Jenson Seed EIS Fund - Clubfinance

Adviser & Anti-Money Laundering Certificate111defghijI confirm that I wish to invest as an elective professional client under the FSA rules and that I am aware of theconsequences of losing the protection and investor compensation rights that I lose by participating in theFund as an elective professional client. I confirm that I have read and understood the Important Notice inrespect of professional client categorisation in the Schedule on pages 117 to 120 inclusive of the InformationMemorandum is true and accurate and Foresight may rely on it. I understand that I will separately beclassified as a retail client by the Administrator & Custodian in respect of the safeguarding and administrationservices to be provided to 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 withthe laws of England and that the courts of England shall have exclusive jurisdiction to hear and determineany suit, action or proceedings and to settle any disputes which may arise out of or in connection with thisApplication 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 beingnominated as the forum to hear and determine any such suit, action or proceedings and to settle any suchdisputes, 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 thedate of my admission to the Fund and this Application Form shall be binding upon and inure to the benefit ofall 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 jurisdictionshall, as to such jurisdiction, be ineffective to the extent of such invalidity or unenforceability without renderinginvalid or unenforceable the remaining terms or provisions of this Application Form or affecting the validity orenforceability of any of the terms or provisions of this Application Form in any other jurisdiction.I undertake to notify the Fund Manager immediately if there are ever any relevant circumstances of which theFund Manager should be aware in relation to managing my Portfolio(s).I confirm, in relation to my investment in the Fund, that:• I wish to seek SEIS and EIS Relief;• I am applying on my own behalf;• I will notify the Fund Manager of any investment with which I am connected within section 163 and sections166 to 177 of the Income Tax Act 2007 and part 5A of the Income Tax Act 2007; and• I will notify the Fund Manager if, within three years of the date of issue of shares by an EIS QualifyingCompany or SEIS Qualifying Company, I become connected with that SEIS Qualifying Company or EISQualifying Company or receive value from it.To Be Completed By The Investor’s Financial Adviser (if you wish to apply withoutinput from a financial adviser, please complete the form on page 113)We certify to Foresight Group LLP in the terms of paragraphs 1 and 2 below:1 Professional Client CategorisationWe have undertaken an adequate assessment of:…………………………………………………………………………………………….....(the “Investor”) and his/herexpertise, experience and knowledge such as to give reasonable assurance to Foresight Group LLP in lightof the nature of the transactions or services envisaged that the Investor is capable of making his/her owninvestment decisions and understanding the risks involved in a participation in the Jenson Seed EIS Fund andof being categorised for this purpose by Foresight Group LLP as an elective professional client within themeaning of the Conduct of Business rules made by the UK Financial Services Authority. We have given to theInvestor a clear written warning of the protections and investor compensation rights the Investor may lose inbeing treated as a professional client in the form set out in the schedule on pages 117 to120 inclusive of theInformation Memorandum.2 Anti-Money Laundering Due DiligenceWe have applied customer due diligence measures on a risk-sensitive basis in respect of the Investor to thestandard required by the Money Laundering Regulations 2007 within the guidance for the UK financial sectorissued by the Joint Money Laundering Steering Group and we certify that we have:(a) obtained information on the purpose and intended nature of the Investor’s proposed investment in theJenson Seed EIS Fund and we are satisfied that this investment is being made for bona fide legitimatepurposes and not to conceal the proceeds of crime; and(b) identified and verified the identity of the Investor on the basis of documents, data and informationobtained from a reliable and independent source.We consent to Foresight Group LLP relying on this certificateFirm name:k Please tick here if you wish to receive paper statements at a price of £3.50 per statements. Otherwise, theAdministrator & Custodian will provide statements in electronic form at no cost.Contact name:lMy contribution will be administered by the Administrator & Custodian in accordance with the Administrator &Custodian’s Standard Terms. I have understood and I agree to be bound by the Administrator & Custodian’sStandard Terms.Address:This Application Form is executed and delivered as a deed on the date mentioned below:Investor Signature:Print name:Postcode:Email:Witness Signature:Print witness name and address:FSA registration number:Signature:Date:Date:by completing and signing this application form,you confirm that your identity may be verified byelectronic means such as the use of data held byspecialised data agencies.