CUSTOMER DATA SHEET
CUSTOMER DATA SHEET
CUSTOMER DATA SHEET
Individual Account Joint Account (With ___ Account Holders) ITF/ FAO:
PLEASE HONOR AND RECOGNIZE THE FOLLOWING SIGNATURES IN PROCESSING (SUBSCRIPTION/SWITCHING/REDEMPTION) OF OUR FUND
PRIMARY INVESTOR
LAST NAME FIRST NAME MIDDLE NAME
CO-INVESTOR 1
LAST NAME FIRST NAME MIDDLE NAME
CO-INVESTOR 2
LAST NAME FIRST NAME MIDDLE NAME
CO-INVESTOR 3
LAST NAME FIRST NAME MIDDLE NAME
CO-INVESTOR 4
LAST NAME FIRST NAME MIDDLE NAME
CO-INVESTOR 5
LAST NAME FIRST NAME MIDDLE NAME
LSC-INDIVIDUAL_201612
ACCOUNT NUMBER SUITABILITY ASSESSMENT FORM - INDIVIDUAL
INSTRUCTION THIS FORM SHOULD BE ANSWERED BY THE PRIMARY INVESTOR ONLY.
FOR PRIMARY INVESTOR ONLY
FINANCIAL PROFILE
1. ANNUAL INCOME <= 500K > 500K - 2M > 2M - 5M >5M - 10M >10M
2. APPROXIMATE TOTAL NET WORTH <= 2M > 2M - 5M > 5M - 10M >10M - 25M >25M
4. INVESTMENT HORIZON LESS THAN A YEAR 1 YEAR TO LESS THAN 3 YEARS 3 YEARS TO LESS THAN 5 YEARS 5 YEARS OR MORE
WILL REQUIRE PLANNED REGULAR DOES NOT REQUIRE REGULAR WILL NOT WITHDRAW
5. LIQUIDITY REQUIREMENT AVAILABLE ANYTIME
FUTURE WITHDRAWALS WITHDRAWAL; ONLY WHEN NECESSARY UNTIL INVESTMENT HORIZON
I/WE ACKNOWLEDGE THAT THE ANSWERS TO THE QUESTIONNAIRE ARE TRUE, ACCURATE, AND COMPLETE AND CAN BE RELIED UPON BY FAMI. I/WE UNDERSTAND THE EXPLANATION OF THE FAMI PERSONNEL ON THE
RESULTS OF THE CLIENT SUITABILITY ASSESSMENT WITH REGARD TO THE RECOMMENDED INVESTMENT FUND(S) SUITABLE TO MY/OUR NEEDS. BASED ON THE RESULTS OF MY/OUR SUITABILITY ASSESSMENT, THE
INVESTMENT FUND(S) MOST SUITABLE FOR ME/ US ARE THOSE INDICATED UNDER MY/OUR RESULTING CLIENT INVESTMENT PROFILE; AND,
(PLEASE CHOOSE ONLY ONE ANSWER)
I/ WE AGREE WITH THE RECOMMENDED INVESTMENT FUND APPROPRIATE TO MY/ OUR RESULTING CLIENT INVESTMENT PROFILE.
I/ WE DO NOT AGREE WITH THE RECOMMENDED INVESTMENT FUND APPROPRIATE TO MY/ OUR RESULTING CLIENT INVESTMENT PROFILE AND WOULD LIKE TO BE RE-CLASSIFIED ACCORDINGLY.
I/WE WILL UNCONDITIONALLY AND IRREVOCABLY HOLD THE COMPANY FREE FROM ANY LIABILITY IN CASE MY INVESTMENTS DECLINE IN VALUE MORE THAN THAT OF THE FUND/PORTFOLIO/PRODUCT ASSESSED MOST
FITTING FOR ME OR SPECIFICALLY CHOSEN BY ME/US AND FOR ANY AND ALL CONSEQUENCES ARISING FROM THIS INVESTMENT. I/WE ALSO UNDERSTAND THAT IN CASE OF JOINT ACCOUNTS WITH VARYING INVESTMENT
PROFILES PER CO-INVESTOR, THE INVESTMENT PROFILE OF THE PRIMARY INVESTOR SHALL PREVAIL, AND THAT IN CASE OF CHANGES TO THE PRIMARY INVESTOR, THE NEW PRIMARY INVESTOR SHALL BE REQUESTED TO
UNDERGO A CLIENT SUITABILITY ASSESSMENT.
PRIMARY INVESTOR: SIGNATURE OVER PRINTED NAME CO-INVESTOR 1: SIGNATURE OVER PRINTED NAME CO-INVESTOR 2: SIGNATURE OVER PRINTED NAME
CO-INVESTOR 3: SIGNATURE OVER PRINTED NAME CO-INVESTOR 4: SIGNATURE OVER PRINTED NAME
WE HAVE EXPLAINED TO YOU IN DETAIL AND DISCUSSED WITH YOU THE (1) RESULTS OF THE CLIENT SUITABILITY ASSESSMENT, (2) BASIS OF OUR RECOMMENDATION, AND (3) TERMS AND CONDITIONS OF THE
RECOMMENDED INVESTMENT FUNDS.
ASSESSED BY:
The value of your investment may change in relation to changes in market value of the fund. The price at the time of subscription may be lower or higher than the price at the time of redemption.
Any reference to historical data should not be interpreted as projections to future performance servicing. Past performance is not an indicative of future returns. References to historical prices are for
illustration purposes only.
It is expected that the Investor has read the prospectus prior to investing. Should there be queries, these should be said with the servicing FAMI Certified Investment Solicitor.
ACKNOWLEDGEMENT:
I/We have read and fully understood the terms and conditions stated above and the same were explained to me/us by a FAMI Certified Investment Solicitor/authorized officer.
PRIMARY INVESTOR: SIGNATURE OVER PRINTED NAME CO-INVESTOR 1: SIGNATURE OVER PRINTED NAME CO-INVESTOR 2: SIGNATURE OVER PRINTED NAME
CO-INVESTOR 3: SIGNATURE OVER PRINTED NAME CO-INVESTOR 4: SIGNATURE OVER PRINTED NAME SIGNATURE VERIFIED BY
CERTIFICATION OF KYC RELIANCE
THIS IS TO CERTIFY THAT (HEREINAFTER, THE “REFERRED CUSTOMER”), A PROSPECTIVE CUSTOMER OF FIRST METRO ASSET MANAGEMENT (HEREINAFTER THE
NAME OF CLIENT
“RELYING INSTITUTION”) IS AN EXISTING CUSTOMER OF OF A COVERED INSTITUTION.
BANK/ COMPANY BRANCH, TBG, TG, SUBSIDIARY, AFFILIATE
IN ACCORDANCE WITH § X806.2.E.1.A OF THE UPDATED ANTI-MONEY LAUNDERING RULES AND REGULATIONS AND ITS OWN MONEY LAUNDERING AND TERRORIST FINANCING PREVENTION PROGRAM (MLPP), WE HAVE
CONDUCTED THE REQUIRED CUSTOMER IDENTIFICATION REQUIREMENTS ON THE REFERRED CUSTOMER WHICH INCLUDE AMONG OTHERS FACE-TO-FACE CONTACT AND CUSTODY OF THE MINIMUM INFORMATION
AND/OR DOCUMENTS RELATIVE TO THE REFERRED CUSTOMER.
FURTHER, IT IS HEREBY CERTIFIED THAT UPON REQUEST OF THE RELYING INSTITUTION, WE SHALL PROVIDE WITHOUT DELAY (A) AUTHENTICATED COPIES OF THE IDENTIFICATION DOCUMENTS OF THE REFERRED
CUSTOMER AND (B) ACCESS TO THE SAME IDENTIFICATION DOCUMENTS BY THE RELEVANT REGULATORY AGENCY(IES) WHICH MAY REQUIRE ACCESS TO THE SAME.
THIS CERTIFICATION IS BEING ISSUED IN COMPLIANCE WITH THE ABOVE CITED REGULATION AND MAY BE RELIED UPON AS LONG AS THE REFERRED CUSTOMER REMAINS A CUSTOMER OF THE SAID BANK AND THE
RETENTION PERIOD REQUIRED TO KEEP ALL DOCUMENTS AND INFORMATION REGARDING THE REFERRED CUSTOMER UNDER THE ABOVE CITED REGULATIONS HAS NOT LAPSED.
NAME, POSITION & SIGNATURE OF THE DESIGNATED OFFICER OF THE COMPANY/ HO DATE ISSUED
UNIT/ SUBSIDIARY/ AFFILIATE