EFTA01354478.pdf

GLDUS143 Henry Nicholas *** PLEASE CHECK THE FOLLOWING BOXES AND SIGN BELOW *** Name of Fund: Glendower Access Secondary Opportunities IV (U.S.), L.P. ❑ The undersigned authorizes Deutsche Bank to provide the undersigned's Information to the iCapital Parties in order to assist the iCapital Parties to verify the undersigned's identity or obtain other "know your customer" information in connection with the undersigned's investment in the Fund. ❑ The undersigned authorizes Deutsche Bank to transfer funds from the undersigned's Deutsche Bank account referenced below (the "Client Account") in order to fund any required capital contribution by the undersigned to the Fund. ❑ In addition, the undersigned authorizes Deutsche Bank to receive from the iCapital Parties any information relating to the undersigned's Fund investment, including but not limited to all correspondence, statements of account and valuations, at the electronic and/or physical address directed by Deutsche Bank. ❑ The undersigned acknowledges that (1) Fund interests will not be held at Deutsche Bank; (2) estimated values of the Fund provided by the iCapital Parties to Deutsche Bank and reported on Client Account statements provided by Deutsche Bank will be for informational purposes only and may not reflect current Fund values or recent activity; and (3) statements of account for the Fund will be sent directly to the undersigned by the iCapital Parties, and not by Deutsche Bank. The undersigned's authorization shall be valid until revoked in writing. Client Authorization: (If you are signing on behalf of your organization, please ensure you are an authorized signatory) Name: Signature: Title (if applicable): Date: Deutsche Bank Representative Name / Number (if applicable): Subscription Amount: $ Confidenbal 2 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0039072 CONFIDENTIAL SDNY_GM_00185256 EFTA01354478