Shareholder Qualification — Prim West S.A.

1 Applicant information

Full legal name *

Country of residence *

Email address *

Mobile number *

2 Investment profile

Shareholder type *

Intended holding horizon *

Proposed allocation range *

Primary interest area *

3 Suitability & compliance

Experience level *

Source of funds *

Accredited / qualified shareholder *

I confirm that all funds intended for investment are derived from legitimate and verifiable sources.

4 Shareholder objectives

Primary objective *

Additional notes (optional)

5 Compliance acknowledgement

I acknowledge that all submissions are subject to internal review, shareholder suitability assessment, and applicable compliance procedures. Submission does not constitute an offer, solicitation, or guarantee of investment access.

Typical review: 48–72 business hours · Encrypted transmission