Client Financial Information Form

If you wish to receive information on an investment proposal in an Unregulated Collective Investment Scheme (UCIS) promoted by FIM directly, you must first complete this form. If you are in any doubt as to whether an investment of this type is a suitable kind of investment for you, you are strongly advised to contact a professional adviser who is regulated by the Financial Conduct Authority (FCA) to advise on investments of this type, prior to submitting this form.

FCA rules restrict the promotion of UCISs or non-mainstream pooled investments to retail investors in the UK. The information you give FIM in this form will be used by FIM to determine whether any particular investment promoted by FIM may be appropriate to you.

As a potential investor in a UCIS you are advised that FIM undertake transactions on an 'execution only' basis, which means that in relation to any particular transaction no advice will be given to you by FIM, and FIM will not exercise any judgement on your behalf about the merits of, or the suitability for you, of that transaction.

Any information you give on this form will be treated as strictly confidential.

By completing this form you are providing consent for FIM or other members of the Gresham House Group to process your personal data and provide details of relevant investment opportunities.

All parties should complete:
1. Section A (Client Information) and Section D (Declaration)
2. Either or both Sections B and C, if appropriate

Section A: The Client

For the following questions please tick the appropriate box:

1. Please indicate the estimated value of your current net assets

Listed investments
Unlisted investments
Other (including property other than your main residence)
2. Please indicate your anticipated total annual income for the current financial year
3. Please indicate the number of deals you have conducted in the last two years in unlisted securities or unregulated collective investment schemes
4. Are you normally a higher rate UK taxpayer?
5. Do you normally pay capital gains tax?
6. Should you invest in an FIM product do you understand that it is likely to be of a long term nature and it may be difficult to realise the investment made or to establish an accurate value for it?
7. Are you aware that there may be very limited market for shares/units in FIM investments during their lifespan?
8. Are you prepared to invest where there might not be any annual dividend/distribution for a number of years?

Section B - High Net Worth Investor Statement (IF APPLICABLE)

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).

Section C - Self-Certified Sophisticated Investor Statement

  1. 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; and
  2. The investment to which the promotions will relate may expose me to a significant risk of losing all of the amount invested.

I am a Self-Certified sophisticated Investor because at least one of the following applies:

Section D: Declaration

Your security is of the upmost importance to us, as such, please be
patient with the reCAPTCHA mechanism below. Do not click "Submit"
until the "tick" in the box by "I’m not a robot" has fully developed.