Accredited Investor Questionnaire

Prefix

First Name

Middle Name

Last Name

Suffix

Will you be registering for yourself or on behalf of an entity?

Self Entity

Home Address

Address 1

Address 2

Address 3

City/Town

Country

State/Province

Postal code

Home/cell telephone

Fax

Confirm Email

Date of birth (DD.MM.YYYY)

Marital Status

Company

Company position

Company Location

Address 1

Address 2

Address 3

City/Town

Country

State/Province

Postal code

Mobile telephone

Preferred method of contact for qualification

Business telephone Home telephone

Preferred time of contact for qualification

Morning Midday Evening

Legal qualification of accredited investor as defined by the U.S. Financial Industry Regulatory Authority, Inc. (“FINRA”)

I attest that I am (Please make an indication for all that apply):

a trust with assets in excess of $5 million, not formed to acquire the securities offered, whose purchases a sophisticated person makes

I further state that I am:

an individual who could be considered a high net worth individual investor

I am an employee or representative of a

Sophisticated financial investor qualification

Please check all that apply:

If CURRENTLY an investor in alternative investments ⁽¹⁾

Approximate value of my alternative investment portfolio

Value of my alternative investment portfolio as % total household net worth

If NOT CURRENTLY an investor in alternative investments

My total household annual income

My total household net worth

With regard to alternative investments, I consider my principal investment objective to be

Investment risk profile

With regard to alternative investments, I consider my tolerance for risk to be

I currently am invested in the following assets (any other type of investment not listed above)

My interest in alternative investments currently is

I found out about this site through

(1) According to the U.S. Financial Industry Regulatory Authority, Inc. (“FINRA”), alternative investments are asset classes considered outside of traditional stocks, bonds and cash. Alternative investments include hedge funds, managed futures, real estate, commodities and derivatives contracts. The alternative investment asset class is generally held by institutional investors or accredited high-net-worth individuals as defined by FINRA. Alternative investments are generally only for investors considered accredited and sophisticated because of their complex nature, limited or no regulations by the authorities, and often times their relative lack of liquidity or transparency when compared to the reporting requirements of securities listed on a major exchange.