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Personal Details			Fields marked with an asterisk (*) and 'yes/no' answers are mandatory.
Title		If 'other' please specify		Forenames*		Surname*
Please select Mr Mrs Miss Ms Dr other
Membership of Octopus is available to those over 18. Please enter your date of birth.				Nationality
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Contact Details (Business)
Business address, line1*				Business address, line2
Town/City*		County		Postcode*		Country*
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Business phone*		Mobile		Fax
Contact Details (Home)
Contact Email*		Confirm Email*
Home address, line1*				Home address, line2
Town/City		County*		Post code*		Country*
						Please Select UK Andorra Argentina Australia Austria Belgium Brazil Canada China France Germany Hong Kong Ireland Italy Korea Mexico Netherlands New Zealand Singapore Spain Sweden Switzerland Taiwan United States Other
Home phone number*		Mobile		Fax
Your Curriculum Vitae
Please copy and paste your CV into the field below from an editable application, such as MS Word, but do not include any images. Once a member you will have the option to allow other members to view your CV and in turn will be able to view other members' CVs who have agreed for theirs to be shared also.
Are you prepared to share your details with other members?						YesNo
Are you prepared to offer your time and expertise to current and prospective investee companies?						YesNo
Your Income and Planned Investment
Is your annual income greater than £100k p.a.?						YesNo
Do you have net assets greater than £300k excluding your prime residence?						YesNo
Total amount available for investment* (max £99m)
What stage of private equity investment are you interested in (please tick as many as apply):
Start-up Early Stage Development Capital Management buy in / out
Are you interested in investing to obtain EIS tax relief?						YesNo
In which sectors do you have some expertise?
Aerospace / DefenceHousehold Goods / Textiles AutomotiveInformation Technology Biotech / Medical Leisure / Entertainment Business ServicesMedia Distribution Property Engineering Retail Financial ServicesTelecommunications Fast Consumer Product (FCP)Transport
What is your area of functional expertise?
FinanceProduction Sales and MarketingLogistics General ManagementIT HR
Investment History
Are you, or have you been, the director of any companies?*						YesNo
If yes, please enter the name(s) of the company(ies)						(Multiple entries with commas)
Have you invested in private companies before?*						YesNo
If yes please enter the name(s) of the company(ies)						(Multiple entries with commas)
Please enter average size of transaction (£k)
Are you aware that investment in private equity opportunities can be very risky and could involve losing all of your invested capital?*						YesNo
Have you invested in listed markets?*						YesNo
- If yes: On average how often do you invest in the listed markets each year?*						1 to 3 times 4 to 6 times 6+ times
- If yes: Over what period have you been investing in listed markets?						0 to 2 years 3 to 6 years 6+ years
- Over what period have you been investing in private companies?						0 - 2 years 3 - 6 years 6+ years
Please enter the average size of a transaction (£k)
Money Laundering Identification
Can you provide a certified copy of your passport to prove proof of your identity?*						YesNo
Can you provide two original utility bills to prove proof of your residence in the UK?*						YesNo
How did you find out about Octopus Ventures?*
Please Select Advertising Direct Marketing Octopus Investee Company Octopus Investor Personal Recommendation Press Article Professional Advisor Recommendation Search Engine Web Site Other
Download Terms and conditions of membership
Please check this box if you do not wish to receive information on our Partner services or other marketing information,
I confirm that I have read and understood the Octopus Ventures terms and conditions of membership.
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