Apply For Access - Breakform

Business or Client Name *

Business or Client Name is required

Contact Name *

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Email *

Invalid Email, proper format "name@something.com" Email is required

Phone

Title *

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First Name *

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Last Name *

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Company *

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Address 1 *

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Address 2

City *

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Post Code *

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Country *

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Business Type *

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Which best describes you? Select as many as apply

I am investing with my own account i.e. my own money
I have clients who may be interested in investing
I represent a group of investors who may be interested in investing
I represent a corporate interested in investing in specific sectors
I represent a fund
I am looking to buy, or take a majority stake, in a business
I am interested in distressed ventures and turnarounds
I am interested as a Tier 1 investor

Are you registering on behalf of a company or as an individual?

Company
Individual

Please choose either a), b) c) or d) below and tick the relevant options within a), b) or c) if you choose one of these:

Have you completed at least 10 relevant transactions per quarter over the last 4 quarters?

Yes
No

Is your investment portfolio at least 500,000

Yes
No

Do you have more than one year's relevant financial experience?

Yes
No

Investor Type

Sophisticated Investor
High-Net-Worth Individual
Everyday Investor

Sophisticated Investor

I am a member of a network or syndicate of business angels, and have been so for at least the last six months prior to the date below;
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;
I have made more than one investment in an unlisted company in the two years prior to the date below;
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.

High-Net-Worth Individual

I had, during the financial year immediately preceding the date below, an annual income to the value of £100,000 or more;
I held, throughout the financial year immediately preceding the date below, net assets to the value of £250,000 or more.

Everyday Investor

In the 12 months preceding the date below, I have not invested more than 10% of my net assets in non-readily realisable securities*;
I undertake that in the 12 months following the date below, I will not invest more than 10% of my net assets in non-readily realisable securities.
I accept that the investments to which the promotions will relate may expose me to a significant risk of losing all of the money or other property invested. I am aware that it is open to me to seek advice from an authorised person who specialises in advising on non-readily realisable securities.

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>> HINT: The password should be at least seven characters long. To make it stronger, use upper and lower case letters, numbers and symbols like ! " ? $ % ^ & ).

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