This form is an example only and you should consult professional advice before signing any form of this type.
I declare that in signing this form I am confirming my status as a self-certified High Net Worth Individual for the purposes of the Financial Services and Markets Act 2000 (Financial Promotion) Order 2001.
I confirm that at least one of the following applies to me:
- I had during the financial year immediately preceding the date below an annual income to the value of £100,000 (one hundred thousand pounds) or more;
- 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:
– the property which is my primary residence or any loan secured on that residence;
– any rights of mine under a qualifying contract of insurance or pension 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 understand that by being a self-certified High Net Worth Individual this means:
- I can receive financial promotions that may not have been approved by a person authorised by the Financial Services Authority;
- the content of such financial promotions may not conform to rules issued by the Financial Services Authority;
- by signing this statement I may lose significant rights;
- I may have no right to complain to either of the following:
– the Financial Services Authority; or
– the Financial Ombudsman Scheme
I may have no right to seek compensation from the Financial Services Compensation Scheme. I understand that I can lose my property and other assets from making investment decisions based on financial promotions and I am aware that it is open to me to seek advice from someone who specialises in advising on this kind of investment.
Name (BLOCK CAPITALS)______________________