Investor Client Information Form

INVESTOR CLIENT INFORMATION FORM AND SERVICES AGREEMENT

Recitals

WHEREAS, Client Name: seeks investment advisory, custodial introductions and related services, and Advisor Name: is willing to provide such services on the terms set forth in this form and agreement.

WHEREAS, the parties desire to document certain investor profile information, the scope of advisory services, payment terms, confidentiality obligations, and other material terms necessary for the provision of investment services and for regulatory and compliance recordkeeping.

NOW, THEREFORE, in consideration of the mutual promises contained herein, the parties agree to the terms and to the accuracy of the information provided in this Investor Client Information Form and Services Agreement.

Investor Information

Beneficial Owners / Authorized Representatives

Provide information for all beneficial owners holding 25% or more or persons authorized to bind the account.

Investment Profile

Scope of Services

The Advisor will provide the services described below. Services may include investment advisory, portfolio construction, trade execution recommendations, due diligence on private investment opportunities, and periodic reporting. The Advisor will not guarantee investment performance.

Payment Terms

Client agrees to compensate Advisor as set forth below. All fees are exclusive of taxes and third-party costs unless otherwise noted.

Fees are payable in accordance with the Payment Schedule. If Client fails to pay fees when due, Advisor may suspend services and recover all collection costs, including reasonable attorneys’ fees. Any fee estimates are subject to actual account size and services rendered.

Term and Termination

This Agreement commences on Start Date: and, unless earlier terminated, continues until End Date: . Either party may terminate this Agreement upon written notice delivered at least Notice Period (days): days prior to the intended termination date.

Upon termination, Advisor will provide a final accounting and any earned but unpaid fees shall be due and payable. Termination does not relieve either party of obligations incurred prior to termination.

Confidentiality

Each party agrees to maintain in strict confidence all nonpublic information disclosed by the other party in connection with this Agreement and to use such information solely for the purposes of performing obligations under this Agreement. Confidential information does not include information that (i) was in the public domain at the time of disclosure, (ii) becomes part of the public domain through no fault of the receiving party, (iii) is independently developed by the receiving party, or (iv) is required to be disclosed by law, regulation or valid subpoena, provided the disclosing party is given prior notice where practicable.

Representations, Warranties, and Certifications

By signing below, Client certifies that the information provided in this form is complete and accurate to the best of Client’s knowledge, that Client has the authority to enter into this Agreement, and that Client will promptly notify Advisor in writing of any material changes to such information. Client further represents that any entity information provided is true and that all beneficial owners have been disclosed as required by applicable laws and regulations.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to principles of conflicts of law. Any action to enforce this Agreement shall be brought in the state or federal courts of that State.

Entire Agreement

This Investor Client Information Form and Services Agreement (including all attachments and acknowledged disclosures) constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements, understandings, and representations, whether oral or written. Any amendment must be in writing and signed by both parties.

Additional Notices

Client consents to electronic delivery of statements and documents unless Client provides written notice requesting paper delivery. Client acknowledges that investments involve risk, and past performance is not indicative of future results.

Signatures

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