INVESTOR QUESTIONNAIRE

INVESTOR QUESTIONNAIRE

State of California Department of Real Estate: Form RE870(v8/18)
Initial Form Submission:

(Check Box)
Date First Completed

MonthDayYear
Date
Updating Investor(s) Details:

(Check If Applicable)
(Date Updated)

MonthDayYear
Date
No Material Changes: Check Here and Sign the Certifications on Page 2

(Check If Applicable)
This questionnaire is intended to assist brokers in determining an investor’s suitability for trust deed and real property sales contract investments as required by Business and Professions Code Section 10232.45.
NOTE: The California Department of Real Estate does not endorse or offer any opinions regarding the suitability of any proposed or existing real estate investments. A guide to trust deed investments entitled “Trust Deed Investments – What You Should Know!!” (RE35) can be downloaded here or you can visit the Department’s web site at www.dre.ca.gov and search under the Publications menu.
GENERAL INFORMATION
INVESTOR NAME*
Authorized Person for Entity Investment Accounts
INVESTOR EMAIL ADDRESS*
example@example.com
ADDRESS
TELEPHONE # *
DATE OF BIRTH

MonthDayYear
Date
CO-INVESTOR NAME
Co-Investor Email Address
example@example.com
ADDRESS
CO-INVESTOER PHONE NUMBER
DATE OF BIRTH

MonthDayYear
Date
If the investor account will be for an entity, this questionnaire should be completed and signed on the entity’s behalf by the natural person with the authority to invest the entity’s funds.
NAME OF ENTITY
TYPE OF ORGANIZATION (Limited Liability Company, Retirement Plan, Pension Plan, Partnership, etc)
NAME OF PERSON COMPLETING THIS QUESTIONNAIRE
TITLE

Investor: Employment & Education Details
RETIRED

Check if Applicable
CURRENT POSITION
TITLE
LENGTH OF TIME IN POSITION
PREVIOUS POSITIONS/PROFESSIONS
HIGHEST LEVEL OF EDUCATION
(High School/GED, College, Masters)
YEAR OF GRADUATION
DEGREE/DIPLOMA
Type
Co-Investor: Employment & Education Details
RETIRED

Check if Applicable
Current Position
TITLE
LENGTH OF TIME IN POSITION
PREVIOUS POSITIONS/PROFESSIONS
HIGHEST LEVEL OF EDUCATION
(High School/GED; College; Masters)
YEAR OF GRADUATION
DEGREE/DIPLOMA
Type

If You Have Prior Investing Experience with Notes Secured by Trust Deeds or Real Property Sales Contracts, Let us know for how long and how many times you have participated.
Years
Months
NUMBER OF PREVIOUS INVESTMENTS IN NOTES SECURED BY TRUST DEEDS OR REAL PROPERTY SALES CONTRACTS
WHAT OTHER TYPE OF INVESTMENTS DO YOU CURRENTLY HOLD?
ARE THERE OTHER FACTORS YOU WANT US TO CONSIDER?
DO YOU HAVE OTHER EDUCATIONAL, BUSINESS, OR FINANCIAL EXPERIENCES, INVESTMENT CONSIDERATIONS, FINANCIAL SITUATIONS, TRAINING INCLUDING SEMINARS, CONTINUING EDUCATION, ETC, OR PROFESSIONAL LICENSES AND CERTIFICATIONS THAT SHOW YOU ARE A GOOD FIT FOR TRUST DEED INVESTING?
WHAT ARE YOUR PRIMARY INVESTMENT OBJECTIVES?
OBJECTIVE OF INVESTOR(S) FOR PURCHASING OR INVESTING IN TRUST DEEDS OR REAL PROPERTY SALES CONTRACTS

INVESTOR ACKNOWLEDGEMENT
I certify (or declare) that the information provided in this questionnaire is true and correct to the best of my knowledge. I am providing this information for the purpose of determining whether or not trust deed or real property sales contract investments are suitable for me. I understand that the broker may request an annual update of this information and that the broker may request additional information regarding my suitability as an investor for each specific transaction. I acknowledge that investments in notes secured by trust deeds and real property sales contracts are subject to risk of loss of principal and monthly income.
INVESTOR SIGNATURE

Clear
DATE

MonthDayYear
Date
CO-INVESTOR SIGNATURE

Clear
DATE

MonthDayYear
Date
BROKER ACKNOWLEDGEMENT
I certify (or declare) that I have reviewed this completed questionnaire and that I will use the information herein to aid in meeting my responsibility to make reasonable efforts to determine that proposed investments are suitable and appropriate for the investor(s) above based on the information provided.
NAME OF BROKER
LICENSE ID NUMBER BROKER’S REPRESENTATIVE
LICENSE ID NUMBER BROKER’S REPRESENTATIVE
LICENSE ID NUMBER
BROKER OR DESIGNATED REPRESENTATIVE SIGNATURE

Clear
DATE

MonthDayYear
Date
A broker shall maintain records of the information used to determine that an investment is suitable and appropriate for each investor/purchaser for at least four years.
Should be Empty:

INVESTOR QUESTIONNAIRE

GENERAL INFORMATION

Investor: Employment & Education Details

Co-Investor: Employment & Education Details

Tell Us About Your Current Financial Situation

Investment Experience

If You Have Prior Investing Experience with Notes Secured by Trust Deeds or Real Property Sales Contracts, Let us know for how long and how many times you have participated.

ARE THERE OTHER FACTORS YOU WANT US TO CONSIDER?

WHAT ARE YOUR PRIMARY INVESTMENT OBJECTIVES?

INVESTOR ACKNOWLEDGEMENT

BROKER ACKNOWLEDGEMENT