Legacy Value Partners CI subscription

Welcome to Legacy Value Partners

This form collects the information required for your subscription to Legacy Value Partners CI, LP. Upon completion and signature, signed copies of the subscription documents will be sent to your email.

You can stop at any point and return to this same link to continue. If a family office is helping you fill in the details, they can complete the form and then forward this link to you for signature.

Who is subscribing? * An individual (or joint individuals) A legal entity (company, partnership, trust, or other)

Subscriber details

Enter your details exactly as they appear on your passport.

First name * Last name *

ID or passport number *

Residential address Number and street *

City * State / province / county

Post code * Country *

Date of birth * Country of birth *

Nationality * I hold an additional citizenship Additional citizenship Source of funds * Please specify * Occupation * Purpose of investment *

Are you a Politically Exposed Person (PEP) or senior political figure? *

A PEP is a senior government, military, or judicial official, a senior political party official, a senior executive of a government-owned corporation, or an immediate family member or close associate of such a person.

Yes No

Please provide details * Phone number * Email address * Contact person name *

Entity details

Tell us about the entity making this subscription.

Legal entity name * Entity type * Please specify * Registration number *

Registered address Number and street *

City * State / province / county

Post code * Country *

Country of incorporation * Date of incorporation *

Source of funds * Please specify * Principal business activity * Purpose of investment *

Is the entity a Politically Exposed Person (PEP) or controlled by one? * Yes No

Please provide details * Phone number * Primary entity email * Contact person *

Authorized signatories

Identify who will sign on behalf of the entity. Each signatory receives their own signature link by email.

First authorized signatory

First name * Last name *

ID or passport number * Email * Title or position *

Is this person a controlling shareholder of the entity? * Yes No

Is there an additional required signatory? * Yes No

Second authorized signatory

First name * Last name *

ID or passport number * Email * Title or position *

Is this person a controlling shareholder of the entity? * Yes No

Your investment

Your subscription amount and the bank account you will wire from. Redemption payments are sent back to this same account.

Investment amount

Currency * Requested investment amount *

Your bank details

Name and address of your bank * Bank contact information SWIFT or ABA * Bank account number * Account holder name * Further credit instructions

Where to send your subscription

These are the Fund's receiving bank details. They are shown here for your reference. No payment is taken through this form. Please wire your subscription after your documents are signed.

Legacy Value Partners CI, LP receiving account

Bank
Branch
Account
IBAN (zahav transfer)

Additional investors

Will there be additional investors in this subscription (including spouse)? * Yes No

Joint holder authorization Any of the joint holders may give instructions on behalf of all All joint holders must sign any instruction

Each additional investor signs their own copy and completes their own Self-Certification.

Accredited investor qualification

Select every qualifying condition that applies. At least one is required, or select "None of the above".

Liquid assets exceed ILS 9,411,809 Earned income exceeded ILS 1,411,772 (or ILS 2,117,657 with spouse) in each of the prior two years Liquid assets exceed ILS 5,882,380 AND income exceeded ILS 705,885 (or ILS 1,058,827 with spouse) in each of the prior two years

The entity has equity exceeding ILS 50 million and was not incorporated solely to purchase securities in this offering Joint investment fund or its managing company Provident fund or its managing company Insurance company Banking corporation Portfolio manager purchasing for itself or qualifying clients Investment advisor or marketing agent purchasing for itself Corporate stock-exchange member purchasing for itself or qualifying clients Underwriter purchasing for itself Venture capital fund Entity wholly owned by qualifying shareholders

OR

None of the above

No independent lawyer or CPA confirmation is needed in this case.

Lawyer or CPA verification

A lawyer or CPA must independently confirm the accredited-investor qualification. We will send them a signing link after your documents are completed. Please let them know their assistance is required.

Do you already have a signed qualification form from the past 12 months? Yes, I will upload it No, I will provide lawyer details

Upload signed qualification form *

PDF, up to 10 MB. Must be dated within the last 12 months.

Document date *

Lawyer or CPA first name * Last name *

Email * Phone Firm

Israeli tax status

I hereby declare that I consent to and accept the provisions of the Tax Ruling the Fund received from the tax authorities in Israel, as amended from time to time. I declare that the following tax status applies:

Country of tax residence *

Tax status * Non-business income. Will be taxed as capital gain per the Tax Ruling. Business income. Will be taxed marginally per the Tax Ruling. Exempted income under section 9(2) of the Ordinance (institutional entities only). I am a Related Person to the General Partner under section 88 of the Israeli Tax Ordinance.

The entity holds a valid withholding-tax exemption it would like applied to Fund income. Upload tax exemption certificate *

PDF, up to 10 MB.

Beneficiary declaration

On whose behalf is this subscription made? * On my own behalf only (individual) / the entity acts on its own behalf only There are beneficiaries

List each beneficiary below.

Relationship between you and the beneficiaries *

FATCA and CRS self-certification

This determines your U.S. tax reporting status. For entities, FATCA and CRS are independent classifications and can differ.

U.S. person status

Are you a U.S. person for tax purposes? * Yes. I am a U.S. citizen or resident for tax purposes.Yes. The entity is a Specified U.S. Person. I was born in the U.S. but have surrendered my citizenship.Yes. The entity is a U.S. Person but not a Specified U.S. Person. No. Not a U.S. person.

U.S. TIN *

Upload your CLN or surrender documentation * Indicate exemption *

Tax residency

Every jurisdiction where you are tax-resident. Up to 3.

FATCA classification

Choose exactly one.

3.1 Registered Foreign Financial Institution (has a GIIN) 3.2 Financial Institution unable to provide a GIIN 3.3 Not a Foreign Financial Institution

Global Intermediary Identification Number (GIIN) *

If registration is in progress, indicate so.

3.3 sub-status *

Passive NFFE controlling-persons reporting method * Using the "Substantial U.S. Owner" definition Using the "Controlling Person" definition per CRS (complete the controlling persons step)

CRS classification

Choose exactly one. CRS classification need not match FATCA.

5.1 Financial Institution 5.2 Active Non-Financial Entity 5.3 Passive Non-Financial Entity (complete the controlling persons step)

FI sub-type

If you are an investment entity managed by another FI in a non-participating jurisdiction with no exemption, you will complete the controlling persons step.

Controlling persons

List each person who controls the entity. The subscription documents will be sent to each controlling person for completion and signature after your signature. Required when the entity is a Passive NFFE or Passive NFE.

Document uploads

We collect these documents to satisfy Cayman Islands AML and KYC requirements. They are stored securely and are never shared publicly.

Passport copy * Second passport (joint holder)

Certificate of Incorporation / government registration * List of authorized signatories * Passport / ID of each authorized signatory * Corporate seal or stamp

Articles of Incorporation * Corporate resolution / authorization *

Partnership agreement * Trust agreement (relevant pages) *

Proof of residential address *

A utility bill (water, electricity, gas, or property tax) or bank statement dated within the last 3 months, showing the residential address entered in your subscription agreement. Accepted: utility bill, property tax bill, bank letter, credit card statement, or government-issued letter.

Date on proof of address *

Communication contacts

Add any additional email addresses for regular communication, including monthly yield updates. These are copied on the completion email to Legacy Value Partners.

Review and submit

When you submit, we assemble your subscription pack and send you a signing link by email. Every signer (you, your lawyer or CPA if applicable, each controlling person, and the General Partner, Velvert Capital Management Ltd.) signs in turn.