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KYC

Step 1 of 11

9%

1. CREATE ACCOUNT

Use for all future correspondence

Legal Residency (report all)*
Legal Residents of Canada are required to supply their legal province of residence.*

Step 2 of 11

18%
Tax Account Type*
Please choose one. If you wish to open an additional account a duplicate form will be provided for your completion and approval.

 

Will all funds in this account belong to the named account holder ONLY and NOT to any third-party individual or entity, in any capacity?*
Will this account be used to invest on behalf of any other person(s) besides the named account holder?*
Is a third party setting up this account?*

Step 3 of 11

27%

2. ACCOUNT HOLDER INFORMATION

Step 4 of 11

36%

3. IDENTIFICATION AND LEGAL STATUS

Please attach copies of 2 identification documents*
Are you presently subject to tax in Canada?*
Canadian Social Insurance Number*
Are you a U.S. Permanent Resident (Green Card Holder)?*
Are you a Politically Exposed Person?*
Are you related to a Politically Exposed Person?*

Step 5 of 11

45%

4. FINANCIALS

The following in CAD $ Millions

Allocation of Assets*

(as a % of 100%)

(excluding primary residence)

(excluding retirement accounts)

Source of Funds*
Does income fluctuate and affect your lifestyle?*
In the next 5 years (due to a change in family or business circumstances, inheritance, etc.)*

Do you expect a large increase in wealth?

Any history of personal bankruptcy or credit issues?*
Employment Status*

(Please select as applicable)

I confirm that I am an Accredited Investor because I satisfy at least one of the following:*

Either alone or with my spouse, I own cash and securities worth more than $1 million, less any related debt.

*

My net income before taxes was more than $200,000 in each of the 2 most recent calendar years and I expect it to exceed $200,000 in this calendar year. (The amount of net income can be found in your personal income tax form.)

*

My net income before taxes combined with my spouse’s was more than $300,000 in each of the 2 most recent calendar years and I expect our combined net income to exceed $300,000 in this calendar year. (The amount of net income can be found in your personal income tax form.)

*

Either alone or with my spouse, I own net assets (being my total assets, including real estate, less my total debt) worth more than $5 million.

Step 6 of 11

45%

5. REGULATORY INFORMATION

Are you: i) a director; ii) a 10% or greater shareholder; or iii) a policy-making officer of any publicly traded company?

(e.g. shareholder, director, senior executive)

Do you, or does someone related to you, exercise control over the affairs of a partnership or trust?

(eg. general partner, trustee, director)

Have the account holder(s) ever been the subject of, or initiated, litigation, arbitration or any other type of dispute or settlement procedure with any investment-related entity?

Step 7 of 11

45%

6. INVESTMENT OBJECTIVES AND RISK TOLERANCE

Investment Objectives

(please tick those that apply)

Do you have income needs from this account?

Step 8 of 11

45%

7. INVESTMENT EXPERIENCE

Knowledge Level

Years Trading

Trades Per Year

Knowledge Level

Years Trading

Trades Per Year

Knowledge Level

Years Trading

Trades Per Year

Knowledge Level

Years Trading

Trades Per Year

Knowledge Level

Knowledge Level

Knowledge Level

Step 9 of 11

45%

8. ACCOUNT RESTRICTIONS AND FUNDING

Are there any regulatory restrictions and/or any particular directions relating to this account? *
Are you transferring securities in addition to cash from another account? *
If Yes, can they be sold by the Firm once they are in the new account? *

Step 10 of 11

45%

9. COMMERCIAL COMMUNICATIONS

I hereby consent to receiving commercial communications from Authentic Asset Management Inc., including, but not limited to, emails, brochures, and promotional materials about new products. *

If I later wish to unsubscribe from receiving further commercial communications, I will email dwebster@AuthenticAsset.com with “Unsubscribe” in the subject line. Authentic Asset Management Inc. will then remove the Client’s name and contact information from the commercial communications list.

Step 11 of 11

45%

10. ACKNOWLEDGEMENT AND SIGNATURE

Singed by:

I agree to the terms and conditions *