Investor Eligibility Verification Form

1
Full Name* This field is required.
First Name
Last Name
2
Email Address* This field is required.
example@example.com
3
Mobile* This field is required.
Please enter a valid phone number.
4
Company* This field is required.
5
Title* This field is required.
6
Date of Birth* This field is required.
Date
Month
Day
Year
7
Are you a U.S. citizen or a resident alien?* This field is required.
Yes
No
8
Individuals: Did your individual annual income exceed $200,000 in each of the last 2 years (or $300,000 jointly with spouse)?* This field is required.
Yes
No
9
Individuals: Do you have a net worth exceeding $1 million, excluding primary residence?* This field is required.
Yes
No
10
Entity (company/LLC/trust): Does your entity have more than $5 million in assets/investments and was it not formed solely to invest in this offering?* This field is required.
Yes
No
11
Have you had any prior investment experience?* This field is required.
Yes
No
12
Please provide any additional information relevant to your eligibility.
13
Entity type* This field is required.
Multi-Asset Investment Institution / Fund of Funds
Single Family Office
High Net Worth Individual/ Accredited Investor
Multi Family Office
Endowment/ University
Private Wealth Management
PE firm/ GP that also co-invests through other PE firms
Placement Agent/ Broker
14
Current AUM allocated to PE* This field is required.Number
15
Investment Types* This field is required.
Fund Investments
Deal-by-Deal
16
Emerging Managers* This field is required.
No
Yes, including Fund 1's
Yes, but only if they have a track record from their previous firm(s)
Yes, but only if they have a track record at their current firm
Yes, only Fund II and Fund III (no Fund 1's)
17
Fund Size PreferencesMinimum fund size
18
Fund Size PreferencesMaximum fund size
19
Willing Investments* This field is required.
Buyout/Control
Venture Early-Stage
Venture Late-Stage
Growth Equity
Preferred Equity
Structured Equity
Convertible Debt
Lien Debt
Secondaries (at PortCo level)
Secondaries (at GP/firm level)
20
Check Size* This field is required.Minimum
21
Check Size* This field is required.Minimum
22
Enterprise Value* This field is required.Minimum
23
Enterprise ValueMaximum
24
Would you consider investing if future contracts exceed LTM thresholds?* This field is required.
YESNO
25
Industries* This field is required.
Tech Software-Only
Professional Services (Roofing, HVAC, Fresh Produces...)
Manufacturing
Energy
Defense
Financial Services
Other
26
Additional Comment(s)
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: