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Thank you for your interest in Nakoma Capital Management. Our website contains information that can only be viewed by “accredited investors” and “qualified purchasers” or is restricted to registered users. Please complete the following questionnaire so that we can verify that you meet these qualifications and issue you a username and password for web site access.
















a natural person with an individual net worth, or joint net worth with spouse, that exceeds
$1 million, excluding the value of your primary residence.



a natural person with income exceeding $200,000 in each of the two most recent years or joint
income with spouse exceeding $300,000 for those years, and a reasonable expectation of the
same income level in the current year.



a business, not formed for the purpose of acquiring the securities offered, in which all the equity
owners are accredited investors.



a bank, insurance company, registered investment company, business development
company, or small business investment company.



an employee benefit plan, as defined by the Employee Retirement Income Security Act (ERISA),
and a bank, insurance company, or registered investment adviser makes the investment decisions,
and the plan has total assets in excess of $5 million.





a natural person who owns at least $5,000,000 in investable assets (as defined in Rule 2a51-1
under the Investment Company Act of 1940).



a company that (i) owns at least $5,000,000 in investable assets and (ii) is owned directly or indirectly
by or for two or more natural persons who are related as siblings or spouses (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.



a trust that was not formed for the specific purpose of acquiring the securities offered, and
whose trustees, decision-makers and settlors, and other person(s) who have contributed assets
to the trust, are qualified purchasers as described in Section 2(a)(51) of the Investment Company
Act of 1940.



a trust that was not formed for the specific purpose of acquiring the securities offered, 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 qualified purchaser
described in clauses (i), (ii), or (iv) of Section 2(a)(51) of the Investment Company Act of 1940.



a qualified institutional buyer as defined in Rule 144A under the Securities Act of 1933 that is
acting for its own account, the account of another qualified institutional buyer, or the account
of a qualified purchaser, provided that subscriber is not (1) a dealer described in Rule
144A(a)(1)(ii), that owns and invests on a discretionary basis less than $25,000,000 in
securities of issuers that are not affiliated persons of the dealer, or (2) a plan referred to
in Rule 144A(1)(1)(i)(D) or (E), or a trust fund referred to in Rule 144A(a)(1)(i)(F)
that holds the assets of such a plan, the investment decisions with respect to which are made
by the beneficiaries of the plan, unless the investment decisions are made solely by the
fiduciary, trustee, or sponsor of such plan.



an entity that owns over $25,000,000 in investable assets and whose outstanding securities
are beneficially owned solely by qualified purchasers.


This section must be completed for the subscriber-beneficial investor.
For more information, see AML Definitions section below.

By initialing below, I hereby represent and certify that I am not involved
in any money laundering scheme and that my investment funds 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 acknowledge that, due to anti-money
laundering requirements operating in the United States and the particular
fund’s own internal anti-money laundering policies, such fund may
require further identification from me and the source of the investment
funds before any subscriptions can be processed, monies accepted or a
redemption request processed. I shall hold the fund, the investment
adviser and each of its respective principals, members, directors, officers,
and employees harmless and indemnified against any loss arising as a
result of a failure to process this Questionnaire or a redemption
application if any information that has been required by an indemnified
party has not been satisfactorily provided by me. I further acknowledge
that all subscription payments transferred to a fund must originate
directly from a bank or brokerage account in my name.

If I am (1) acting as trustee, agent, representative or disclosed nominee
for another person or entity, or (2) 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 (hereinafter referred collectively as
Beneficial Owners), I represent and warrant that:

  • I understand and acknowledge the representations, warranties and
    agreements made herein are made by me with respect to me, and 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 Questionnaire and
    Registered User’s 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 B
      
 

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