EX-99.D(IV) 4 a06-12459_1ex99ddiv.htm EX-99

Exhibit 99(d)(iv)

 

H&Q LIFE SCIENCES INVESTORS

RIGHTS OFFERING

 

BENEFICIAL OWNER CERTIFICATION

 

The undersigned, a bank, broker or other nominee of Rights to purchase shares of beneficial interest (“Shares”) of H&Q Life Sciences Investors (“Trust”) pursuant to the rights offering (“Offer”) described and provided for in the Trust’s Prospectus, dated        , 2006 (“Prospectus”), hereby certifies to the Trust and to Computershare Shareholder Services, Inc., as Subscription Agent for the Offer, that for each separate line filled in below the undersigned has exercised, on behalf of the beneficial owner thereof (which may be the undersigned), the number of Rights specified on such line pursuant to the Primary Subscription (as defined in the Prospectus) and such beneficial owner wishes to subscribe for the purchase of additional Shares pursuant to the Over-Subscription Privilege (as defined in the Prospectus), in the amount set forth in the third column of such line:

 

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I

 

II

 

III

 

 

 

NUMBER OF RIGHTS

 

NUMBER OF SHARES REQUESTED

 

NUMBER OF RECORD DATE

 

EXERCISED PURSUANT TO THE

 

PURSUANT TO

 

SHARES OWNED

 

PRIMARY SUBSCRIPTION

 

OVER-SUBSCRIPTION PRIVILEGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total =

 

Total =

 

Total =

 

 

 

By:

 

 

Number of Nominee Holder

 

 

 

Name:

 

 

Title:

 

 

Dated:                                    , 2006 

 

Provide the following information if applicable.

 

DTC Participant Number

 

 

Name of Broker:

 

 

 

 

DTC Primary Subscription

 

Confirmation Number

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone:

 

 

 

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