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First Name

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Last Name

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Phone

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Firm Information

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Name of firm

What is your firm name?

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What is your target close date?

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Have you incorporated your VC Firm?

Specify if you have already formed your VC Firm. If you have already incorporated your VC Firm, specify the provider that you used to do so. If you have not, write 'Not Formed'.

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Have you engaged a fund administration provider?

Specify if you have signed an engagement letter with a fund administration provider. If the answer is yes, specify the fund administrator. If you have not, write 'We have not engaged a Fund Administrator.'

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Target Domicile for Fund Formation

United States (Delaware)

Canada (Ontario)

British Virgin Islands (BVI)

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Fund thesis

Keep to one sentence.

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How are you turning VC into a force for good?

Keep to one sentence.

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What is your investment strategy?

Keep to 1-2 sentences.

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What countries are you fundraising in?

Separate by commas.

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What percent of your target fund is hard circled?

Hard circled typically means signed PACT or equivalent.

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What percent of your target fund is soft circled?

Soft circled typically means verbal agreement or equivalent.

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What countries do you have known limited partners in?

Separate by commas.

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Number of managing partners

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Anticipated number of partners and venture partners

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Are you currently, or have you previously, been involved as a GP or VP with another fund?

Yes

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Are you working exclusively on your VC firm?

Yes

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Are you registered as broker dealer with FINRA or the SEC, or an equivalent securities regulator?

Yes

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Have you or any of your partners ever been:

Select all that apply

Convicted of any felony or accused of any crime or wrongdoing relating to the securities laws or financial industry, including the issuance or sale any security

Subject to an order of the Securities and Exchange Commission or any other federal or state government regulatory agency (in the U.S. and abroad)

Subject to any cease and desist, temporary restraining order or injunction.

Subject to any action by any financial self-regulatory agency, including stock exchanges

Accused of a breach of fiduciary duty or mismanagement of funds in any context

Filed for bankruptcy as an individual or as part of a management team of an entity

None of the above apply

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Firm Information

Person Name Person Name

Prospect Name Prospect Name

Prospect Name

Organization Name

Capital Account Name