Employee Assessment (Performance Review)

Individual Information
Today's Date*

MonthDayYear
Date
Investor Type*
Product*
Full Legal Name (if person then enter their name, if institution enter the name of the contact)*

First NameLast Name
Phone Number*

Country CodePhone Number
Email*
example@example.com
Address (to be supported with POA)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Citizenship*
Are you or have you ever been a U.S. citizen?*
NOTE: The Subscription Application (SA) requires the signature of a witness. Please enter their full and proper legal name as well as their e-mail address below.
Full Name (Witness)*

First NameLast Name
Email (Witness)*
example@example.com

Institutional Information

**ONLY FOR CORPORATIONS OR INSTITUTIONS**
You can skip this entire Institutional Investor section if the investor is an individual.
Institution Name
Domiciled Country
Institution Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Website (if applicable)
Required document confirmation
Ask them if the can supply the following documents below
Can you supply the following documents?

You will need to collect the following for all Institutional Investors:
- Certified copy of the certificate of incorporation;
- Certified copy of the certificate of change of name (if applicable);
- Certified copy of memorandum and articles of association;
- Certified register of directors;
- Certified register of shareholders;
- Identification for any individual or company as stated above for every director and shareholder; and
- Authorized signatory list showing specimen signatures and signing powers for the company (e.g. solely, jointly, etc.).
NOTE: Please ensure that all documents are in English. If any document isn't in English, then you can submit the original document, but we will also require a notarized translation. Thank you for ensuring that we remain compliant.
UBO (Ultimate Beneficial Owners)

**Enter all UBOs that own 10% or more**
If there are more than three UBOs, we will require an excel document will all the pertinent information listed below completed.
UBO 1 (name)
Full name if a person and full company name is a company
UBO 1 (% ownership)
Enter a whole number (e.g. 10, 55, 100)
UBO 1 Address (to be supported with POA)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
UBO 2 (name)
Full name if a person and full company name is a company
UBO 2 (% ownership)
Enter a whole number (e.g. 10, 55, 100)
UBO 2 Address (to be supported with POA)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
UBO 3 (name)
Full name if a person and full company name is a company
UBO 3 (% ownership)
Enter a whole number (e.g. 10, 55, 100)
UBO 3 Address (to be supported with POA)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Investment Details
Investor Status*
Investment Amount (USD):*
Please add whole numbers with commas only (ex: 250,000)
Investment Execution*
Fund Transfer Data

For In-kind Investments (USDC/USDT)
Does the client already have an exchange setup?*
Experience transferring digital assets?*
Investor relations assistance?*
USDT/USDC Asset Type
USDT (Tether)/USDC Address for Dividends
Please add the ERC20, centralized exchange wallet address
USDT/USDC Wallet Type
Blockchain Wallet Type
ONLY ERC20 IS ACCEPTABLE despite other options available to be selected
What exchange is the wallet on?
If 'other' exchange
If they chose an exchange not listed, please enter it here
Fund Transfer Data

For Fiat Investments (USD)
Full Legal Name (on bank account)

First NameLast Name
Bank Name
Bank Location

Wealth Declaration Document Data

Used to create the Wealth Declaration Document
PEP*
Are you currently or have you ever been considered a PEP (politically exposed person)?
Source of wealth (for WD document):*

Family fortuneActive entrepreneurialFormer entrepreneurialIncomeRetirement AccountExisting Digital Assets HeldOther
Description (to be added to the Wealth Declaration form)*

Enter the detailed answer here regarding the description of their wealth which will be entered in the WD document0/0
Company Name
If applicable, where client is employed and/or the company they own
Company Position/Title
If applicable, the position or title at the company of the client
Declaration of Tax

Please note that the fund does not report any of its investors to any regulatory boards with the exception of the CIMA (Cayman Island Monetary Authority) and its U.S. citizens to the U.S. SEC and IRS. We do require a tax domicile for KYC/AML purposes.
Tax domicile (country)*
Tax identification type*
If 'other is selected' please clarify
Please be as detailed as possible
Tax Identification Number*
This will in most cases be your national ID number

Contact Details
Email (for documents to be sent to)*
example@example.com
Line Profile Name
Please enter your Line profile name if applicable, if not then enter N/A
Whatsapp Phone Number
Telegram Profile Name
Please enter your Telegram profile name if applicable, if not then enter N/A

AML & KYC Documents
INDIVIDUALS

You will need to collect the following for all Individual Investors:
- Passport (cover image), notarized
- Passport (photo/signature page), notarized
- POA (proof of address) dated no later than 90 days, in English, notarized
NOTE: Please ensure that the Proof of Address is in English. If it isn't then you can submit the original document but, we will also require a notarized translation. Thank you for ensuring that we remain compliant.

INSTITUTIONS

You will need to collect the following for all Institutional Investors:
- Certified copy of the certificate of incorporation;
- Certified copy of the certificate of change of name (if applicable);
- Certified copy of memorandum and articles of association;
- Certified register of directors;
- Certified register of shareholders;
- Identification for any individual or company as stated above for every director and shareholder; and
- Authorized signatory list showing specimen signatures and signing powers for the company (e.g. solely, jointly, etc.).
NOTE: Please ensure that all documents are in English. If any document isn't in English, then you can submit the original document, but we will also require a notarized translation. Thank you for ensuring that we remain compliant.
Passport Cover

Showing the country of origin
Cancelof
Passport Inside

Passport picture page
Cancelof
Proof of Address

No later than 90 days old, in English
Cancelof
Certified Document Definition

The certified documents must:
- Be signed and dated within the last 3 months;
- Indicate the full name and position/capacity of the certifying person, professional designation institution, professional designation number, and contact details; and
- Include the statement "Certified true copy of the original", and, for certification of the ID proof, “The photo is a true likeness of the individual”.
Ascent accepts the following individuals as ‘certifier’: lawyer, member of the judiciary, accountant, solicitor, embassy official, notary public, or senior-level employee of a regulated financial institution in a FATF or equivalent jurisdiction.
Should be Empty:

Individual Information

Institutional Information

UBO (Ultimate Beneficial Owners)

Investment Details

Fund Transfer Data

Fund Transfer Data

Wealth Declaration Document Data

Contact Details

AML & KYC Documents