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The information contained in
this Investor Qualification Questionnaire and Agreement
is being furnished by you in connection with determining
whether you will be granted access to certain password-protected
areas of the web site.
You understand that all information
furnished is for the sole use of DeSpenza Capital
Management, LLC its affiliates and its counsel.
Except, this questionnaire may be furnished to such
other parties as deemed necessary or desirable, including
to establish compliance with federal or state securities
laws.
The following information must be provided by anyone
who would like to obtain on-line complete access
to information concerning investment funds managed
and offer by DeSpenza Capital Management, LLC. Once
completing the questionnaire please submit the e-application
for review and to receive your access code. Or, if
you prefer to return questionnaire via standard mail
or fax, please click
here to download a printable
copy of this form.
(Note: Adobe Acrobat Reader software
will be required to open this PDF document. If necessary,
you can download
a free copy from Adobe's web site).
The questionnaire should be returned to
DeSpenza
Capital Management, LLC
71 South Orange Ave Ste.
401
South Orange , New Jersey , 07079 .
Our fax
number is (973) 677-0091. Upon completion of questionnaire,
we will review the questionnaire and contact you
to verify the information you have provided and
to ask any additional questions. When we are satisfied
with the information provided, we will send you
a password that will enable you to gain access to
information concerning investment funds that we manage.
We have the right to deny anyone a password.
i. BACKGROUND INFORMATION
- General Information
- Employment and Business Information
- Please check off one or enter information in the
categories 3-12
Total Net Worth |
Liquid Net Worth |
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Less
than $1,000,000 |
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Less
than $1,000,000 |
|
$1,000,000
- $2,000,000 |
|
$1,000,000
- $2,000,000 |
|
$2,000,000
- $3,000,000 |
|
$2,000,000
- $3,000,000 |
|
$3,000,000
- $4,000,000 |
|
$3,000,000
- $4,000,000 |
|
$4,000,000
- $5,000,000 |
|
$4,000,000
- $5,000,000 |
|
$5,000,000
- $10,000,000 |
|
$5,000,000
- $10,000,000 |
|
Greater
than $10 million |
|
Greater
than $10 million |
|
Greater
than $20 million |
|
Greater
than $20 million |
- Annual Earnings
- Investment Objectives
- Portfolio Analysis
Do You Own Securities
and/or liquid investments having an aggregate
market value of at least $5,000,000? |
|
- Prior Investments (include stocks, futures, bonds, limited partnerships, venture
capital) initiated in past 24 months
- Please identify specific hedge fund or manged account
investments:
-
Do
you believe that you have sufficient knowledge
and experience in financial and business
matters to evaluate the merits and risk
of managed accounts? : |
|
- Please list any academic or business experience
that relate to your ability to evaluate the merits
and risk of managed accounts, futures, or insurance
products.
- Please list any academic or business experience
that relate to your ability to evaluate the
merits and risk of managed accounts, futures,
or insurance products.
|
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MANAGED ACCOUNTS INVESTEMENTS INVOLVE A HIGH DEGREE
OF RISK AND ARE SUITABLE ONLY FOR PERSONS OF SUBSTANTIAL
FINANCIAL MEANS WHO HAVE NO NEED FOR LIQUIDITY OF THEIR
INVESTMENTS AND WHO COULD BEAR THE ENTIRE LOSS OF THERE
INVESTMENTS.
The current value of my liquid assets (cash, freely
marketable securities, cash surrender value of life
insurance, etc) is sufficient to provide for my current
and anticipated needs and possible contingencies,
so that I am capable of bearing the economic risk
of managed account investments.
Initial Here:
I here by acknowledge the information I will be
able to access on DeSpenza Capital Management, LLC
web site is not an offer, but is for informational
purposes only. I will not share my password. Any
further formal relationship with DeSpenza Capital
Management, LLC may require additional steps to insure
adherence to local rules and regulations.
Initial Here:
Type Name Here
Signature or Online signature/email
Date&Phone Number(cell orhome)
ii. Qualification
Access to DeSpenza Capital Management, LLC web site
will be given only to persons who qualify as "Accredited
Investor" within the meaning of Rule 501(a) under
the Securities Act of 1933, as amended. Please check
the relevant responses below.
NOTE: If you are a non-accredited investor and only
interested in insurance & annuity products please
initial here and do not complete this section proceed
to section (iii).
Non-accredited investor
Initial here:
I am:
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an
individual who had an income in excess of $200,000
in each of the two most recent Years (or joint
income with my spouse in excess of $300,000 in
each of those years) I have a reasonable expectation
of reaching the same income level in the coming
year; |
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an
individual who has a net worth (or joint net
worth with my spouse) in the excess of $1,000,000; |
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and
Individual Retirement Account ("IRA")
and the individual who established the IRA is
an accredited investor on the basis of (a) or
(b) above; |
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a
self-directed pension plan and the participant
responsible for directing the investment of assets
of his or her account is an accredited investor
on the basis of (a) or (b) above and (ii) such
participant is the only participant whose account
would be invested in a managed account by DeSpenza
Capital Management, LLC; |
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a
pension plan that is not a self-directed plan
and that has total assets in excess of $5,000,000; |
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a
revocable trust and each grantor of the trust
is accredited investor on the basis of (a) or
(b) above; |
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an
irrevocable trust that consist of a single trust
(I) with total assets in excess of $5,000,000,
(ii) that was not formed for the specific purpose
of investing in an investment fund managed by
DeSpenza Capital Management, LLC and (iii) the
person Responsible for directing the investment
of assets of the trust in a fund has such knowledge
and experience in financial and business matters
that he or she is capable evaluating the merits
and risk of the prospective investment; |
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a
corporation, partnership, limited liability company,
limited liability partnership or similar business
trust that was not formed for the specific purpose
of acquiring and Interest in a fund managed by
DeSpenza Capital Management, LLC and that has
total in excess of $5,000,000; |
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an
entity in which all of the equity owners are
accredited investors; or |
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none
of the above applies (further information may
be required to determine accredited Investor
status). |
iii. Confidentially
- "Confidential Material" shall
mean any information disclosed to you in connection
with your use of DeSpenza Capital Management, LLC
web site, including, without limitation. The user
identification number and the password to the web
site issued to you and any Information that relates
to or involves any of the investment funds managed
by DeSpenza Capital Management, LLC, including information
relating to a funds performance.
- You shall not have
any obligation to preserve the confidentiality
of any Confidential Material which (i) is already
in your possession or (ii) is or becomes generally
available to the public other than as a result of
an unauthorized disclosure to you.
- You
acknowledge that the Confidential Material is of
a proprietary and confidential nature and that
damage to DeSpenza Capital Management, LLC and/or
the investment funds it manages could result it the
information is disclosed to any third party. You
hereby agree that the Confidentiality Material will
be used solely for individual investment purposes,
including the purpose of more efficiently evaluating
the performance of any of the funds managed by DeSpenza
Capital Management, LLC. You agree that, except as
required by law, you will keep the Confidential Material
confidential and will not disclose it in any manner
whatsoever, except that you may disclose all or portions
of the Confidential Material to your directors, officers,
employees, agents, affiliates, representatives and
advisors (collectively the "Representatives")
who need to know such information for the purposes
of evaluating an investment in any of the funds managed
by DeSpenza Capital Management, LLC. You shall inform
your Representatives of the confidential nature of
the Confidentiality Material and shall direct your
Representatives to treat such information confidentially
and otherwise to comply with the terms of this Agreement.
In any event, you shall be responsible for any breach
of this Agreement by any of your Representative and
you will, at your sole expense, use your best efforts
(including but not limited to, court proceedings)
to restrain you Representatives from prohibited or
unauthorized disclosure or use of the Confidential
Material.
- You understand and agree that money damages
would not be an adequate remedy for any breach of
the this Agreement and that DeSpenza Capital Management,
LLC shall be entitled to equitable relief, including
injunctions and specific performance, if you or your
Representatives breach or threaten to breach any
provision of the Agreement. Such remedies shall not
be deemed to be the exclusive remedies for a breach
or threatened breach by you or your Representatives
of this Agreement but shall be in addition to all other
remedies available at law or equity to DeSpenza Capital
Management, LLC. You further agree to waive any requirement
for the posting of a bond in connection with any such
equitable relief in the event of litigation relating
this Agreement, if a court of competent jurisdiction
determines in a final, nonmalleable order that that you
have breached this Agreement, then you shall be liable
pay to DeSpenza Capital Management, LLC the legal fees
DeSpenza Capital Management, LLC has incurred in connection
with such litigation, including any appeal there from.
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