Know Your Client Form for Individuals

Investor Information

Name*
MM slash DD slash YYYY

Spouse/Partner Information

MM slash DD slash YYYY

Address Information

Legal Address*

Registered Account Beneficiary information

Beneficiary Name
MM slash DD slash YYYY

Verification of Identity

Exponent Investment Management Inc. Statement Delivery

Investment Profile

Client Assets:

Client Liabilities:

Net Investable Assets

Net Assets: (Total assets less Total liabilities)

Time Horizon

Liquidity Requirements:

Additional Information:

Investment Restrictions:

Emergency Contact Information

Emergency Contact Name
Emergency Contact Address