New User Registration Form

* First Name:
* Last Name:
* Email / Username:
* Company Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Country:
* Phone:
Cell Phone:
You are completing this information on behalf of:
Your Organization
Are you an accredited investor in accordance with Rule 501(a) of Regulation D of the Securities Act of 1933?
If yes, please select a category that most accurately describes your specific situation:
Individual - I am a natural person whose individual investments, or joint investments with my spouse, as of the date hereof exceeds $5,000,000 excluding the individual's primary residence.
Individual - I am a natural person who had an individual income in excess of $200,000 in each of the two most recent years or joint income with my spouse in excess of $300,000 in each of those years and I have a reasonable expectation of reaching the same income level in the current year.
Entity Not Formed For The Specific Purpose Of Acquiring The Security Offered - I am an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986, as amended, a corporation, a similar business trust, or partnership, not formed for the specific purpose of acquiring any specific security, with total assets in excess of $5,000,000.
Regulated Entity - I am (i) a U.S. bank or any banking institution organized under the laws of any state, territory or the District of Columbia, the business of which is substantially confined to banking and is supervised by the State or Territorial banking commission or similar official agency, (ii) a U.S. savings and loan association or other similar institution, whether acting in its individual or fiduciary capacity; (iii) a broker or dealer registered pursuant to Section 15 of the Securities Exchange Act of 1934; (iv) a U.S. insurance company; or (v) an investment company registered under the Investment Company Act of 1940.
Business Development Company - I am a "business development company" as defined in the Investment Company Act of 1940.
Private Business Development Company - I am a "private business development company" as defined in the Investment Advisers Act of 1940.
Small Business Investment Company - I am a "small business investment company" licensed by the U.S. Small Business Administration under Section 301(c) or 501(c)(3) of the Small Business Investment Act of 1958.
Employee Benefit Plan - I am an "employee benefit plan" within the meaning of Title I of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), and either (i) the investment decision to invest is made by a plan fiduciary, as defined in ERISA, which is either a bank, savings and loan association, insurance company, or registered investment adviser; or (ii) the employee benefit plan has total assets in excess of $5,000,000; or (iii) if a self-directed plan, the investment decisions are made solely by persons that are "accredited investors".
State Plan - I am a plan established and maintained by a State, its political subdivisions, or any agency or instrumentality of a State or its political subdivisions, for the benefit of its employees, if such plan has total assets in excess of $5,000,000.
Trust - I am a trust with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring any specific security, whose purchase is directed by a sophisticated person as described in Regulation D.
Recovable Trust - I am a "recovable trust" that may be amended or revoked at any time by the grantors thereof, an all of the grantors are "accredited investors".
What is your investment horizon?
Long Term (>5 years)
Med Term (2-5 years)
Short Term (<2 years)
What is your risk tolerance?
High (Agressive)
Low (Conservative)
Do you invest in hedge funds?
How many years have you been investing in hedge funds?
Approximately how many hedge funds are you invested in?
What percentage do hedge funds comprise of your portfolio?
What is the approximate total value (in US$) of your hedge fund portfolio?
Please choose the category that best describes you:
Fund Manager
Pension Fund
Insurance Co.
Family office
Registered Investment Adviser
Third-Party Marketer
You heard about Sandell through:
News Article
Current Investor
Third Party
Other (Referral)

Anti-Money Laundering Certification

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

By submitting this form, 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’s 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 Sandell 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. Users of the Sandell website may view, download and print information and materials on this Site for their own personal and internal business use provided that all hard copies contain all copyright and other applicable notices. Users may not reproduce, modify, copy, alter in any way, distribute, sell, resell, transmit, transfer, license, assign or publish any information obtained from this Site. Registered Users shall not use this Site at any time for any purpose that is unlawful or prohibited and shall comply with any applicable local, state, national or international laws or regulations when using this Site.

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.

We will review the information you have submitted and contact you directly with any follow-up questions we may have.

* Required fields