NewcrestImage Investor Portal

Investor Qualification Form

Thank you for your interest in NewcrestImage Investments. Please fill out the investor qualification form and we will be in communication with you shortly.

Name

Email address

Phone number

Country

Please make selections from the choices below (may select more than one choice):

I currently reside in the United States of America

I am a foreign national residing in a country outside of the United States and its territories

I am a United States of America resident (Green Card Holder)

I am a United States of America passport holder

Are you an Individual or an Entity?

Individual Subscriber - Please check all boxes below that describe the subscriber:

A natural person whose individual net worth, or joint net worth with that person’s spouse, at the time of his/her purchase exceeds $1,000,000 (excluding the value of the primary residence of such natural person).

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.

Entity Subscriber - Please check all boxes below that describe the subscriber:

An entity with total assets in excess of $5,000,000 which was not formed for the purpose of investing in the securities offered.

An employee benefit plan (for example, an IRA) or retirement plan in which all of the participants are accredited investors.

A private business development company as defined in section 202(a)(22) of the Investment Advisers Act of 1940.

Another entity investor: A bank; A broker or dealer; An insurance company; An investment company; A Small Business Investment Company; 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; Any employee benefit plan

Are you a Qualified Purchaser? Please check all boxes below that describe the subscriber:

A natural person (including any person who holds a joint, community property, or other similar shared ownership interest in an issuer that is excepted under 15 U.S.C § 80a–3(c)(7) with that person’s qualified purchaser spouse) who owns not less than $5,000,000 in investments, as defined by the Securities and Exchange Commission.

A company that owns not less than $5,000,000 in investments and that is owned directly or indirectly by or for two 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.

Any trust that is not covered by the previous category and that was not formed for the specific purpose of acquiring the securities offered, 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 “qualified purchaser” described by one of the categories in this section.

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.

A qualified institutional buyer (QIB) as defined in Rule 144A under the Securities Act of 1933, as amended, acting for its own account, the account of another QIB, or the account of a qualified purchaser, provided that the subscriber is not (1) a dealer described in Rule 144A(a)(1)(ii), that owns and invests on a discretionary basis less than $25,000,000 in securities of issuers that are not affiliated persons of the dealer, or (2) a plan referred to in Rule 144A(a)(1)(i)(D) or (E), or a trust fund referred to in Rule 144A(a)(1)(i)(F) that holds the assets of such a plan, the investment decisions with respect to which are made by the beneficiaries of the plan, unless the investment decision to invest in the Fund is made solely by the fiduciary, trustee, or sponsor of such plan.

A company in which each beneficial owner of the company's securities is a qualified purchaser.

Are you a Qualified Client?

Yes - I am an investor who is not planning to invest at least $1,000,000.00 but that has a net worth exceeding $2,100,000.00. If you are a “business development company,” as defined in Section 202(a)(22) of the U.S. Investment Advisers Act of 1940, an investment company registered under the U.S. Investment Company Act of 1940, of a company that would be an investment company under the U.S. Investment Company Act of 1940 but for the exception provided by Section 3(c)(1) of the U.S. Investment Company Act of 1940, then you must also provide certifications from your beneficial owners regarding their status as qualified clients.

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