Thames Valley Investment Network

Contact Details

Name:

Position:

Telephone:

Mobile:

Address line 1:

Town/City:

Company/Organisation:

Email:

Fax:

Website:

Address line 2:

Postcode:

Investor Details

Please indicate your current affiliation

Private investor

Venture Capital company

Venture Capital Trust

Corporate Investor

Amount available for investment
Indicate the amount you would consider investing in any one company

£10,000 - £25,000

£25,000 - £50,000

£50,000 - £100,000

Over £100,000

Amount available for investment
Indicate the total amount you are seeking to invest per year

£25,000 - £50,000

£50,000 - £100,000

Over £100,000

Collaboration with other investors
Indicate whether you are willing to invest alongside other investors (apart from co-investors you may organise yourself) in the same company

Yes

No

Experience as a private investor
Indicate whether you have previously invested in companies as a business angel

Yes

No

How many?

Business sector interest

Indicate the types of investment opportunity which are of interest to you

Start-up venture

Early stage venture (under 3 years trading)

Established company (over 3 years trading)

Opportunities of interest

Indicate types of opportunities and business or market sectors which would be of particular interest to you.

Tick all that apply

Technology - all areas

Electronics

Engineering / Materials

Environmental

Bioscience

Motorsport

ICT / Media

Diagnostics

Nanotechnology

Medical Devices

Other

Please specify:

Interaction with companies in which you invest

Indicate areas of experience which you would be able to contribute to investee companies

Tick all that apply

Marketing

Production

Finance

Technical

General Management

Other

Please specify:

Indicate the type of management involvement you would like with a company in which you invest

Non-executive

Part time executive

Full time executive

No direct involvement

Financial reference

Please give the name and address of a person who can confirm that you have the amount you have specified available for investment, which would be available to investee companies on a rapid basis.

Note: that the reference you give will be taken up by the Network

Reference

How did you hear about The Thames Valley Investment Network?

I understand that the information I have provided will be stored on a database and will be used by Thames Valley Investment Network to ensure that appropriate companies seeking investment can be brought to my attention.

I confirm that I have read and understand the notice relating to the Financial Services and Markets Act 2000 ("FSMA")

Individual Investor Statement:

I confirm that I have the appropriate High Net Worth or Sophisticated Investor certificate

Institutional Investor Representative Statement:

I am an "investment professional" I make this statement so that I, on behalf of (please insert company name), am able to receive promotions which are exempt from the restrictions on financial promotion in the Financial Services and Markets Act 2000. I accept, on behalf of the Company named in this application that the contents of promotions and other material I receive may not have been approved by an authorised person and thus their content may not be subject to the controls which would apply if the promotion was made or approved by an authorised person. I am aware that it is open for me to seek advice from such an authorised person.

Under the FSMA 2000 Investors are required to hold a relevant certificate, indicating they are a High Net Worth Individual or Sophisticated Investor.

Investing in Innovation

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