1. A Joint Investments Trust Fund, within its meaning in the Joint Investment Trusts Law 5754-1994, or a company for management of a said fund;

2. A provident fund or a management company, as defined in the Control of Financial Services Law (Provident Funds) 5765-2005;

3. An insurance company, within its meaning in the Insurance Control Law 5741-1981;

4. A banking corporation and an auxiliary body corporate, within their meaning in the Banking (Licensing) Law 5741-1981, exclusive of a joint service company, which acquire for themselves or for customers who are investors enumerated in Section 15A(b) of the Securities Law;

5. A portfolio manager, within its meaning in section 8(b) of the Regulation of Investment Advices, Investment Marketing and Portfolio Management Law 5755-1995, purchasing for himself or for customers who are investors enumerated in Section 15A(b) of the Securities Law;

6. An investment advisor or an investment marketing agent, within their meaning in Section 7(c) of the Regulation of Investment Advices, Investment Marketing and Portfolio Management Law 5755-1995, purchasing for himself;

7. A member of the Stock Exchange as defined in Section 50A of the Securities Law purchasing for himself or for clients who are investors that are listed in Section 15A(b) of the Securities Law;

8. An underwriter who meets the qualifications under Section 56(c) of the Securities Law purchasing for himself;

9. A venture capital fund; for this purpose, a “venture capital fund” shall mean a corporation whose main business is investing in corporations, which, at the time the investment is made, are primarily engaged in research and development or in the manufacture of innovative and high-tech products or processes, where the risk of investment is higher than what is customary for other investments;

10. A legal entity, the entire share capital of which is held by shareholder(s) satisfying any of the following: (i) natural person satisfying the conditions of investor status as specified in subsection (12) herein; or (ii) any of the entities specified in this section (1);

11. A legal entity, other than a legal entity formed for the acquisition of securities from a certain offer, with an equity capital in excess of NIS 50 million;

12. An individual that satisfies one of the condition prescribed hereinafter (kindly check with respect to which of the following subsections (1), (2) or (3) this declaration is made) (*) :

__ (1) the aggregate value of the Liquid Assets[1] owned by undersigned exceeds NIS 8,364,177;

__ (2) the undersigned's income in each of the two most recent years exceeds 1,254,627 NIS or the joint income of the Family Unit[2] to which the undersigned belongs in each of the two most recent years exceeds 1,881,940 NIS.

__ (3) the aggregate value of the Liquid Assets owned by the undersigned exceeds 5,227,610 NIS and the undersigned's income in each of the two most recent years exceeds 627,313 NIS or the joint income of the Family Unit to which the undersigned belongs exceeds 940,969 NIS.

(*) The amounts prescribed in this section 12 above shall be updated on January 1st of every third year commencing on March 25, 2016 (the "Update Date") at the change rate of the New Index over the Basic Index; for this purpose, the "Index" - the consumer price index published by the Central Bureau of Statistics in Israel; the "Basic Index" – the Index which was published with respect to the month of December 2015; the "New Index" – the last Index published prior to the Update Date. The amounts provided herein are updated according to the New Index, in effect as of January 1st 2022.  

Attached are the following references / documentation supporting the above (kindly complete the description below and provide us with such references by the date of the investment supported by this document): 

1.    I / we hereby confirm that I am / we are aware of the meaning of being a Qualified Investor, and agree to be defined as such.   

2.    I / we hereby undertake that in the event there will be any change in the above declarations under section 1, I / we will immediately inform you on such change, and that each time that I / we will perform an additional investment through you, I / we will deliver to you an updated declaration and /or additional documentation or details as shall be required by you.      

3.    I / we hereby consent that the above information relating to me/us shall be included in the database managed by you, and used by you for the purposes of offering investment opportunities.

4.    I / we acknowledge the fact you are relying on the declarations, representations and commitments included in this document and that the provision of false representations and declarations by me / us herein and/or failure to comply with my commitments, may cause you significant damage.