Full Name:

Date of Birth:

Address:

Email:

Phone:

Nationality:

Company Name:

Position/Title:

Years of Experience:

Industry:

Amount You Wish To Invest:

Investment Timeframe:Short-termMedium-termLong-term

Preferred Sector for Investment:

Investment Objectives:Capital preservationIncome GenerationGrowthSpeculationOther

Previous Investment Experience:YesNo

If yes, provide details:

Risk Tolerance:LowMediumHigh

Annual Income:

Net Worth:

Source of Funds for Investment:

Existing Investments:YesNo

Type of Investment:

Value:

Are you a politically exposed person (PEP)?YesNo

Are you subject to any legal proceedings or regulatory actions?YesNo

If yes, provide details:

Do you have any conflicts of interest that may affect your investment?YesNo

If yes, provide details:

Signature:

Date: