Self Certification – Novus Black

Self Certification

We’d like to make sure that our investments are suitable for you before sharing any more information on what we can offer. Please complete the below form to confirm your eligibility. Do not worry, this is not committing to invest. You are under no obligation to place an investment with us, this is simply to check you understand the risks involved with investments in general.

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Full Name *

First

Last

Email Address *

Phone Number

Initial Indicative Investment *

This does not obligate you to placing an investment and is merely indicative of what you may consider investing should the product suit your requirements.

I confirm that I am: *

Sophisticated Investor
High Net Worth Individual
Professional Client

I confirm that the following statement applies to me: *

I declare that I am a self-certified sophisticated investor for the purposes of the restriction on promotion of non-mainstream pooled investments. I understand that this means:

I can receive promotional communications made by a person who is authorised by the Financial Conduct Authority which relate to investment activity in non-mainstream pooled investments;

the investments to which the promotions will relate may expose me to a significant risk of losing all of the property invested.

I am a self-certified sophisticated investor because at least one of the following applies:

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;

I have made more than one investment in an unlisted company in the two years prior to the date below;

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;

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 the investments to which the promotions will relate may expose me to a significant risk of losing all of the money or other property invested. I am aware that it is open to me seek advice from someone who specialises in advising on non-mainstream pooled investments.

I confirm that the following statement applies to me: *

I make this statement so that I can receive promotional communications which are exempt from the restriction on promotion of non-mainstream pooled investments. The exemption relates to certified high net worth investors and I declare that I qualify as such because at least one of the following applies to me:

I had, throughout the financial year immediately preceding the date below, an annual income to the value of £100,000 or more. Annual income for these purposes does not include money withdrawn from my pension savings (except where the withdrawals are used directly for income in retirement).

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:
1. the property which is my primary residence or any money raised through a loan secured on that property; or
2. any rights of mine under a qualifying contract of insurance; or
3. 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; or
4. any withdrawals from my pension savings (except where the withdrawals are used directly for income in retirement).

I accept that the investments to which the promotions will relate may expose me to a significant risk of losing all of the money or other property invested. I am aware that it is open to me to seek advice from an authorised person who specialises in advising on non-mainstream pooled investments.

I confirm that the following statement applies to me: *

I represent an entity required to be authorised or regulated to operate in the financial markets. The following list includes all authorised entities carrying out the characteristic activities of the entities mentioned, whether authorised in the UK or a third country:

a credit institution;

an investment firm;

any other authorised or regulated financial institution;

an insurance company;

a collective investment scheme or the management company of such a scheme;

a pension fund or the management company of a pension fund;

a commodity or commodity derivatives dealer;

a local authority;

any other institutional investor;

Company Name

Signature *