IPRO GROWTH FUND     E-TOP UP APPLICATION FORM

    BRC No. C06010411
    SHAREHOLDER DETAILS
    SHAREHOLDER REFERENCE NO.
    SHAREHOLDER NAME
    PHONE NO.
    E-MAIL ADDRESS
    TOP UP (ADDITIONAL SUBSCRIPTION) DETAILS
    TOP UP AMOUNT (MUR)

    (Min. Top Up is MUR 1,000)

    EXPECTED DATE OF BANK TRANSFER
    REMITTING BANK
    SOURCE OF FUNDS TOP UP DECLARATION
    (In compliance with the Financial Intelligence & Anti-Money Laundering Act 2002). I / We declare that the information provided on the source of my/our funds / origin of wealth is true and complete. I agree to provide the Company or Galileo Portfolio Services Ltd (in its capacity as Registrar & Transfer Agent) with any further information in respect of funds on request.

    THE SOURCE OF FUNDS OF THIS TOP UP SUBSCRIPTION IS:

    if "Others"
    OTHER DECLARATIONS

    By clicking on the “Submit” button, I / We confirm that:

    1. I / We wish to subscribe for Shares in IPRO Growth Fund Ltd based on the amount specified in the "Top Up Amount" field above.
    2. I / We agree to be bound by the terms and conditions of the Prospectus and by the Constitution of IPRO Growth Fund Ltd and I / We confirm that this application for subscription for Shares is made on the basis of and subject to those documents.
    3. I / We hereby affirm that I / We have the legal capacity, the legal age and authority to make the subscription pursuant to this application whether this is in my/our own name(s) or is made on behalf of another person or institution.
    4. I / We hereby hold harmless IPRO Growth Fund Ltd and its Service Providers for any losses or expenses incurred as a result of action taken pursuant to the above considerations, save where such losses or expenses arise from the gross negligence or willful misconduct of such party.
    5. I / We accept the risks related to the submission of this application form by electronic means and to the potential for misuse of the information contained herein by unauthorised parties. I / We accept that IPRO Growth Fund Ltd or its Service Providers shall not be held responsible for any loss resulting from the non-receipt of this application form or losses incurred from any loss or misuse of the information contained herein and I / We shall hold them harmless from any claim or liabilities resulting from the submission of this application form by me/us. I / We accept that I / we shall be solely responsible and liable for the use of this facility.
    6. I / We understand and accept that a subscription will be made only upon obtaining written confirmation by IPRO Growth Fund Ltd's bank of receipt of the monies into the prescribed IPRO Growth Fund Ltd bank account and upon receipt by IPRO Growth Fund Ltd and/or its Service Providers of this Top Up application form properly completed by me/us.

    I / We also request that a copy of this application form duly completed by me/us be sent to my/our e-mail address provided by me/us above

    I / We wish to print a copy of this application form.