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 Sophisticated Investor 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:

  1. I am a member of a network or syndicate of business angels and have been so for at least six months prior to the date below.
  2. I have made more than one investment in an unlisted company in the two years prior to the date below.
  3. 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.
  4. 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 understand that by being a self-certified Sophisticated Investor this means:

    1. I can receive financial promotions that may not have been approved by a person authorised by the Financial Services Authority;
    2. the content of such financial promotions may not conform to rules issued by the Financial Services Authority;
    3. by signing this statement I may lose significant rights;
    4. 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.


Signature:____________________ Date__________

Name (BLOCK CAPITALS)______________________

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