Accredited Questionnaire

To obtain access, please complete and submit this form. You will be contacted by a member of our Investor Relations team to verify the information you submit, and then a username and password will be provided to you. The investment funds described in this website have not been registered under the federal securities laws of the United States, the securities laws of any state, or the laws of any other jurisdiction. This website shall not constitute an offer to sell or the solicitation of an offer to purchase shares of any of such funds in any jurisdiction. Such an offer may only be made by the private placement memorandum for the relevant fund, and only to investors who meet certain eligibility requirements. This registration form is not an application form to subscribe for interests in or shares of any of the funds. All information provided on this questionnaire will be held in confidence in accordance with the Privacy Policy as in effect from time to time.

CONTACT INFORMATION......

First Name

Last Name

BUSINESS ADDRESS / PLACE OF RESIDENCE 

Street Address

Address Cont.

City

  

State / Providence / Region:

  

Zip / Postal Code:

Country

Phone Number

Email Address

Please check the appropriate accredited investor definition

I am a natural person who has individual net worth, or joint net worth with my spouse, that exceeds $1 million.
I am a natural person with income exceeding $200,000 in each of the two most recent years or joint income with my spouse exceeding $300,000 for those years and a reasonable expectation of the same income level in the current year.
I represent a business in which all the equity owners are accredited investors.
I represent a bank, insurance, investment, business development or small business investment company
I represent an employee benefit plan, within the meaning of the Employee Retirement Income Security Act with total assets in excess of $5 million.
I represent a charitable organization, corporation, or partnership with assets exceeding $5 million.
I represent a trust with assets in excess of $5 million, not formed to acquire the securities offered.

Please check the appropriate qualified investor definition

I am a natural person who owns at least $5,000,000 in investments (defined in the Investment Company Act of 1940).
I represent a company that (i) owns at least $5,000,000 in investments and (ii) is owned directly or indirectly by or for two or more natural persons who are related as siblings or spouses (including former spouses), or direct lineal descendants by birth or adoption, spouses of such persons, the estates of such persons, or foundations, charitable organizations, or trusts established by or for the benefit of such persons.
I represent a trust that was not formed for the specific purpose of acquiring the securities offered and each person who has contributed assets to the trust, is a qualified purchaser described in the Investment Company Act of 1940.
I am a natural person or an entity who/which is acting for its own account or the accounts of other qualified purchasers and who/which in the aggregate owns and invests on a discretionary basis totaling at least $25,000,000 in investments.
I am is a qualified institutional buyer as defined in Rule 144A under the Securities Act of 1933 that is acting for its own account, the account of another qualified institutional buyer, or the account of a qualified purchaser.
I represent an entity the outstanding securities of which are beneficially owned solely by qualified purchasers.

Anti Money Laundering Certification

By checking this box, I hereby represent and certify that I am not involved in any anti-money laundering scheme and that my investment funds have not been directly or indirectly derived from activities that may contravene U.S. or international laws, rules and regulations designed to avoid money laundering, including, without limitation, the provisions of the Bank Secrecy Act of 1970, as amended. Neither I nor any person controlling, controlled by, or under common control with me, nor any person having a beneficial interest in my investments is a country, territory, person or entity named on the U.S. Department of Treasury's Office of Foreign Asset Control list, or is a person or entity that resides or has a place of business in a country or territory named in such lists. I agree to notify you promptly should I become aware of any changes to the information set forth in this statement. I hereby agree to hold Partner Vision Partners, LLC and each of its principals, members, directors, officers, and employees harmless and to indemnify the same against any loss arising as a result of a inaccuracy in the foregoing or any other statement in this questionnaire. If I am (I) acting as trustee, agent, representative or disclosed nominee for another person or entity, or (II) an entity investing on behalf of underlying investors (including a fund-of-funds), other than a publicly traded company listed on an organized exchange (or a subsidiary or a pension fund of such a company) based in a Financial Action Task Force (FATF) Compliant Jurisdiction (the persons, entities and underlying investors referred to in (I) and (II) being referred to collectively as the (Beneficial Owners), I represent and warrant that: I understand and acknowledge the representations, warranties and agreements made herein are made by me (A) with respect to me, and (B) with respect to the Beneficial Owners. I have all requisite power and authority from the Beneficial Owners to execute and perform the obligations under this Questionnaire and Registered User s Agreement. I have adopted and implemented anti-money laundering policies, procedures and controls that comply with, and will continue to comply in all respects with, the requirements of applicable anti-money laundering laws and regulations. I have established or have access to the identity of all Beneficial Owners, hold evidence of or have access to such identities and will make such information available to a fund upon request. I have procedures to ensure that the Beneficial Owners are not Prohibited Investors.
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