Request for Access

Access to the mangrovepartners.com website is restricted. In order to obtain access, please complete and submit this form. You may be contacted to verify the information submitted.

This website does not constitute an offer to sell or the solicitation of an offer to buy any security which may only be made pursuant to the terms of the constituent documents of the relevant fund, including their respective, current offering memoranda, which contain important information, including risk factors. In the event of any inconsistency between the descriptions or terms contained in this website and the constituent documents, the constituent documents shall control. These securities shall not be offered for sale in any jurisdiction in which such an offer, solicitation or sale would be unlawful until the requirements of the laws of such jurisdiction have been satisfied.

Please indicate your email address, which will be your Username for the website, and choose a password. If approved, you will use these credentials to access the website.

* Email:
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Please complete the following information so that Mangrove can evaluate your qualifications to access restricted information contained on the website. All information provided on this questionnaire will be held in confidence in accordance with Mangrove Partners’ Privacy Policy as in effect.

* First Name:
* Last Name:
Company Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Country:
* Phone:
Cell Phone:
1. I currently have or have previously made investments in (please check all that apply):
Stocks or bonds

Mutual funds

Futures, commodities, options or other derivative instruments

Real estate

Private investment funds (hedge funds, private equity funds, commodity pools, etc.)

Other

None of the above

2. Accredited Investor Status
The Subscriber is a natural person whose own net worth, or joint net worth with the Subscriber’s spouse, at the time of purchase, exceeds $1,000,000, excluding the value of the Subscriber’s primary residence1.

The Subscriber is a natural person who has had income in excess of $200,000 in each of the two most recent years or joint income with the Subscriber’s spouse in excess of $300,000 in each of those years and has a reasonable expectation of reaching the same in the current year.

A bank as defined in Section 3(a)(2) of the 1933 Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the 1933 Act, whether acting in its individual or fiduciary capacity.

A broker or dealer registered pursuant to Section 15 of the 1934 Act.

An insurance company as defined in Section 2(13) of the 1933 Act.

An investment company registered under the Company Act.

A business development company as defined in Section 2(a)(48) of the Company Act.

A Small Business Investment Company licensed by the Small Business Administration under Section 301(c) of the U.S. Small Business Investment Act of 1958, as amended.

A private business development company as defined in Section 202(a)(22) of the Advisers Act.

An employee benefit plan within the meaning of Title I of ERISA: (a) whose investment decisions are made by a plan fiduciary, as defined in Section 3(21) of ERISA, which is either a bank, insurance company or registered investment adviser; or (b) having total assets in excess of $5,000,000; or (c) if self-directed, the investment decisions are made solely by persons that are Accredited Investors.

An organization described in Section 501(c)(3) of the Code, corporation, Massachusetts or similar business trust, or partnership, not formed for the specific purpose of acquiring an Interest, with total assets in excess of $5,000,000.

A trust, with total assets in excess of $5,000,000 not formed for the specific purpose of acquiring an Interest, whose purchase is directed by a sophisticated investor as described in Rule 506(b)(2)(ii) promulgated by the SEC under the 1933 Act:

A plan which has total assets in excess of $5,000,000 and which is established and maintained by a state, its political subdivisions, or any agency or instrumentality of a state or its political subdivisions for the benefit of its employees.

A revocable trust which may be amended or revoked at any time by the grantors thereof, and all such grantors are Accredited Investors.

An entity in which all of the equity owners are Accredited Investors.

The Subscriber is not an Accredited Investor.

3. Qualified Purchaser
The Subscriber is a natural person (including any person who holds a joint, community property or other similar shared ownership interest in an issuer that is excepted under Section 3(c)(7) of the Company Act with that person’s Qualified Purchaser spouse) who owns not less than U.S.$ 5,000,000 in “investments2

The Subscriber is a company, partnership or trust not formed for the specific purpose of acquiring Interests in the Partnership that owns not less than U.S.$ 5,000,000 in “investments2” and that is owned directly or indirectly by or for two or more natural persons who are related as siblings or spouse (including former spouses), or direct lineal descendants by birth or adoption, spouses of such persons, the estates of such persons, or foundations, charitable organizations or trusts established by or for the benefit of such persons.

The Subscriber is a trust not formed for the specific purpose of acquiring Interests in the Partnership and that is not covered by paragraph 2 above as to which the trustee or other person authorized to make decisions with respect to the trust, and each settlor or other person who has contributed assets to the trust, is a person described in paragraphs 1, 2 or 4 of this Section).

The Subscriber is a person, acting for its own account or the accounts of other Qualified Purchasers, not formed for the specific purpose of acquiring Interests in the Partnership, who in the aggregate owns and invests on a discretionary basis not less than U.S.$ 25,000,000 in “investments2.”

The Subscriber is a “qualified institutional buyer” (as defined in paragraph (a) of Rule 144A under the 1933 Act), acting for its own account, the account of another qualified institutional buyer, or the account of a Qualified Purchaser, provided that (i) a dealer described in paragraph (a)(1)(ii) of Rule 144A shall own and invest on a discretionary basis at least U.S.$ 25,000,000 in securities of issuers that are not affiliated persons of the dealer and (ii) a plan referred to in paragraph (a)(1)(D) or (a)(1)(E) of Rule 144A, or a trust fund referred to in paragraph (a)(1)(F) of Rule 144A that holds the assets of such a plan, will not be deemed to be acting for its own account if investment decisions with respect to the plan are made by the beneficiaries of the plan, except with respect to investment decisions made solely by the fiduciary, trustee or sponsor of such plan.

The Subscriber is an entity (other than a trust), each beneficial owner of the securities of which is a Qualified Purchaser. The General Partner, in its sole discretion, may request information regarding the basis on which such beneficial owners are Qualified Purchasers.

The Subscriber is a charitable foundation formed as a non-profit, non-stock corporation that qualifies for tax-exempt status under Section 501(c)(3) of the U.S. Internal Revenue Code of 1986, as amended, not formed for the specific purpose of acquiring an Interest in the Partnership, and with respect to which.

The Subscriber is not a Qualified Purchaser.

Please specify:
(A) all of the persons who have contributed assets thereto are related in one or more of the ways enumerated in paragraph 2 above and such entity owns not less than U.S.$ 5,000,000 in “investments2

(B) each person authorized to make investment decisions with respect thereto, and each person who has contributed assets thereto, is a Qualified Purchaser within the meaning of paragraphs 1, 2 or 4 above.

4. Please choose the category that best describes you:
Individual

Family Office

Foundation/Endowment

Fund-of-Funds

Institution

Consultant

Insurance Company

Fund Manager

Pension Fund

Registered Investment Advisor

Other

Other
5. * Where did you hear of Mangrove?

Anti-Money Laundering Certification

This section must be completed.

By submitting this form, I hereby represent and certify that I am not involved in any anti-money laundering scheme and that my investment funds, including any investment funds over which I have investment authority, have not been directly or indirectly derived from activities that may contravene U.S. or international laws, rules and regulations designed to avoid money laundering, including, without limitation, the provisions of the Bank Secrecy Act of 1970, as amended. Neither I nor any person controlling, controlled by, or under common control with me, nor any person having a beneficial interest in my investments is a country, territory, person or entity named on the U.S. Department of Treasury’s Office of Foreign Asset Control list, or is a person or entity that resides or has a place of business in a country or territory named in such lists. I agree to notify you promptly should I become aware of any changes to the information set forth in this statement. I hereby agree to hold Mangrove Partners and each of its principals, members, directors, officers, and employees harmless and to indemnify the same against any loss arising as a result of an inaccuracy in the foregoing or any other statement in this questionnaire.

If I am (I) acting as trustee, agent, representative or disclosed nominee for another person or entity, or (II) an entity investing on behalf of underlying investors, including a fund-of-funds, other than a publicly traded company listed on an organized exchange (or a subsidiary or a pension fund of such a company) based in a Financial Action Task Force (“FATF”) Compliant Jurisdiction (the persons, entities and underlying investors referred to in (I) and (II) being referred to collectively as the (“Beneficial Owners”)), I represent and warrant that:

  • I understand and acknowledge the representations, warranties and agreements made herein are made by me (A) with respect to me, and (B) with respect to the Beneficial Owners
  • I have all requisite power and authority from the Beneficial Owners to execute and perform the obligations under this Request for Access Agreement
  • I have adopted and implemented anti-money laundering policies, procedures and controls that comply with, and will continue to comply in all respects with, the requirements of applicable anti-money laundering laws and regulations
  • I have established or have access to the identity of all Beneficial Owners, hold evidence of or have access to such identities and will make such information available to a fund upon request and have procedures in place to ensure that the Beneficial Owners are not Prohibited Investors.

We will review the information you have submitted and contact you directly with any follow-up questions we may have.

Thank you very much for your time. By pressing the "Submit/I Agree" button below, you agree that you have filled in this questionnaire completely, truthfully and to the best of your ability and that you also have read and agree to the Terms of Use which you should review carefully.

1In calculating net worth for purposes of this question, you may include your equity in personal property and real estate (excluding the positive value of your principal residence but including any negative value (i.e., the amount by which any mortgages thereon exceed the market value)), cash, short-term investments, stock and securities. Your inclusion of equity in personal property and real estate should be based on the fair market value of such property less debt secured by such property.

2“Investments” are securities, real estate (held for investment purposes), commodity interests, physical commodities, and cash and cash equivalents held for investment purposes.