ICA Investor Questionnaire

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:
Are you "Politically Exposed Person?
Company Name:
Phone:
Email:
Website:
Country:
   
What is your job?
Name of Company or Organization:
   
What is the name of your current broker(s)?
   
How did you hear about us?
   
Financial Information
   
Your annual Income (USD):
My current and future income sources are:
Risk Capital: (capital if lost would not change your lifestyle, Must be greater than initial deposit) (USD)
   
I want to invest in the following strategy
Principal Protected (Structured Product):   Risk (0%), Expected annual return (+20%)
Conservative Strategy (Managed Account):   Risk (5%-11%), Expected annual return (+50%)
Aggressive Strategy (Managed Account):   Risk (11%-25%), Expected annual return (+100%)
   
What is the total amount of your investable assets (excludes principal residence)? (USD)
How much money are you willing to invest? (USD)
   
I plan to begin taking money from my investments in:
   
What is the source of funds? (check all applicable):  
Sale of other investment
Savings
Retirement
Line of Credit
Others
 
   
I am a/an (check all applicable):  
Individual Investor
Money Manager
CTA
Investment Consultant
Introducing Broker
 
   
Are you an accredited investor? (information about Accredited Investor)
Yes No  
   
Are you a Qualified Eligible Person (QEPs)? (For USA Resident) (information about QEP Investor)
Yes No  
   
Are you an ECP investor? (For USA Resident) (information about ECP Investor)
Yes No  
   
Are you a Professional Client? (For UK Resident) (information about Professional Client)
Yes No  
   
When it comes to investing in stocks, Futures  or Foreign Exchange. I describe myself as :
   
For further information and notes:

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