Self-assessment questionnaire.

A. Identity & status

Full legal name *

Date of birth *

Country of residence *

Tax residency (CRS self-certification) *

Investor type *

Natural personLegal entity

I am not a US person within the meaning of Regulation S. *

Email *

Phone (optional)

Net financial assets *

Expected subscription amount (EUR) *

I confirm these funds are not needed for short-term liquidity. *

This investment does not exceed a reasonable share of my overall portfolio. *

Source of funds *

Source of wealth (required for higher net-worth bands)

PEP self-declaration *

I am not a politically exposed person (PEP)I am a PEP or related to one (details will be requested)

I consent to sanctions screening and source-of-funds checks via the issuer's KYC/AML provider (SumSub). *

I self-certify my FATCA / CRS status and agree to provide supporting documentation on request. *

The information I have provided is true, accurate, and complete. *

I acknowledge that, in opting up to professional-client status, I lose the investor-protection rules applicable to retail clients under MiFID II. *

I agree to notify the issuer promptly of any material change to my circumstances that affects this assessment. *

I consent to e-signature of this questionnaire and to timestamp and IP capture for record-keeping. *

Type your full name as e-signature *

Version 2026.04-v1 · 2026-05-31