New Interest Qualification and Information Questionnaire

eKapital Investments, LLC (eKi) appreciates the interest with your request for information. To ensure we send the correct information specific to your objectives and/or the entity in which you represent, we must require you to complete the following questionnaire. If you have any questions please contact webinfo@ekapital.net. Thank you in advance for your time.


*Denotes Required Field
*First Name:
*Last Name:
  Middle Name (if applicable):
*Address:
*City:
*State/Province:
*Zip/Postal Code:
*Country of Domicile:
*Work Phone:
  Home Phone:
  Fax:
*E-mail Address:
*Profession:
  Employer:
  Title:
  Highest level of education attained:
  Personal Certifications, if any:
   
*Are you completing this form on behalf of any company, entity or other third-party?
        Yes  No
If yes, please describe the entity (corporation, limited partnership, trust etc. and jurisdiction of organization and address of principal place of business) and your relationship to the entity (including your form of organization, jurisdiction of organization and address of principal place of business):
   
*Were you referred to us by any person or entity?  Yes  No
If yes, by whom and address:
If no, how did you become aware of our services:
   

Qualifying Questions

  
What kind of investments have you previously participated in?
   
Hedge funds, private equity funds, venture funds or other private investment vehicles whereby the investment manager is compensated based on performance.
Mutual Funds
Exchange-Traded Funds (ETFs)
Individual Company Securities
Debt Securities
Options or Warrants
Currency Trading
None
*Do you have any other investment experience in addition to that described above?
       Yes  No
If yes, please describe:
   
If you are a U.S. person or acting on behalf of a U.S. person, in order to access this website, you must be an accredited investor as defined in the U.S. Securities Act of 1933, as amended (“1933 Act”).

You are an accredited investor if you meet any of the following descriptions (please check the applicable description(s)):*
a bank, as defined in Section 3(a)(2) of the 1933 Act, acting in its individual or fiduciary capacity.
a savings and loan association or other institution as defined in Section 3(a)(5)(A) of the 1933 Act, acting in its individual or fiduciary capacity.
a broker or dealer registered pursuant to Section 15 of the U.S. Securities Exchange Act of 1934, as amended (“Exchange Act”).
an insurance company as defined in Section 2(13) of the 1933 Act.
an investment company registered under the U.S. Investment Company Act of 1940, as amended (the “1940 Act”), or a business development company as defined in Section 2(a)(48) of the 1940 Act.
a small business investment company licensed by the U.S. Small Business Administration under Section 301(c) or (d) of the U.S. Small Business Investment Act of 1958, as amended.
a plan which has total assets in excess of US$5,000,000 and which is established and maintained by a state, its political subdivisions, or any agency or instrumentality of a state or its political subdivisions for the benefit of its employees.
an employee benefit plan within the meaning of the U.S. Employee Retirement Income Security Act of 1974, as amended (“ERISA”), if the investment decision is made by a plan fiduciary, as defined in Section 3(21) of ERISA, which is either a bank, savings and loan association, insurance company, or Registered Investment Advisor, or if the employee benefit plan has total assets in excess of US$5,000,000 or, if a self-directed plan, with investment decisions made solely by persons that are accredited investors.
a private business development company as defined in Section 202(a)(22) of the Investment Advisors Act of 1940, as amended.
a corporation, a Massachusetts or similar business trust, a partnership, or an organization described in Section 501(c)(3) of the U.S. Internal Revenue Code of 1986, as amended, which has total assets in excess of US$5,000,000.
a natural person whose individual net worth, or joint net worth with his or her spouse, exceeds US$1,000,000.
a natural person who had an individual income in excess of US$200,000 in each of the two most recent years or joint income with his or her spouse in excess of US$300,000 in each of those years, and who has a reasonable expectation of reaching the same income level in the current year.
a trust with total assets in excess of US$5,000,000, the investment activities of which are directed by a person who has such knowledge and experience in financial and business matters that he is capable of evaluating the merits and risks of the investment.
an entity in which all of the equity owners are accredited investors.
We may ask you to provide additional information, depending on which box has been checked.
   
Do you have the necessary knowledge and experience in financial and business matters to enable it to evaluate the merits and risks of an investment in a private investment fund? 
       Yes  No
   
Are you aware that an investment in a private investment fund entails risk, and the trading strategies of private investment funds may be speculative in nature?
       Yes  No
   
*By checking this box, you represent and acknowledge that the information provided on this page will be relied upon in determining whether you meet the legal requirements for receiving additional information from eKapital Investments, LLC, and all of the information provided is true and accurate. If any of the information on this page changes, you agree to promptly contact us at webinfo@ekapital.net and notify us of the change.