Jenson Seed EIS Fund - Clubfinance

ClubfinancePage 3 of 3Are you an approved person on the Financial Services AuthorityRegister?If so, please provide your Individual Reference Number:ELECTIVE PROFESSIONAL CLIENTDECLARATION & QUESTIONNAIRE6YES / NOHave you had relevant experience of the types of investment/company listed in the tables above, for exampleas: Director; Adviser; Fund Manager; Corporate Financier; Consultant; Auditor; Accountant; Business Angel(and if so if you are member of a Business Angel Network). Please provide details including how recently andfor how long.Relevant qualificationsDo you have any relevant qualifications or training, e.g. degree or professional qualification?KnowledgeHow do you keep up-to-date with your technical knowledge, and changes in the market, products, legislationand regulation?Understanding risksDo you understand that these investments are high risk, and have fewer regulatory protectionsand controls compared to regulated collective investment schemes?Do you understand that tax legislation is complex and subject to change at any time, and aninvestment could lose or fail to qualify for a particular tax treatment, which could result in lossof reliefs?Do you understand that these investments can be volatile and that you could lose some or allof your original investment?Do you understand that it may be difficult to obtain reliable information about theseinvestments, and there may be difficulty in selling at a reasonable price, or at all?Do you understand that these are generally long-term investments and you may not be able toexit the investment for a considerable period of time?Do you understand that the charges on these investments can be very high?Do you understand that unforeseen circumstances could result in the loss of your investment?YES / NOYES / NOYES / NOYES / NOYES / NOYES / NOYES / NOAny other relevant information (any other information that may be relevant to Clubfinance’s assessment)Clubfinance 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.