Access to www.dentoniapark.com is restricted. In order to obtain access, please complete and submit this form. You will be contacted by a member of our Investor Relations team to verify the information you submit, and then a login to access the site will be provided to you. The investment funds described in this website have not been registered under the federal securities laws of the United States, the securities laws of any state, or the laws of any other jurisdiction. This website shall not constitute an offer to sell or the solicitation of an offer to purchase shares of any of such funds in any jurisdiction. Such an offer may only be made by the private placement memorandum for the relevant fund, and only to investors who meet certain eligibility requirements. This registration form is not an application form to subscribe for interests in or shares of any of the funds.

All information provided on this questionnaire will be held in confidence in accordance with Dentonia Park's Disclaimer as in effect from time to time.

All fields marked with an asterisk (*) are required.

  • Personal Information
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  • * 1. You are completing this information on behalf of:


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  • * 2. Are you an accredited investor in accordance with Rule 501(a) of Regulation D of the Securities Act of 1933?
  • If yes, please select one:
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  • * 3. Are you a qualified client as defined under Rule 205-3(d)(i) under the Investment Advisers Act of 1940?
  • If yes, please select one:
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  • * 4. Are you a qualified purchaser in accordance with Section 2(a)(51) of the Investment Company Act of 1940?
  • If yes, please select one:
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  • 5. What investment styles suit your particular interest in hedge funds and separately managed accounts?
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  • 6. What are your return objectives?
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  • * 7. What is your investment horizon?
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  • * 8. What is your risk tolerance?
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  • * 9. Do you invest in hedge funds?
  • If yes,


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  • 10. Please choose the category that best describes you:
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  • 11. If you selected Fund-of-Funds:
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  • 12. You heard about Dentonia Park Capital Management through
    (please describe in detail):
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  • Anti-Money Laundering Certification

  • This section must be completed for you/beneficial investor. For this section, please see Definitions.

    By checking this box, I hereby represent and certify that I am not involved in any anti-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 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 hereby agree to hold Dentonia Park Capital Management LLC and each of its principals, members, directors, officers, and employees harmless and to indemnify the same against any loss arising as a result of a inaccuracy in the foregoing or any other statement in this questionnaire.

    If I am (I) acting as trustee, agent, representative or disclosed nominee for another person or entity, or (II) 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 (the persons, entities and underlying investors referred to in (I) and (II) being referred to collectively as the (Beneficial Owners), I represent and warrant that:

  • I understand and acknowledge the representations, warranties and agreements made herein are made by me (A) with respect to me, and (B) 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 Beneficial Owners are not Prohibited Investors.
  • Thank you very much for your time. By pressing the "Submit/I Agree" button below, you agree that you have filled in this questionnaire completely, truthfully and to the best of your ability and that you also have read and agree to the Terms of Use Agreement which you should review carefully.