You have a new Registration and [field id="investment"] Pledge from [field id="fname"] [field id="lname"]!

Investor Contact Information

Name: [field id="fname"] [field id="mname"] [field id="lname"]

Address: [field id="address"]

Telephone Number: [field id="tel"]

Email: [field id="email"]

Date of Birth: [field id="date_of_birth"]

Gender: [field id="gender"]

Country of Birth: [field id="ccountry_of_birth"]

Country of Residence: [field id="country_of_residence"]

Country of Citizenship: [field id="country_of_citizenship"]

Occupation Status: [field id="occupation_status"]

Job Title: [field id="job_title"]

Employer/Business Name: [field id="bussiness_name"]

Are you a Politically Exposed Person (PEP)?: [field id="question"]

Is this a Joint Account?: [field id="question2"]

How much do you expect to invest over the next year?: [field id="invest_price"]

KYC Documents

Passport, Drivers License, National Identity Card, Permanent Resident Card, Work/Spousal Permit, Birth Certificate or Voters Card: [field id="fileupload"]

NIB Card: [field id="nib_card"]

NIB Number: [field id="nib_number"]

Investment Details

Investor Name: [field id="fname"] [field id="mname"] [field id="lname"]

Price per Share: [field id="share_price"]

Number of Shares: [field id="number_shares"]

Investment Amount: [field id="investment"]

Agreement to Terms and Conditions

[field id="fname"] [field id="lname"] has verified that the information provided in their application and investment request is true and complete and has certified that all funds being invested are beneficially owned by [field id="fname"] [field id="lname"]. [field id="fname"] [field id="lname"] has agreed to the General Terms and Conditions and has acknowledged that they have read, understand, and agree to be bound by the terms in the attached Risk Awareness and Investor Limits Agreement. [field id="less_total_amount"]

 

[field id="fname"] [field id="lname"] has verified that the information provided in their application and investment request is true and complete and has certified that all funds being invested are beneficially owned by [field id="fname"] [field id="lname"]. [field id="fname"] [field id="lname"] has agreed to the General Terms and Conditions and has acknowledged that they have read, understand, and agree to be bound by the terms in the attached Individual Accredited Investors and Elective Professional Investor Declaration. [field id="greater_total_amount"]