INVESTOR QUESTIONNAIRE

Confidential | For Internal Use Only

Thank you for your interest in investing. This questionnaire is designed to help us verify your identity, assess
your suitability as an investor, and comply with applicable legal and regulatory requirements including Know
Your Customer (KYC) and Anti-Money Laundering (AML) regulations. All information provided will be kept
strictly confidential.

Please complete all sections. Incomplete forms may delay or prevent processing of your investment.

1. Personal Information

Full Legal Name *

Date of Birth *

Nationality / Citizenship *

Country of Residence *

Tax Residency *

Government-Issued ID Number (Passport / National ID) *

Residential Address *

Email Address *

Phone Number *

2. Professional Background

Current Occupation / Position *

Company / Organization Name

Industry

LinkedIn Profile or Professional Website

3. Investor Accreditation Status

Please indicate which of the following applies to you:
Annual income exceeding $200,000 (or $300,000 jointly) for the past two yearsNet worth exceeding $1,000,000 (excluding primary residence)Licensed securities professional (Series 7, 65, or 82)Director, executive officer, or general partner of the issuerEntity with assets exceeding $5,000,000None of the above

Note: Accreditation criteria may vary by jurisdiction. If you are unsure, please consult a legal advisor.

4. Investment Experience

Years of Investment Experience *
SelectLess than 1 year1 - 3 years3 - 7 years7 - 15 years15+ years

Types of Previous Investments
Public equities (stocks)Bonds / Fixed incomeReal estatePrivate equity / Venture capitalStartups / Angel investingCryptocurrency / Digital assetsCommoditiesHedge funds

Briefly describe your most relevant investment experience

5. Source of Funds (AML Compliance)

To comply with Anti-Money Laundering (AML) regulations, please provide details about the source of funds you
intend to use for this investment.

Primary Source of Investment Funds *
Employment income / SalaryBusiness profits / DividendsSale of real estateSale of investments / SecuritiesInheritance / GiftPension / Retirement fundsSavings / Accumulated wealthOther

If "Other", please describe

Intended Investment Amount (USD or equivalent): *
SelectUnder $25,000$25,000 - $100,000$100,000 - $500,000$500,000 - $1,000,000Over $1,000,000

Name of bank or financial institution from which funds will be transferred *

6. Risk Tolerance & Investment Goals

Risk Tolerance *
SelectConservative (capital preservation)Moderate (balanced growth)Aggressive (high growth, accept losses)Very aggressive (speculative)

Investment Time Horizon *
SelectLess than 1 year1 - 3 years3 - 5 years5 - 10 years10+ years

What are your primary goals for this investment?

7. Referral Information

How did you learn about this investment opportunity?
SelectPersonal referralProfessional networkSocial mediaConference / EventOnline searchOther

If referred by someone, please provide their name

8. Politically Exposed Person (PEP) Declaration

A Politically Exposed Person (PEP) is an individual who holds or has held a prominent public function, or is a close family member or associate of such a person.*
I am NOT a Politically Exposed PersonI AM a Politically Exposed Person

If PEP, please describe your role and jurisdiction

9. Declaration & Signature

Print Name *

Date *

Electronic Signature (type your full legal name) *

I declare that all information provided is true, accurate, and complete to the best of my knowledge; the funds I intend to invest are from legitimate sources; I consent to verification of the information provided, including background checks and third-party verification services; and I agree to provide additional documentation if requested.

CONFIDENTIALITY NOTICE: This document and all information contained herein is strictly confidential and intended solely for the purpose of evaluating a potential investment. The information provided will be handled in accordance with applicable data protection laws and will not be shared with third parties except as required by law or for the purpose of conducting due diligence. This document should be returned or destroyed if the investment does not proceed.