Sophisticated - New Capital Link

Self-Certification High Net Worth.

HIGH NET WORTH INVESTOR STATEMENT

Please confirm whether you qualify as a high-net-worth investor on the basis that A or B apply to you.

In the last finanical year did you have:

A) an annual income of £100,000 or more? Income does NOT include any one-off pension withdrawls

Yes No

B) If yes, please specify your income (as defined above) to the nearest £10,000 in the last financial year:

C) net assets of £250,000 or more? Net assets do NOT include: your home (primary residence), your pension (or any pension withdrawals) or any rights under qualifying contracts of insurance.

Yes No

If yes, please specify your net assets (as defined above) to the nearest £100,000 in the last financial year:

Date

Full Legal Name

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