EFTA01384730.pdf

HUBUS133 Alpha Group Capital INVESTOR ANTI-MONEY LAUNDERING DECLARATION - SUPPLEMENT FORM Name(s) of Investor(s) In addition to completing the relevant section of this form, the following declaration must be signed by an authorized signatory per the Subscription Agreement. Completed forms and documentation may be faxed initially to facilitate commencement of our review, but, where applicable, the originals or certified true and correct copies must be received before the subscription can be finalized and shares issued. By executing this declaration form the investor acknowledges the following: 1. that measures aimed at the prevention of money laundering may require verification of their identity: 2. that Shares will not be issued until such time as the Administrator has received and is satisfied with all the information and documentation requested to verify the suitability of the source of the funds and/or their identity 3. that the Administrator shall be held harmless against any loss arising as a result of a failure to process their subscription request if such information and documentation as has been requested by the Administrator has not been provided: and 4. That the Administrator is authorized to provide the Investment Manager and the fund's legal counsel with information regarding their subscription. (Signalise) (Name of Signatory) (Tele) (Date) 2 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SONY-0085205 CONFIDENTIAL SDNY_GM_00231389 EFTA01384730