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DMK Advisor Group Investor Portal

Sample Company

The following questionnaire will collect information which will serve as a new account opening document with DMK Advisor Group. Financial regulations require us to collect your personal information to verify your identity. Any account opened with us is deemed a self-directed account. We do not provide for recommendations nor direct you toward or advertise any specific investment.

Personal Information

Your personal information shall be maintained securely with limited access by our team. Any information provided here shall only be used in the context of this financial product, and shall not be sold or reused without your express consent.

Is my Social Security number safe?

Address

Use a permanent address where you can receive mail. Must be a residence or principal address. May not be a P.O. box.

Identification

Please provide the details of an identifying document, such as your driver's license or passport. You will be required to submit proof of this document later.

Trusted Contact

Your trusted contact must be age 18 years or older. Your account details cannot be released to the trusted contact, nor can this person transact on your behalf. Providing a trusted contact is optional, and this person will only be contacted if the account owner cannot be reached.

Background

This information is required to determine eligibility for this investment opportunity. Note that all information will be verified.

Are you or an immediate family member...

What are your investment objectives?

Suitability

This information attempts to determine your level of experience with regards to investments of this nature.

Do you have sufficient knowledge and experience in financial and business matters so as to be capable of evaluating the merits and risks associated with investing in a private securities transaction?

Please indicate the source of funds for the investment:

Are you a member, formal or informal, of a network which invests in private placements, an angel network, for example?
Are you a member of the board of a public and/or private company other than those listed above?
I understand that the shares are exempt from registration under the safe harbor laid out in Rule 144 of the Securities Act of 1933 and as a result may not be purchased with intention to distribute them, nor may they be sold within one year of the completed purchase.
Have you read the offering documents (including all Exhibits and supplements) and do you understand the nature of an investment in the Company and the risks associated with such an investment?
Do you understand that there is no guarantee of any financial return on this investment and that you run the risk of losing your entire investment?
Our clients must be accredited investors within the meaning of Rule 501(a) of Regulation D promulgated under the Securities Act of 1933, or cannot invest 10% or more of the lessor of their annual income or net worth.
What is an accredited investor versus a non-accredited investor?

Statement of Veracity

I understand that the brokerage firm and the Company will be relying on the accuracy and completeness of my responses to the foregoing questions. I confirm the answers to the above questions are complete and correct and may be relied upon by the brokerage firm and the Company in determining whether the offering described in the appropriate disclosure documents is exempt from registration under the Act, and any other exemption provided by applicable state securities law.