Purchaser
Registration

REQUEST ADDITION OF NAME TO LIST

I acknowledge that I have received a copy of the Stock Information Policy (the “Policy”) adopted by Acrisure Holdings, Inc. (the “Company”) and that I wish to participate in the procedures outlined in that Policy. I acknowledge that the Company is acting in a purely administrative role, and I hereby release the Company and its direct and indirect subsidiaries and their respective shareholders, directors, officers, members, managers and employees from any claims in connection with my participation in the procedures described in the Policy, including with respect to any dispute I may have with any potential seller or other party. I understand all transfers of the Company’s Common Stock and/or its Series C Preferred Stock (collectively, “Company Stock”) must be made in accordance with the terms and conditions of the Stockholders Agreement among the Company and its stockholders (the “Stockholders Agreement”), which allows for transfers pursuant to and in accordance with the Policy.

I hereby confirm and agree to the following:

1. I am a full-time employee of the Company or any of its direct or indirect subsidiaries;
2. My individual net worth, or joint net worth with my spouse, exceeds $1,000,000 (excluding my primary residence and excluding indebtedness secured by my primary residence that is not in excess of the fair market value of that residence);
3. My individual income is in excess of $200,000 (or $300,000 with my spouse) for each of the two most recent years and I have a reasonable expectation of reaching the same level in the current year;
4. I agree to purchase shares of Company Stock having a minimum sales price of $100,000 in each transaction; or, for transactions having a sales price of less than $100,000, I agree that I must (i) be an existing stockholder at the time of the transaction and (ii) purchase all of the shares of the selling stockholder.

IMPORTANT – PLEASE READ: The Company makes no representations regarding the current value of the Company Stock or regarding the existence or nonexistence of any facts, circumstances or developments concerning the Company that could affect the value of such stock.

By signing below, I hereby consent to having my name and contact information provided to prospective sellers of the Company Stock in accordance with the Policy. Please include my name, telephone number and email address in the list of Prospective Purchasers pursuant to the Policy.