Hip Impact Protection Limited

EIS Investment Application Form

To apply, please take the time to fill out the information below.

Paying your Subscription

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Please pay by bank transfer if possible. Use the details below to make payment:

Bank name: Santander

Account name: Hip Impact Protection

Account No: 60372988

Sort Code: 09-01-53

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To pay by cheque: please make your cheque payable to “Hip Impact Protection Limited” and enclose with your application.

NOTES:

1. This Application Form and payment must arrive no later than 1pm on the Closing Date (26th March 2021), or such later date as Hip Impact Protection Limited may at its sole discretion decide to close the Offer. 

2. Hip Impact Protection Limited reserves the right to reject an Application Form if it has reasonable cause to do so, for example, if relevant information is not included.

3. Due to anti-money laundering regulations, you will need to provide two different forms of identification, one to prove your identity (passport or driving licence) and one to confirm where you live (utility bill or bank statement less than three months old). Copies must be certified.

4. If you are a lawyer or an accountant or other professional person who is subject to professional rules preventing you from making investments in particular EIS-qualifying companies, please advise Hip Impact Protection Limited.

NB: We can only accept cheques drawn on an account in your own name. Third party cheques cannot be accepted. 

SUITABILITY QUESTIONNAIRE

1. INTRODUCTION

1.1.        In order for us to accept your application, we will need to undertake an assessment to determine whether this product is appropriate for you. In order for us to do this we need to consider:

• Your knowledge and experience of investing in similar investments;

• Your financial situation so that we can assess whether you are able financially to bear the risk of your investment in Hip Impact Protection Limited; and

• Your investment objectives so that we can assess whether Hip Impact Protection Limited meets these objectives.

1.2.       In addition, we want to satisfy ourselves that you understand Hip Impact Protection Limited and the risks associated with it. We would therefore appreciate it if you could answer the following questions. If you do not answer these additional questions we will not be able to determine whether your investment in Hip Impact Protection Limited is appropriate for you which may result in your application being rejected. You must ensure that any information which you give us about your circumstances must be true and not misleading in any material respect and you must notify Hip Impact Protection Limited immediately if there is any material change in the information which you have provided.

2. KNOWLEDGE AND EXPERIENCE

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2.1. During the last 5 years, in which of the following investments have you invested?

TYPE OF INVESTMENT

If yes, please state the average numbers and volumes per annum

2.2 KNOWLEDGE

Is investing in shares similar to depositing money with a bank?

When can I withdraw my investment?

What is the nature of the investment and how is it managed?

What is the nature of EIS relief?

3. FINANCIAL SITUATION

4. INVESTMENT OBJECTIVES

5. DECLARATION

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I, the Investor, confirm that:

1. I have truthfully answered this questionnaire;

2. I wish to seek EIS relief for my investment in Hip Impact Protection Limited;

3. I am applying on my own behalf;

4. I acknowledge that Hip Impact Protection Limited is not providing investment, legal, financial, tax or other advice and that any tax information provided is only a generic summary of EIS;

5. I am a person to whom the Memorandum may lawfully be distributed without contravention of the Financial Services and Markets Act 2000;

6. I agree to be bound by the terms of the Investor Agreement;

7. I have advised Hip Impact Protection Limited if I am a solicitor or accountant or other professional person who is subject to professional rules preventing me from making investments, in particular in Hip Impact Protection Limited;

8. I have supplied the correct anti-money laundering documents as requested in this Application Form;

9. I recognise that Hip Impact Protection Limited is a speculative venture;

10. I recognise that there is no established market for shares in Hip Impact Protection Limited, that it is not expected that there will be such a market at any time and that I may have difficulty in selling my shares or in obtaining reliable information about their value;

11. I have the financial ability to bear the economic risk of my investment, have adequate means for providing for any current needs and possible contingencies and no need for liquidity of my investment in Hip Impact Protection Limited;

12. I have provided Hip Impact Protection Limited with a valid sophisticated investor certificate, self-certified sophisticated investor certificate, certificate of high net worth or such other proof that I am an Applicable Investor as Hip Impact Protection Limited may require.

Please upload the following TWO documents:

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* Copy of the picture page of you passport (including name and other details)

* Copy of a proof of address (for example, a driver's license or utility bill not more than three months old)

Passport

Proof of Address

Should you encounter any issues or have any further questions, please contact Martin Taylor at martin@arietech.co.uk.