Illiquidx

Institutional Investor

IMPORTANT NOTE: If you wish to certify to Illiquidx Limited ("IlliquidX") that you qualify as an Institutional Investor, please complete the form below. You are urged to consult your legal and financial advisors prior to completing this Member Attribute Certification ("MAC"). As with all other activities with IlliquidX, completing this MAC is subject to the IlliquidX Terms & Conditions which, among other things, strictly require that only truthful and accurate information is communicated to IlliquidX. It is also necessary that you timely update your membership information on file with IlliquidX so that the information on file with IlliquidX remains accurate and complete at all times. Accordingly, if you certify to IlliquidX that you qualify as described below and subsequently you experience a change in circumstances and you no longer have such qualification, you must immediately report such change to IlliquidX by editing your IlliquidX Member Profile.

IlliquidX defines an "Institutional Investor" as a governmental entity, investment bank, commercial bank, insurance company, hedge fund, pension fund, mutual fund, labor union or other entity which has net assets under its active investment management of at least US$10 million and is duly qualified in its country of domicile to invest its own and client funds in securities.

It is hereby certified to IlliquidX that Member is an Institutional Investor because Member is:
a governmental entity
an investment bank
a commercial bank
an insurance company
a hedge fund
a pension fund
a gmutual fund
a labor union
an entity (other than an entity set forth above) which has net assets under its active investment management of at least US$10 million and is duly qualified in its country of domicile to invest its own and client funds in securities.

Licensed Securities Agent Questionnaire

IMPORTANT NOTE: If you wish to certify to Illiquidx Limited (“IlliquidX”) that you qualify as a Licensed Securities Agent, please complete the form below. You are urged to consult your legal and financial advisors prior to completing this Member Attribute Certification (“MAC”). As with all other activities with IlliquidX, completing this MAC is subject to the IlliquidX Terms & Conditions which, among other things, strictly require that only truthful and accurate information is communicated to IlliquidX. It is also necessary that you timely update your membership information on file with IlliquidX so that the information on file with IlliquidX remains accurate and complete at all times. Accordingly, if you certify to IlliquidX that you qualify as described below and subsequently you experience a change in circumstances and you no longer have such qualification, you must immediately report such change to IlliquidX by editing your IlliquidX Member Profile.
IlliquidX defines a “Licensed Securities Agent” as any individual or entity that is licensed by a country, state, province or other political subdivision to represent others as an agent in effecting transactions in securities.

Member licensing data:

Jurisdiction in which you are licensed:

Registration number:

Registered Since:

Licensed Securities Agent Certification


Member hereby certifies to IlliquidX that Member qualifies as a License Securities Agent (as defined above) that is currently licensed and in good standing in the jurisdictions set forth above to represent others as an agent in negotiations and for effecting transactions in securities. Member further certifies to IlliquidX that all of the information provided above is true, accurate and complete in all respects.

Accredited Investor (includes individuals)

IMPORTANT NOTE: If you wish to certify to Illiquidx Limited ("IlliquidX") that you qualify as an Institutional Investor, please complete the form below. You are urged to consult your legal and financial advisors prior to completing this Member Attribute Certification ("MAC"). As with all other activities with IlliquidX, completing this MAC is subject to the IlliquidX Terms & Conditions which, among other things, strictly require that only truthful and accurate information is communicated to IlliquidX. It is also necessary that you timely update your membership information on file with IlliquidX so that the information on file with IlliquidX remains accurate and complete at all times. Accordingly, if you certify to IlliquidX that you qualify as described below and subsequently you experience a change in circumstances and you no longer have such qualification, you must immediately report such change to IlliquidX by editing your IlliquidX Member Profile.

I hereby certify to IlliquidX that I am a non-institutional "Accredited Investor" as defined in Rule 501(a) of the General Rules and Regulations (the "Securities Act Rules") promulgated under the U.S. Securities Act of 1933 (the "Act") because I am (check all choices, below, that apply to your circumstances):
A bank as defined in section 3(a)(2) of the Act, or a savings and loan association or other institution as defined in section 3(a)(5)(A) of the Act whether acting in its individual or fiduciary capacity; any broker or dealer registered pursuant to section 15 of the Securities Exchange Act of 1934; an insurance company as defined in section 2(a)(13) of the Act; an investment company registered under the Investment Company Act of 1940 or a business development company as defined in section 2(a)(48) of that Act; an Small Business Investment Company licensed by the U.S. Small Business Administration under section 301(c) or (d) of the Small Business Investment Act of 1958; an plan established and maintained by a state, its political subdivisions, or any agency or instrumentality of a state or its political subdivisions, for the benefit of its employees, and such plan has total assets in excess of $5,000,000; an employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974 with investment decisions made by a plan fiduciary, as defined in section 3(21) of such act, which is either a bank, savings and loan association, insurance company, or registered investment adviser, or the employee benefit plan has total assets in excess of $5,000,000 or, is a self-directed plan, with investment decisions made solely by persons that are Accredited Investors.
A private business development company as defined in section 202(a)(22) of the Investment Advisers Act of 1940.
A natural person whose individual net worth, or joint net worth with that person's spouse, exceeds $1,000,000.
A natural person who had an individual income in excess of $200,000 in each of the two most recent years or joint income with that person's spouse in excess of $300,000 in each of those years and has a reasonable expectation of reaching the same income level in the current year.
A trust, with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring the securities offered, whose purchase is directed by a sophisticated person as described in Rule 506(b)(2)(ii) of the Securities Act Rules.
An entity in which all of the equity owners are Accredited Investors.

Qualified Institutional Buyer

IMPORTANT NOTE: If you wish to certify to Illiquidx Limited ("IlliquidX") that you qualify as an Institutional Investor, please complete the form below. You are urged to consult your legal and financial advisors prior to completing this Member Attribute Certification ("MAC"). As with all other activities with IlliquidX, completing this MAC is subject to the IlliquidX Terms & Conditions which, among other things, strictly require that only truthful and accurate information is communicated to IlliquidX. It is also necessary that you timely update your membership information on file with IlliquidX so that the information on file with IlliquidX remains accurate and complete at all times. Accordingly, if you certify to IlliquidX that you qualify as described below and subsequently you experience a change in circumstances and you no longer have such qualification, you must immediately report such change to IlliquidX by editing your IlliquidX Member Profile.

Member hereby certifies to IlliquidX that Member is a "Qualified Institutional Buyer" as defined in Rule 144A of the General Rules and Regulations (the "Securities Act Rules") promulgated under the U.S. Securities Act of 1933 (the "Act") because Member is (check all choices, below, that apply to you):
One of the following entities, acting for its own account or the accounts of other qualified institutional buyers, that in the aggregate owns and invests on a discretionary basis at least $100 million in securities of issuers that are not affiliated with the entity: (A) an insurance company as defined in section 2(a)(13) of the Act ; (B) an investment company registered under the Investment Company Act or any business development company as defined in section 2(a)(48) of that Act; (C) a Small Business Investment Company licensed by the U.S. Small Business Administration under section 301(c) or (d) of the Small Business Investment Act of 1958; (D) a plan established and maintained by a state, its political subdivisions, or any agency or instrumentality of a state or its political subdivisions, for the benefit of its employees; (E) an employee benefit plan within the meaning of title I of the Employee Retirement Income Security Act of 1974; (F) a trust fund whose trustee is a bank or trust company and whose participants are exclusively plans of the types identified in(D) or (E) of above, except trust funds that include as participants individual retirement accounts or H.R. 10 plans, (G) a business development company as defined in section 202(a)(22) of the Investment Advisers Act of 1940; (H) an organization described in section 501(c) (3) of the Internal Revenue Code, corporation (other than a bank as defined in section 3(a)(2) of the Act or a savings and loan association or other institution referenced in section 3(a)(5)(A) of the Act or a foreign bank or savings and loan association or equivalent institution), partnership, or Massachusetts or similar business trust; and (I) an investment adviser registered under the Investment Advisers Act.
A dealer registered pursuant to section 15 of the Exchange Act, acting for its own account or the accounts of other qualified institutional buyers, that in the aggregate owns and invests on a discretionary basis at least $10 million of securities of issuers that are not affiliated with the dealer.
An investment company registered under the Investment Company Act, acting for its own account or for the accounts of other qualified institutional buyers, that is part of a family of investment companies which own in the aggregate at least $100 million in securities of issuers, other than issuers that are affiliated with the investment company or are part of such family of investment companies.
An entity, all of the equity owners of which are Qualified Institutional Buyers, acting for its own account or the accounts of other qualified institutional buyers.
A bank as defined in section 3(a)(2) of the Act, a savings and loan association or other institution as referenced in section 3(a)(5)(A) of the Act, or a foreign bank or savings and loan association or equivalent institution, acting for its own account or the accounts of other qualified institutional buyers, that in the aggregate owns and invests on a discretionary basis at least $100 million in securities of issuers that are not affiliated with it and that has an audited net worth of at least $25 million as demonstrated in its latest annual financial statements.

Qualified Purchaser

IMPORTANT NOTE: If you wish to certify to Illiquidx Limited ("IlliquidX") that you qualify as an Institutional Investor, please complete the form below. You are urged to consult your legal and financial advisors prior to completing this Member Attribute Certification ("MAC"). As with all other activities with IlliquidX, completing this MAC is subject to the IlliquidX Terms & Conditions which, among other things, strictly require that only truthful and accurate information is communicated to IlliquidX. It is also necessary that you timely update your membership information on file with IlliquidX so that the information on file with IlliquidX remains accurate and complete at all times. Accordingly, if you certify to IlliquidX that you qualify as described below and subsequently you experience a change in circumstances and you no longer have such qualification, you must immediately report such change to IlliquidX by editing your IlliquidX Member Profile.

I hereby certify to IlliquidX that I am a "Qualified Purchaser" as defined in Rule 2a51-l under the U.S. Investment Company Act because I am (check all choices, below, that apply to you):

An individual who owns $5 million or more in investments. (Investments include securities, financial contracts entered into for investment purposes, cash, cash equivalents held for investment purposes, real estate held for investment purposes, CDs, bankers acceptances and other similar bank instruments held for investment purposes. Investments do not include real estate held for personal purposes, jewelry, art, antiques, and other collectibles. Debt used to acquire the investments is excluded from the value of the investments.
a company that owns not less than $5,000,000 in investments and that is owned directly or indirectly by or for 2 or more natural persons who are related as siblings or spouse (including former spouses), or direct lineal descendants by birth or adoption, spouses of such persons, the estates of such persons, or foundations, charitable organizations, or trusts established by or for the benefit of such persons.
a trust that did not check the box for the category above and that was not formed for the specific purpose of acquiring specified securities, as to which the trustee or other person authorized to make decisions with respect to the trust, and each settlor or other person who has contributed assets to the trust, is a person who is a Qualified Purchaser.
a person, acting for its own account or the accounts of other Qualified Purchasers, who in the aggregate owns and invests on a discretionary basis, not less than $25,000,000 in investments.

Qualification as a Professional Client Under MiIFID (European Community financial regulations)

IMPORTANT NOTE: If you wish to certify to Illiquidx Limited ("IlliquidX") that you qualify as an Institutional Investor, please complete the form below. You are urged to consult your legal and financial advisors prior to completing this Member Attribute Certification ("MAC"). As with all other activities with IlliquidX, completing this MAC is subject to the IlliquidX Terms & Conditions which, among other things, strictly require that only truthful and accurate information is communicated to IlliquidX. It is also necessary that you timely update your membership information on file with IlliquidX so that the information on file with IlliquidX remains accurate and complete at all times. Accordingly, if you certify to IlliquidX that you qualify as described below and subsequently you experience a change in circumstances and you no longer have such qualification, you must immediately report such change to IlliquidX by editing your IlliquidX Member Profile.

I hereby certify to IlliquidX that I am qualified as a "Professional Client" under the MIFID regulatory definitions as are currently in effect.

For a complete and detailed definition of
"per se professional client" - see COBS 3.5.2 of the FSA Handbook
2elective professional client" - see COBS 3.5.3 of the FSA Handboo

http://www.fsa.gov.uk/pubs/hb-releases/rel71/rel71cobs.pdf

Qualification as an Eligible Counterparty Under MiIFID (European Community financial regulations)

IMPORTANT NOTE: If you wish to certify to Illiquidx Limited ("IlliquidX") that you qualify as an Institutional Investor, please complete the form below. You are urged to consult your legal and financial advisors prior to completing this Member Attribute Certification ("MAC"). As with all other activities with IlliquidX, completing this MAC is subject to the IlliquidX Terms & Conditions which, among other things, strictly require that only truthful and accurate information is communicated to IlliquidX. It is also necessary that you timely update your membership information on file with IlliquidX so that the information on file with IlliquidX remains accurate and complete at all times. Accordingly, if you certify to IlliquidX that you qualify as described below and subsequently you experience a change in circumstances and you no longer have such qualification, you must immediately report such change to IlliquidX by editing your IlliquidX Member Profile.

I hereby certify to IlliquidX that I am qualified as an "Eligible Counterparty" under the MIFID regulatory definitions as are currently in effect.

For a complete and detailed definition of
"per se eligible counterparty" - see COBS 3.6.2 of the FSA Handbook
"elective eligible counterparty" - see COBS 3.6.4 of the FSA Handbook

http://www.fsa.gov.uk/pubs/hb-releases/rel71/rel71cobs.pdf