invent network investor membership - self certification and registration form Unless you specify otherwise, the information in the registration form will be included in our confidential computerised database for administrative purposes and to facilitate matching. The information will remain confidential to those in the invent network who manage and administer the invent network and its associated organisations, and it will not be divulged to third parties without your prior consent. Contact details: Title: _____________________ First Name: ______________________________ Surname: _____________________ Company: ______________________________ Address: _____________________ Position: ______________________________ _____________________ Phone: ______________________________ _____________________ Skype: ______________________________ _____________________ Email: ______________________________ Website: ______________________________ Postcode: Please complete the box above and sign the Declaration and Application for membership of the invent network and either the Statement for Certified High Net Worth Individual or the Statement for Self-Certified Sophisticated Investor. Signed and completed documents can scanned and emailed to phopkinson@inventnetwork.co.uk or returned by post to the address at the foot of this page. Once we have received your application we will create a log in and password for you to access our cloud based deal room system (provided by GUST). invent is a trading name of Open Door UK Limited company number 5176288 registered in England and Wales invent investor network The Pheasantry, Henley Road, Medmenham, Marlow SL7 2EU www.invent-in.com file name: document1 Please complete the applicable form (EITHER the Sophisticated Investor OR HNW form) Statement for Certified High Net Worth Individual I declare that I am a certified high net worth individual for the purposes of the Financial Services and Markets Act 2000 (Financial Promotion) Order 2001. I understand that this means: a) I can receive financial promotions that may not have been approved by a person authorised by the Financial Services Authority; b) the content of such financial promotions may not conform to rules issued by the Financial Services Authority; c) by signing this statement I may lose significant rights; d) I may have no right to complain to either of the following the Financial Services Authority; or the Financial Ombudsman Scheme; e) I may have no right to seek compensation from the Financial Services Compensation Scheme. I am a certified high net worth individual because at least one of the following applies: a) I had, during the financial year immediately preceding the date below, an annual income to the value of £100,000 or more; b) I held, throughout the financial year immediately preceding the date below, net assets to the value of £250,000 or more. Net assets for these purposes do not include: (i) the property which is my primary residence or any loan secured on that residence; (ii) any rights of mine under a qualifying contract of insurance within the meaning of the Financial Services and Markets Act 2000 (Regulated Activities) Order 2001(a); or (iii) any benefits (in the form of pensions or otherwise) which are payable on the termination of my service or on my death or retirement and to which I am (or my dependants are), or may be, entitled. I accept that I can lose my property and other assets from making investment decisions based on financial promotions. I am aware that it is open to me to seek advice from someone who specialises in advising on investments Signature..................................................................................................... Date:...................................... invent is a trading name of Open Door UK Limited company number 5176288 registered in England and Wales invent investor network The Pheasantry, Henley Road, Medmenham, Marlow SL7 2EU www.invent-in.com file name: document1 Please complete the applicable form (EITHER the Sophisticated Investor OR HNW form) Statement for Self-Certified Sophisticated Investor I declare that I am a self-certified sophisticated investor for the purposes of the Financial Services and Markets Act (Financial Promotion) Order 2001. I understand that this means: a) I can receive financial promotions that may not have been approved by a person authorised by the Financial Services Authority; b) the content of such financial promotions may not conform to rules issued by the Financial Services Authority; c) by signing this statement I may lose significant rights; d) I may have no right to complain to either of the following the Financial Services Authority; or the Financial Ombudsman Scheme; e) I may have no right to seek compensation from the Financial Services Compensation Scheme. I am a self-certified sophisticated investor because at least one of the following applies: a) I am a member of a network or syndicate of business angels and have been so for at least the last six months prior to the date below; b) I have made more than one investment in an unlisted company in the two years prior to the date below; c) I am working, or have worked in the two years prior to the date below, in a professional capacity in the private equity sector, or in the provision of finance for small and medium enterprises; d) I am currently, or have been in the two years prior to the date below, a director of a company with an annual turnover of at least £1 million. I accept that I can lose my property and other assets from making investment decisions based on financial promotions. I am aware that it is open to me to seek advice from someone who specialises in advising on investments. Signature..................................................................................................... Date:...................................... invent is a trading name of Open Door UK Limited company number 5176288 registered in England and Wales invent investor network The Pheasantry, Henley Road, Medmenham, Marlow SL7 2EU www.invent-in.com file name: document1 Declaration and Application for membership of the invent network I/we confirm that we wish apply to become investor members of the invent network and that we are actively looking to invest. I/we accept that the invent network and its associated organisations (‘the network’) reserves the right to refuse membership at its absolute discretion. I/we accept that the role of the network is to link firms seeking investment with potential investors, in respect of which activities the network are persons exempt from Authorisation under the Financial Services and Markets Act 2000. I/we understand that the network are not authorised under the Financial Services and Markets Act 2000 to give advice on the merits of any investment or to carry out any other form of regulated investment activity. I/we consent to being informed of possible investment opportunities by telephone or other convenient means. I/we accept that no responsibility can be accepted by the network for any damage or loss of whatever nature due to negligence, disclosure, or non disclosure or any cause occasioned by me/us or by a business registered as an investee whether an individual, partnership, unincorporated business or incorporated company acting upon information provided under the scheme. I/we acknowledge that the network has drawn to my/our attention the following statement: “Investment in new businesses and existing private business carries high risks, as well as the possibility of high rewards. It is highly speculative and potential investors should be aware that no established market exists for the trading of shares in private companies. Before investing in a project about which information is given, potential investors are strongly advised to take advice from a person authorised under the Financial Services and Markets Act 2000 who specialises in advising on investments of this kind. Potential investors may be expected to carry out their own due diligence into the opportunities presented to them.” I/we accept that the network at its sole discretion reserves the right to suspend or discontinue its services for whatever reason at any time. I/we understand that proposals for investment are submitted in confidence to investors registered with the network and that any and all information on these proposals provided to me/us is provided on the understanding that such information will be held confidential to myself/ourselves and my/our advisers and will not be communicated to any other person nor will it be used for any purpose other than in connection with considering whether or not I/we should enter into discussions and seek further information with a view to providing funds to the business which the proposals describe. I/we acknowledge and understand that any business introduced through The Investor network or associated organisations, in which I/we may invest, would be liable to pay the network a success fee as agreed with the investee company. I/we agree to inform the network within 7 days of any such investments. I/we agree that in the future the network may charge an annual investor membership fee. I/we have the right to cancel our membership if we do not want to pay the fee. I/we agree to notify the network immediately if the conditions upon which we have self certified as a high net worth or sophisticated investor no longer apply. I/we accept that in this circumstance my/our membership will be cancelled. I/we understand that we will be set up as a user of the network’s online deal room system (provided by GUST). Signed : ………………………………………… ……………................ Date: ……………………............... Please print name..................................................................................... invent is a trading name of Open Door UK Limited company number 5176288 registered in England and Wales invent investor network The Pheasantry, Henley Road, Medmenham, Marlow SL7 2EU www.invent-in.com file name: document1