79th Group Investor Reliance Questionnaire

Fields marked * are required. Please answer from your own recollection and identify any documents that support your response. If you do not know or cannot remember, please say so rather than guessing.

Full Name

Email *

Phone *

Street Address

City

State / County

Country

Postal Code

79th Group issuer and investment product *

Investment date or dates *

Amount invested *

How did you invest? *

Before investing, which professional firms, advisers, trustees, security providers, introducers, board members or advisory board members were you aware of ?

Where did you see or hear each reference?

What were your principal reasons for investing?

Did any identified professional name, governance arrangement, trustee, security arrangement or advisory role materially influence your decision?

What would you probably have done if the relevant reference or arrangement had not appeared?

If you invested more than once, did the same information influence each later investment?

Total amount you believe remains outstanding

Repayments, distributions or compensation received

Upload supporting documents. Please retain the originals.

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Please retain the originals.

Document description

8. Is there anything else you believe may assist the investigation?

I accept the following:

I confirm that the information provided is true to the best of my knowledge and belief.

I confirm that I am entitled to provide the uploaded documents and have redacted unrelated sensitive information where appropriate.

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I have read the Privacy Notice and understand how I&L will use and may disclose my information.

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