European Angels Fund - Application Form

1. Title*(e.g. Mr, Ms, Dr.)
2. First Name*
3. Last Name*
4. Address*
5. City*
6. Country*
7. Zip Code*
8. Phone Number*
9. E-mail Address*
10. Confirm E-mail Address*
11. How did you hear about this initiative supported by EIF
12. Details on Intermediary / investment vehicleIf applicable (name, shareholder structure, management, etc.)
13. Business Experience*Please describe your business skills, experience and significant accomplishments. Include companies, positions held and dates. A curriculum vitae can be attached to this application form (see below).

1. Number of equity investments in SME's*made in the last 10 years as a Business Angel/Private Investor
2. Global amount invested personally in SME's*in the last 10 years (in EUR) as a Business Angel/Private Investor
3. Investment Strategy*Please describe your previous investment strategy (e.g. geography, stage, sector, stake, etc.)
5. Portfolio development
   Please indicate the number of Business Angel investments (0 if not applicable)
exited at proceeds at or above cost*

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6. exited at proceeds below cost*
7. lost by insolvency*
8. currently being valued at or above cost*
9. currently being valued below cost*
11. Portfolio performance
    Please indicate the overall multiple
of all realised Business Angel investments (exit proceeds / at cost realised investments)*

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12. of all unrealised Business Angel investments (fair market value / at cost unrealised investments)*
13. of all Business Angel investments (total value / total at cost)*

2. Investment intentions over the next 5 years
number of Business Angel investments*

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3. indicative global amount (EUR, excluding EAF co-investment)*
4. Countries/regions targeted*Please list all the countries/regions where you plan to make investments and indicate the geographic focus
5. Strategy Change*Please indicate any changes in your future investment strategy (e.g. volumes, stage, sector, stake, etc.) compared to your previous investment activity
6. Dealflow*Please list your main sources of dealflow and the total number of deals reviewed in the last 12 months
7. Comments and questions (if any)
8. Curriculum Vitae, if available

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1. I have read and accept the Statement on Personal Data Protection.

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