Know Your Client Form for Individuals

"*" indicates required fields

Investor Information - Client 1

Title - Client 1*

Name - Client 1*

First Last

Date Of Birth - Client 1*

Email - Client 1*

Home Phone - Client 1*

Cell Phone - Client 1*

Occupation - Client 1*

Maritial Status - Client 1*

Employer Name - Client 1*

Citizenship - Client 1*

Employer Address*

Sin - Client 1*

Annual Income - Client 1*

If US resident, TIN,SSN - Client 1

Investor Information - Client 2

Name - Client 2*

Spouse DOB - Client 2*

Email - Client 2*

Home Phone - Client 2*

Cell Phone - Client 2*

Occupation - Client 2*

Sin - Client 2*

Employer - Client 2*

Employer Address - Client 2*

Annual Income - Client 2*

Citizenship - Client 2*

If US resident, TIN,SSN - Client 2

Address Information - Client 1

Mailing address same as legal address? - Client 1*

Yes

No

Legal Address - Client 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Address Information - Client 2

Mailing address same as legal address? - Client 2*

Yes

No

Address (if different) - Client 2

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Verification of Identity - Client 1

Driver’s License No. - Client 1

Passport No. - Client 1

Citizenship Card No. - Client 1

Health Card - Client 1

Other ID - Client 1

Reference Number - Client 1

Place Of Issue - Client 1

Client 2 Verification of Identity

Driver’s License No. - Client 2

Passport No. - Client 2

Health Card - Client 2

Citizenship Card No. - Client 2

Reference Number - Client 2

Other ID - Client 2

Place Of Issue - Client 2

Investment Profile - Client 1

Investment Knowledge - Client 1*

Professional

Sophisticated

Good

Limited

Risk Tolerance - Client 1*

Speculative

High Risk

Medium

Low

Investment Objectives - Client 1*

Growth

Balanced

Capital Preservation

Cash Management

Investment Profile - Client 2

Risk Tolerance - Client 2*

Speculative

High Risk

Medium

Low

Investment Knowledge - Client 2*

Professional

Sophisticated

Good

Limited

Investment Objectives - Client 2*

Growth

Balanced

Capital Preservation

Cash Management

Client Assets - 1

Principal Residence - Client 1*

Cottage - Client 1

Other Real Estate - Client 1

Private Company - Client 1

Stocks - Client 1*

Bonds - Client 1*

Insurance - Client 1*

Other Assets - Client 1

Total Assets - Client 1

Client Assets - 2

Principal Residence - Client 2*

Cottage - Client 2

Other Real Estate - Client 2

Private Company - Client 2

Stocks - Client 2*

Bonds - Client 2*

Insurance - Client 2

Other Assets - Client 2

Total Assets - Client 2

Liabilities - Client 1

Mortgages - Client 1*

Loans - Client 1

Lines Of Credit - Client 1

Other Liabilities - Client 1

Total Liabilities - Client 1

Net Worth - Client 1

Notes - Client 1

Liabilities - Client 2

Mortgages - Client 2*

Loans - Client 2

Lines Of Credit - Client 2

Other Liabilities - Client 2

Total Liabilities - Client 2

Net Worth - Client 2

Notes - Client 2

Net Investable Assets - Client 1

Net Investable Assets - Client 1*

Over 1,000,000

Under 1,000,000

Net Assets - Client 1*

0 - 1,000,000

1,000,000 - 5,000,000

5,000,000 +

Time Horizon - Client 1*

Short Term (under 1 yr)

Medium Term (1-5yrs)

Long Term (5yrs +)

Net Investable Assets - Client 2

Net Investable Assets - Client 2*

Over 1,000,000

Under 1,000,000

Net Assets - Client 2*

0 - 1,000,000

1,000,000 - 5,000,000

5,000,000 +

Time Horizon - Client 2*

Short Term (under 1 yr)

Medium Term (1-5yrs)

Long Term (5yrs +)

Liquidity Requirements - Client 1

Do you require any regular withdrawals? - Client 1*

Yes

No

Do you expect any large, lump sum withdrawals in the next 24 months? - Client 1*

Yes

No

Limp Sum Withdrawals (IF Yes) - Client 1

Are you an 'insider' of a public company? (Are you a director or officer of a public company? Do you control more than 10% of the voting rights of a public company?) - Client 1*

PEP? - Client 1*

In opening this account, are you acting on the instructions of or on behalf of a third party? - Client 1

Are you or anyone you know the Head of an International Organization (HIO) or close associate of an HIO? - Client 1

(If YES to any of the above please provide details here): - Client 1

Liquidity Requirements - Client 2

Do you require any regular withdrawals? - Client 2*

Yes

No

Do you expect any large, lump sum withdrawals in the next 24 months? - Client 2*

Yes

No

Limp Sum Withdrawals (IF Yes) - Client 2

Do you expect any large, lump sum withdrawals in the next 24 months? - Client 2*

Yes

No

Are you an 'insider' of a public company? (Are you a director or officer of a public company? Do you control more than 10% of the voting rights of a public company?) - Client 2

PEP? - Client 2*

In opening this account, are you acting on the instructions of or on behalf of a third party? - Client 2

Are you or anyone you know the Head of an International Organization (HIO) or close associate of an HIO? - Client 2*

(If YES to any of the above please provide details here): - Client 2

Investment Restrictions

Investment Restrictions:*

Investment Restrictions Comments: (If YES to any of the above please provide details here):

Emergency Contact Information - Client 1

Emergency Contact Name - Client 1*

First Last

Emergency Contact Relationship - Client 1*

Emergency Contact Email - Client 1*

Emergency Contact Home Phone - Client 1

Emergency Contact Cell Phone - Client 1*

Emergency Contact Address - Client 1*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Information - Client 2

Emergency Contact Name - Client 2*

First Last

Emergency Contact Relationship - Client 2*

Emergency Contact Email - Client 2*

Emergency Contact Home Phone - Client 2*

Emergency Contact Cell Phone - Client 2*

Emergency Contact Address - Client 2*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Exponent Investment Management Inc. Statement Delivery - Client 1

Receive one consolidated family account statement each quarter? - Client 1*

Online Access? - Client 1*

Exponent Investment Management Inc. Statement Delivery - Client 2

Receive one consolidated family account statement each quarter? - Client 2*

Online Access? - Client 2*

Know Your Client Form for Individuals

Investor Information - Client 1

Investor Information - Client 2

Address Information - Client 1

Address Information - Client 2

Verification of Identity - Client 1

Client 2 Verification of Identity

Investment Profile - Client 1

Investment Profile - Client 2

Client Assets - 1

Client Assets - 2

Liabilities - Client 1

Liabilities - Client 2

Net Investable Assets - Client 1

Net Investable Assets - Client 2

Liquidity Requirements - Client 1

Liquidity Requirements - Client 2

Investment Restrictions

Emergency Contact Information - Client 1

Emergency Contact Information - Client 2

Exponent Investment Management Inc. Statement Delivery - Client 1

Exponent Investment Management Inc. Statement Delivery - Client 2

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