excluding Venture Capital Trusts (VCTs)Venture Capital Trusts (VCTs)Shares Quoted on Alternative Investment Market (AIM)or PLUS Market (OFEX)Unquoted SharesNon-EIS Managed PortfoliosDirect investment in individual EIS qualifying sharesApproved EIS FundsUnapproved EIS funds / EIS managed portfolios (notincluding Approved EIS Funds)Unregulated Collective Investment Schemes (notincluded elsewhere)BPRA investmentsOther alternative investments (including, EZTs,EZPUTs and other unauthorised unit trusts, QualifiedInvestor Schemes, direct property investment,derivatives, CFDs, structured products (please specify)No. ofinvestmentsmade overpast yearTypicalinvestmentsize over pastyear (£)Total no. ofinvestmentsmade over ayear agoPlease describe your investment selection process: (e.g. make own investment decisions; personalrecommendation by adviser; investment made on my behalf by adviser/portfolio manager)Does your financial instrument portfolio, defined as including cash depositsand financial instruments, exceed EUR 500,000?YES / NOOther relevant experienceCurrent profession (or formerprofession if retired)Have you worked in the financial sector for at least one year in a professional position, which requiresknowledge of the following?EIS investmentsYES / NOSmaller company sharesYES / NOUnregulated Collective Investment SchemesYES / NOClubfinance Ltd. Registered Office: Charleston House, 13 High Street, Old Town, Hemel Hempstead, Hertfordshire, HP1 3AATelephone: 01442 217 287, Fax: 01442 241 045. Registered in England, Registered Number: 04522114Clubfinance Ltd. is authorised and regulated by the Financial Services Authority (400139). © 2010-2013 Clubfinance Ltd. all rights reserved.