I, the undersigned, being duly authorised to act on behalf of the applicant entity, hereby confirm that: (i) the information provided in this Form is true, accurate, and complete to the best of my knowledge; (ii) I have read and understood the disclaimer below; and (iii) I am authorised to submit this funding request on behalf of the applicant.

This Funding Request Form ("Form") is issued by Ratio Capital Management B.V. ("Ratio Capital"), a company incorporated in the Netherlands (KvK: 53611039), registered with and regulated by the Autoriteit Financiële Markten (AFM).

The completion and submission of this Form does not constitute, and shall not be construed as, a binding commitment, offer, or agreement by Ratio Capital to provide financing of any kind. Any indicative term sheet issued following receipt of this Form is non-binding and subject to satisfactory completion of due diligence, credit committee approval, and execution of definitive legal documentation.

All information provided in this Form is received in strict confidence. Ratio Capital will not disclose such information to third parties without the prior written consent of the applicant, except as required by applicable law or regulation.

The applicant represents and warrants that all information provided herein is true, accurate, complete, and not misleading in any material respect. Ratio Capital reserves the right to withdraw from any transaction at any stage if information provided was materially inaccurate or incomplete.

This Form and any related communications are subject to Dutch law. Any disputes arising in connection with this Form shall be subject to the exclusive jurisdiction of the courts of Amsterdam, the Netherlands.