Initial Application Form - Investor

SECTION A

This Application Form constitutes an offer to acquire:

constituting a Partnership Interest in Premier Legal Finance L.P., and Premium Legal Finance L.P as described below.

SECTION B

Investor Details:

Contact Details:

Investor Bank Account Details:

The account nominated below will be used for all payments of interest and principal when they become payable. If you have not provided this previously, please enclose a bank encoded deposit slip, bank statement or confirmation from your bank verifying account name and number.

I/We irrevocably appoint the General Partner and every director, officer or duly appointed agent for the time being of the General Partner as our lawful attorney to execute the Partnership Agreement and any ancillary deed, instrument or document necessary in respect of the Partnership Agreement and we hereby ratify and confirm whatever the General Partner or its substitutes may lawfully do by virtue of this provision.

If this Application Form is being executed by a company, the signatures of 2 directors are required. If there is only 1 company director, the director’s signature must be witnessed below the signature where provided.

I am/we are aware that a Product Disclosure Statement will not be issued (or any information usually given by the issuer in respect of a retail financial product) for this investment.

The Anti-Money Laundering and Countering Financing of Terrorism Act 2009 requires verification of the identity of new investors. We will need to obtain further information from you to meet our legal obligations under the Act before and after you invest with us.

I am/we are aware that a Product Disclosure Statement will not be issued (or any information usually given by the issuer in respect of a retail financial product) for this investment and that I/We certify that that I/We are:

SECTION C

Additional Conditions:

1. By signing this Application Form, the applicant also acknowledges that the information supplied by him/her/it in the Application Form is true and correct.

2. The applicant acknowledges that Premier Legal Finance L.P. and Premium Legal Finance L.P. may request certain information from time to time to comply with its regulatory obligations and agrees to provide such information promptly upon request. The applicant acknowledges and agrees that Premier Legal Finance L.P. and Premium Legal Finance L.P. may take enforcement action in the event that the applicant refuses or fails to comply with such request.

3. To the extent permitted by law, each applicant acknowledges and confirms that Premier Legal Finance L.P., Premium Legal Finance L.P. the General Partner or their respective officers or directors have no liability for any loss incurred by any applicant howsoever arising in connection with its investment.

4. Each applicant acknowledges and confirms that none of Premier Legal Finance L.P., Premium Legal Finance L.P., the General Partner or their respective officers or directors have made any warranties in connection with returns from Premier Legal Finance L.P.

5. An application cannot be withdrawn or revoked by the applicant once made.

6. The General Partner reserves the right to reject any application in whole or in part without giving any reason.

7. In the case of joint applicants, only the address of the first named of the joint applicants will be recorded on our register and all distributions, notices and communications will be sent to the address of the first named applicant.

8. The Partnership Agreements contain an indemnity in respect of any claims by the borrower and any guarantors.

9. This Application Form and any contract arising out of its acceptance is governed by New Zealand law.

SIGNED: