Legacy Value Partners CI subscription

Welcome to Legacy Value Partners

This form collects the information needed for your subscription to the fund.

The subscription documents are in English, so please complete every field in English. A few name fields also ask for Hebrew, and those are marked.

You can pause and come back to this link at any time. If a family office is filling the form for you, they can use this same link and pass it back to you for signature.

Once everything is completed and signed, we will email you the signed copies.

Upload your documents

Maximum file size: 10MB.

Passport

ID card

I hold a biometric ID card

1 Front side Required

2 Appendix Separate appendix page

3 Back side Biometric cards only

Download your ID appendix from the Population Authority

Proof of residential address

A document dated within the last 3 months: utility bill (water, electricity, gas, phone, internet, TV), property tax bill, credit card statement, bank letter, or other government-issued letter.

Date on proof of address

Bank account confirmation

A letter or statement from your bank confirming the account is held in your name.

Certificate of Incorporation / government registration List of authorized signatories

Articles of Incorporation Corporate resolution / authorization

Corporate seal or stamp

Upload an image of the seal at original size, without a background, so it prints clearly on the documents.

Proof of registered address

A document dated within the last 3 months: utility bill (water, electricity, gas, phone, internet, TV), property tax bill, credit card statement, bank letter, or other government-issued letter.

Date on proof of address

Bank account confirmation

A letter or statement from the entity's bank confirming the account is held in the entity's name.

Subscriber details

First name Last name

First name in Hebrew Last name in Hebrew

ID or passport number

Residential address

Number and street

City State / province / county

Post code Country

Personal and contact details

Date of birth

//

Country of birth

Nationality

Contact

Phone number Email address

Source of funds and occupation

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

Entity details and contact

Tell us about the entity making this subscription.

Legal entity name Entity name in Hebrew Registration number

Contact

Phone number Primary entity email Contact person

Registered address

Number and street

City State / province / county

Post code Country

The mailing address differs from the registered address

Mailing address Number and street

City State / province / county

Post code Country

Incorporation and business

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?

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

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

Currency Investment amount

Your bank details

The account you will wire from.

Name and address of your bank

SWIFT code Bank account number

Account holder name

Must match the individual LP's name exactly.

Must match the entity's legal name exactly.

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.

Qualified investor status

Select the condition that applies to you. If none applies, choose the last option.

Select all conditions that apply to you. If none apply, choose the last option.

I am joining as a non-qualified investor with the knowledge of the fund manager Omri Velvart.

We are joining as a non-qualified entity with the knowledge of the fund manager Omri Velvart.

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 verification

A lawyer or CPA needs to confirm your qualified investor status. Once you finish your part of the form, we will email them a link to sign. It helps if you let them know to expect it.

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 The entity is a family company for tax purposes

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 onlyThe entity acts on its own behalf only There are beneficiaries in this transaction

Tax residency

Your tax residency for FATCA and CRS reporting. List each jurisdiction where you are tax-resident below.

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. I am not a U.S. person.No. The entity is not a U.S. person.

U.S. TIN

Upload your CLN or surrender documentation Indicate exemption

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

Entity FATCA and CRS classification

How the entity is classified for tax reporting. For almost every entity FATCA and CRS match, so we ask once.

Entity classification Passive holding entity. It holds investments or assets (most family and holding companies). Active business. An operating company that mainly trades or produces. Financial Institution. A fund, bank, insurer, or similar regulated entity.

This entity FATCA classification is outside standard onboarding. Please contact Legacy Value Partners to onboard this entity.

Advanced: the entity's FATCA and CRS classifications differ

FATCA classification

Choose exactly one.

FATCA 3.3 (NFFE) sub-status

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

A Financial Institution (CRS 5.1) cannot subscribe through this form. Please contact Legacy Value Partners.

5.1 sub-type 5.2 sub-type

The entity has substantial U.S. owners

List each substantial U.S. owner.

Controlling persons

List each person who controls the entity: anyone who owns 25% or more, or who controls it by other means. You can add up to 4.

Communications

The signed documents and monthly updates go to your email. Add anyone else who should be copied.

Additional recipients (up to 2)

Copy my family office

Link unavailable

Welcome to Legacy Value Partners

Upload your documents

Subscriber details

Residential address

Personal and contact details

Contact

Source of funds and occupation

Entity details and contact

Contact

Registered address

Incorporation and business

Authorized signatories

First authorized signatory

Second authorized signatory

Your investment

Your bank details

Additional investors

Tax residency

Jurisdiction 2

Jurisdiction 3

Qualified investor status

Lawyer or CPA verification

Israeli tax status

Beneficiary declaration

Tax residency

Entity FATCA and CRS classification

FATCA classification

CRS classification

Controlling persons

Communications

Review and sign

Your signature