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.

Personal Information
   
Full Name:
Are you "Politically Exposed Person?
Did/Do you hold any political position?
Residence Address:
Apartment or Suit Number: Street Address:
City: State/Province:
Postal/Zip Code: Country:
Phone: Email:
   
Professional Information
   
Are you self-employed?
Name of the company or Organization:
Position Held:
Type of Business:
Job Description:
Business address:
Street Address: City:
State/Province: Country:
Phone: Email:
   
Financial Information
   
Annual Income: USD
Total Assets: USD
How much are you going to invest: USD
What is the source of funds?  
Sale of other investment
Savings
Retirement
Line of Credit
Others, if others please state:
 
What is the name of the bank at which the money is held at now?

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