DIVA SYNERGY LIMITED - Bernheim, Dreyfus & Co.

DIVA SYNERGY LIMITEDSIGNATURE PAGE(ADMINISTRATOR COPY)IFINA (BVI) Ltd, P.O. Box 4443, Road Town, Tortola, British Virgin IslandsTelephone No.: (284) 494 0732 - Facsimile No.: (284) 494 0014NAME:ADDRESS:TELEPHONE NO:FACSIMILE:SIGNATURE (*1) NAME & TITLE (*2)SIGNATURE (*1) NAME & TITLE (*2)*1: To be completed if joint tenants in Common (if an individual) or where a second director/officermust sign.*2: To be completed only where an entity is investing.Please affix seal of the Company here:Please complete details of your subscription:Amount Remitted:€uroSales Fee: % €uroNet Subscription:€uroAgreed and accepted by:DIVA SYNERGY LIMITEDAdministrator:Date:Additional Information:In order to facilitate any requests for redemption, please complete your specific mandate and bankinginstructions below:Persons authorized to request redemption of your investment from the Company (you may alternativelyenclose a copy of your corporate resolution):Name:Name:Name:Signature:Signature:Signature:Bank Instructions:NAME OF BANK:ADDRESS OF BANK:BANK CODE:ACCOUNT NAME:ACCOUNT NUMBER:BY SIGNING THIS AGREEMENT I/WE CONFIRM THAT WE HAVE READ AND FULLY UNDERSTAND THEOFFERING MEMORANDUM RELATING TO DIVA SYNERGY LIMITED.DIVA SYNERGY – CLASS A (€uro)37