ICA Investor Questionnaire

Please complete the prospective investor questionnaire to help us identify your objectives and risk tolerance in order to make sure that they are compatible with our program.
Your privacy is very important to us. This information is not shared with any third party.

General Information
Full Name:
Phone:
Email:
Website:
Address:
How did you hear about us?
Broker
Website
Other
Financial Information
You annual Income:	USD
Total Assets: (value of all you own e.g. money, bank accounts, stocks, bonds, real estate, etc.)	USD
Total Liabilities: (all debt and financial obligations, such as taxes, mortgages, car loans, credit card balances, etc.)	USD
Risk Capital: (risk capital if lost would not change your lifestyle, Must be greater than or equal to initial deposit)	USD
My current and future income sources (such as Salary, Social Security, Pension) are:	Very unstable Unstable Stable Very stable
What is the total amount of your investable assets (excludes principal residence)?	USD
How much money are you willing to invest?	USD
What is the source of funds?
Sale of other investment Savings Retirement Line of Credit Others
What is the maximum drawdown you can tolerate?	5% to 10% 10% to 15% 15% to 20% 20% to 25% More than 25%
What is the annual return you are targeting?	%
I plan to begin taking money from my investments in:	1 year or less 1–2 years 3–5 years 5 – 10 years More than 10 years
I am a/ an:
Individual Investor Money Manager CTA Investment Consultant Introducing Broker
What Type of Investor are you:
Individual Fund-of-Funds Family Office Endowment/Foundation Others
When it comes to investing in stocks, bonds or Foreign Exchange. I describe myself as :	Very inexperienced Somewhat inexperienced Somewhat experienced Experienced Very experienced
Authentication Code:
Please enter the string shown in the image in the form.