INVESTOR PROGRAMME APPLICATION

Fund Name*

What country is your fund headquartered?*

- Please Select -United Arab EmiratesAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChagos IslandsChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo, Democratic Republic Of TheCongo, Republic of theCook IslandsCosta RicaCote d'Ivoire (Ivory Coast)CroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIreland, Republic ofIsraelIsle of ManItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Republic OfKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthélemySaint HelenaSaint Kitts & NevisSaint LuciaSaint Martin (France)Saint Martin (Netherlands)Saint Pierre & MiquelonSaint Vincent and GrenadinesSamoaSan MarinoSao Tome and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwan, ChinaTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited KingdomUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis & FutunaYemenZambiaZimbabwe

Fund Type*

- Please select -Venture CapitalAcceleratorIncubatorCorporateBankFamily OfficeUniversity InstitutionPrivate EquitySovereign Wealth FundHedge FundAsset ManagementLender / Debt ProviderFund of FundsOther

If you selected other, please clarify your fund type:

Fund Website (If you are an Angel Investor, please specify your LinkedIn Profile)*

Have you ever invested before?*

Yes

No

If you have, name your top 3 investments. If you haven't, put in NA*

First Name*

Last Name*

Email Address*

Business Phone*

Job Title*

Nationality*

United Arab EmiratesAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChagos IslandsChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo, Democratic Republic Of TheCongo, Republic of theCook IslandsCosta RicaCote d'Ivoire (Ivory Coast)CroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIreland, Republic ofIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Republic OfKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoReunionRomaniaRussian FederationRwandaSaint BarthélemySaint HelenaSaint Kitts & NevisSaint LuciaSaint Martin (France)Saint Martin (Netherlands)Saint Pierre & MiquelonSaint Vincent and GrenadinesSamoaSan MarinoSao Tome and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwan, ChinaTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited KingdomUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis & FutunaYemenZambiaZimbabwe- Please Select -

What stage of startups are you investing in? If you are an LP, put in NA*

Please SelectPre-seed stageSeed Funding StageIPOOthers

What is your fund’s average ticket size?*

- Please select -Less than 10K$Between 10-50K$Between 50-100K$Between 100-500K$Between 500K-1M$1M-5M$5M$ and above

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