Alternative Investments Investor Profile Questionnaire
The following paperwork should be completed for each investor that you are recommending an investment into a Direct
Participation Program, or DPP. Many alternative investments are considered DPP’s and henceforth are subject to more
stringent suitability and concentration guideline limits by the states (some more than others), and therefore the following
paperwork is meant to aid you in your discovery process of the types of investments that your client currently holds in
accounts that are with you, as well as any that may be held away at another firm through a different advisor.
To help in documenting your conversations with clients and to help you with your respective state requirements, as well as
comply with FINRA’s Know Your Customer Rule, these forms should be viewed as a tool to be used in your fact finding
meeting with new clients, as well as with existing clients to whom you recommend alternative investments.
Please Note: Investors who are residents of Kansas, Maine, Massachussets, New Jersey or Ohio are subject to more
scrutiny by their respective states and therefore, it is important that you carefully complete pages 2-3 & 5 in their entirety and
submit with any new business paperwork for non-traded REIT and/or Business Development Company (BDC) business.
Residents of these states are prohibited from particitating in any DRIP program:
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Iowa
Kansas
Kentucky
Maine
Massachusetts
Michigan
Missouri
New Jersey
New Mexico
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Nebraska
Ohio
Oregon
Pennsylvania
KC Rev_070113 Final
Alternative Investment - Investor Profile
Rep Code _________
NFS Account #: ______________________
Client Information:
To help the government fight the funding of terrorism, Federal law requires that Kalos Capital verify your identity by obtaining the information listed below before your requested transaction can be
completed. Your request may be denied if Kalos Capital cannot verify this information. Kalos Capital will not be responsible for any losses or damages (including but not limited to, lost
opportunities) resulting from any failure to provide this information in a timely manner, or from our refusal of your requested transaction.
Type of Account:
 Individual
 Joint
 Retirement
 Trust
 Other: ______________________
Individual / Entity Information
Owner’s Name_______________________________________________________________
ID Number ________________________________
Issued by _________
Issue Date ____________
Exp Date_____________
SSN _____________________________________
Citizenship ______________________
Date of Birth __________________
 YES  NO
Employed
Occupation _____________________________
Employer ____________________________
Employer Address: ________________________________________
City ____________________
ST ______
Zip ________
Jt. Owner’s Name ____________________________________________________
Joint / Trustee or Fiduciary Information
ID Number ________________________________
Issued by _________
Issue Date ____________
Exp Date_____________
SSN _____________________________________
Citizenship ______________________
Date of Birth __________________
Employed  YES
 NO
Occupation ________________________
Employer ____________________________
Employer Address: ________________________________________
City ____________________
ST ______
Zip ________
Owner(s) Legal Address (PO Box Not acceptable): _________________________________________________________________
City _____________________________________________________________
ST _______
Zip _______________________
Phone Number _______________________________________
Email Address _________________________________________
Financial Information & Investment Objectives:
Federal Income Tax Bracket: (%) ______________
Gross Annual Household Income: $_______________________
Net worth (excluding residence): $________________________
Risk Tolerance:
 Aggressive
 Moderate
 Moderately Aggressive
Investment Objectives:
 Income/Moderate Growth
Time Horizon:
 Short (0-5 years)
Investment Product Knowledge:
_____ Stocks
_____ Bonds
 Growth/Income
 Intermediate (6-10 yrs)
 Growth
 Aggressive Growth
 Long (10+ yrs)
N = None
L = Limited
G = Good
_____Mutual Funds
_____Options
_____ Variable Ann
E = Extensive
_____ Alt. Inv.
Questionnaire:
Is client employed or affiliated with FINRA, a FINRA member firm or registered stock exchange?
Is client’s age:
 Less than 70
 70 to 79
 80-85
Yes No
 Over 85 (exception Ltr. Required)
Is client considered to be an Accredited Investor(s)? (see page 3 for definition)
Yes
If investor
lives in
OH, NJ,
MA, ME
or KS.
Page 5
must be
completed
in addition
to this
page
Enter formula percentage that Alternative Investments (new and current) will make-up of the portfolio?
A = Current Liquid Net Worth: $
No
%
(B+C / A+B)
(see page 3 for definition)
If the Client already owns Alternative Investments, please list the name and amount of current alternative positions (see p.6 worksheet if needed)
B = Current ALT Investments:
C = NEW ALT Investments:
Acknowledgement of Risks and Illiquidity of Investment: Initial
Owner
Initial
Co-Owner
These are illiquid investments and redemptions are subject to holding periods and/or discretion of the Management or Board.
Distribution payments are subject to change i.e. increase, decrease or be eliminated at the discretion of Management, and could
consist of one or a combination of the following: cash flow from the assets, a return of capital, and/or borrowings.
Share price stability does not indicate stability in the value of the underlying assets, which will fluctuate and may be worth more or less
than Management of the program initially paid.
Any dates specified for a “liquidity event” are not guaranteed and could be changed or delayed at the Management’s discretion.
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KC Rev_070113 Final
I have reviewed the above information with my Representative and agree the provided information is accurate. I have read and understand the
Arbitration Clause listed on page two of this form. I have received Kalos Capital’s Business Continuity Plan and Privacy Notice. I have received
and understand the Investor Kit required by the Issuer(s) regarding the products prior to purchase.
Client Signature
Date
Joint Account Holder Signature (if applicable)
Date
 A signature guarantee is required on the attached transfer paperwork and the estimated value of the transfer will be $
I, __________________________ (Rep Name), attest the signature was genuine; the signer was the appropriate person to endorse or originate the instruction, or if the signature is by an
agent, the agent had actual authority to act on behalf of the appropriate person; the signer had legal capacity to sign; the photo and signature of signer was visually confirmed from the
signer’s state driver’s license.
Representative’s Signature
Date
Kalos Capital Principal Signature
Date
 Confirmed NFS
 N/A
DEFINITIONS:
LIQUID NET WORTH (General Definition): Liquid Assets are easily converted to cash subject to no more that a 10% penalty/loss. Assets include
structured products, Cash, CDs, Stocks, MF, Bonds, Retirement Accounts, Variable Annuities and Fixed Index Annuities. Do not include real estate or
business equity, personal property and automobiles, expected inheritances or funds already earmarked for other purposes
ACCREDITED INVESTOR : A natural person who has individual net worth, or joint net worth with the person’s spouse, that exceeds $1 million at the time of
the purchase (excluding personal residence); a natural person with income exceeding $200,000 in each of the two most recent years or joint income with
a spouse exceeding $300,000 for those years and a reasonable expectation of the same income level in the current year; or a trust with assets in excess of
$5 million, not formed to acquire the securities offered, whose purchases a sophisticated person makes.
INCOME / MODERATE GROWTH: Seeks to generate income from investments and experience some growth of capital. Interested in investments with low
or moderate historical risk of loss of principal.
GROWTH AND INCOME: Seeks to grow principal value over time and generate some income from investments. Interested in investments with moderate
historical risk of loss of principal.
GROWTH: Seeks to grow principal value over time. Willing to invest in securities with moderate to above-average historical risk of principal.
AGGRESSIVE GROWTH: Seeks a significant increase in principal over time. Willing to accept a greater degree of risk by investing in securities with high
historical risk of loss of principal.
ARBITRATION CLAUSE:
I agree that all controversies that may arise between me and Kalos Capital, Inc., including, but not limited to those arising out of any transaction or any
agreement between us, whether entered into prior, on, or subsequent to the date hereof, shall be determined by arbitration. Any arbitration under this clause
shall be conducted before, and pursuant to, the arbitration procedure then in effect of the Financial Industry Regulatory Authority. Any award the arbitrator
makes will be final, and judgment on it may be entered in any court having jurisdiction. This arbitration provision shall be enforced and interpreted exclusively
in accordance with applicable federal law, including the Federal Arbitration Act.
I understand that:
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Arbitration is final and binding on the parties.
The parties are waiving their right to seek remedies in court, including the right to a jury trial.
Pre-arbitration discovery is generally more limited than and different from court proceedings.
The arbitrators' award is not required to include factual findings or legal reasoning and any party's right to appeal or to seek modification of the
rulings of the arbitrators is strictly limited.
The panel of arbitrators may include a minority of arbitrators who were or are affiliated with the securities industry.
No person shall bring a putative or certified class action to arbitration, nor seek to enforce any pre-dispute arbitration agreement against any
person who has initiated in court a putative class action or who is a member of a putative class who has not opted out of the class with respect to
any claims encompassed by the putative class action until: (i) the class certification is denied; or (ii) the class is decertified; or (iii) the customer is
excluded from the class by the court. Such forbearance to enforce an agreement to arbitrate shall not constitute a waiver of any right under this
agreement except to the extent stated herein.
BUSINESS CONTINUITY PLAN & KALOS CAPITAL PRIVACY POLICY - Both documents can be obtained by visiting our website.
www.kalosfinancial.com
Page 3 of 6
KC Rev_070113 Final
Investor Suitability & Concentration Standards for Ohio, Kansas, Massachusetts, Maine
and New Jersey Residents Investing in Non-traded REIT’s and/or BDC’s
Several states have established suitability requirements that are more stringent than the standards that we have established as a firm. Shares
will be sold to investors in these states only if they meet the special suitability standards set forth below. In order to determine the investor’s
“liquid net worth” these special suitability standards exclude from the calculation of net worth the value of the investor’s home, home
furnishings and automobiles.
General Suitability Standards for all Investors unless your state below defines differently:
 Investors must have either (a) a net worth of at least $250,000 or (b) an annual gross income of $70,000 and a minimum net worth
of $70,000.
Below are descriptions for specific states that apply a more strict application for determining how much an investor may invest. Please note
that investors in these states may NOT participate in the DRIP program of ANY offering.
Massachusetts & Ohio
• An investor’s aggregate investment in any non-traded REIT shares, shares of an affiliate, and in other non-traded real estate investment
programs may not exceed ten percent (10%) of his or her liquid net worth. ‘‘Liquid net worth’’ is defined as that portion of net worth (total
assets exclusive of home, home furnishings, and automobiles minus total liabilities) that is comprised of cash, cash equivalents, and readily
marketable securities that can be converted to cash under ordinary and routine business conditions within 10 calendar days. Note that
investors cannot participate in the DRIP feature that reinvests distributions into subsequent affiliated programs.
New Jersey
• A New Jersey investor must have either (a) a minimum liquid net worth of $100,000 and an annual gross income of $85,000 or (b) a
minimum liquid net worth of $350,000. In addition, a New Jersey investor’s total investment in a non-traded REIT offering and in other nontraded REIT’s shall not exceed 10% of his or her liquid net worth. ‘‘Liquid net worth’’ is defined as that portion of net worth (total assets
exclusive of home, home furnishings and automobiles, minus total liabilities) that is comprised of cash, cash equivalents and readily
marketable securities.
Maine
• The Maine Office of Securities recommends that an investor’s aggregate investment in any non-traded REIT offering and similar direct
participation investments should not exceed 10% of the investor’s liquid net worth. For this purpose, ‘‘liquid net worth’’ is defined as that
portion of net worth that consists of cash, cash equivalents and readily marketable securities. Note that Maine investors cannot participate
in the DRIP feature that reinvests distributions into subsequent affiliated programs.
Kansas
• In addition to the general suitability requirements described above, it is recommended that investors should invest no more than 10% of their
liquid net worth, in the aggregate, in any real estate investment trust(s). ‘‘Liquid net worth’’ is defined as that portion of net worth (total assets
minus total liabilities) that is comprised of cash, cash equivalents and readily marketable securities.
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KC Rev_070113 Final
Suitability and Concentration Limits in Non-traded REIT / BDC for residents of KS, MA, ME, NJ, & OH
Please complete this form for each of the client’s non-traded REIT & BDC purchase(s).
SECTION 1:
Below are Direct Participation Program (DPP) investments that would be considered illiquid, meaning investment for which there is not a readily
active market that I/we own in other investment accounts held at another financial institution. Investment accounts include non-qualified (non-IRA)
and qualified accounts (IRA), qualified employer sponsored plans (401(k), 403(b), etc.), & Trust accounts. Check all that apply and indicate the
percentage that each represents of your present liquid net worth.
Percentage
Percentage
Non-traded REITs
Equipment Leasing Funds
Non-traded BDC
Commodity Pools
Private Equity/Venture Capital Funds
Oil & Gas DPP Programs (not Reg D)
Other (include percentages):
SECTION 2:
Use the following formula to help determine allowable amount to be invested in any Direct Participation Program:
Concentration Formula
Total
Net Worth
(A+B) / C ≤ 10%
Assets
Minus Primary Residence
minus all net assets other than cash,
Home Furnishings
Minus
cash equivalents, and readily
Ⓐ
Ⓑ
Minus
Automobiles
marketable securities or other
(
+
Minus total liabilities
holdings that can be converted
= Net Worth
to cash as defined by your
particular state.
Ⓒ
$
= Liquid Net Worth
It may be unsuitable for an investor’s aggregate investment in shares of
the Issuer, Affiliates of the Issuer, and in other non-traded DPP programs
similar
to the one being recommended, to exceed 10% of his/her liquid
net
worth or net worth depending on your state.
Residents in the following states are prohibited from
participating in the DRIP program: IA, KS, KY, ME, MA, MI,
MO, NJ, NM, NE, OH, OR, PA.
Enter results here
)
% (must ≤ 10%)
A = investor’s current aggregate investment in securities of the Issuer,
affiliates or the Issuer, and other similar non-traded DPP’s;
B = amt. of the prospective addl. purchase of securities of the Issuer,
Affiliates of the Issuer, or other similar non-traded DPP’s;
C = investor’s Liquid Net Worth immediately prior to the purchase of B.
SECTION 3:
I/We hereby agree that I/we have listed the illiquid assets above and that I/we do not have other undeclared investments in Direct
Participation Programs held at another firm that would alter or change the concentration limits as stipulated by my respective states guidelines
outlined in the prospectus which I have received prior to investing.
_________________________________
Print Name
Individual/Trust/Beneficial Account Owner Signature
_________________________________
Print Name
Joint Owner/Co-Trustee Signature
Date Signed
Page 5 of 6
KC Rev_070113 Final
Alternative Investments Worksheet (optional)
CLIENT NAME:
Date:
Client’s Total Portfolio Value (excluding Residence): $ Liquid Net Worth: $ Please list current alternative Investments and the dollar amounts: Non‐traded REITs: $ $ $ $ $ $ $ $ % TOTAL REITs $ % of Total Portfolio Equipment Leasing/Finance: $ $ $ $ Total Equip. Leasing/Finance $ % of Total Portfolio % Business Development Companies (BDC) $ $ $ $ $ $ $ $ TOTAL BDC’s $ % of Total Portfolio % Private Equity/Venture Capital: $ $ $ $ % of Total Portfolio % TOTAL PE/VC
$
Energy Programs (Drilling/Royalty or other income generating programs): $ $ $ $ $ $ TOTAL Energy $ Other Alternative Investments/Reg. D programs: % of Total Portfolio % $ $ $ $ $ $ TOTAL Other ALT’s $ % of Total Portfolio % Total % of Portfolio Value Allocated to Alternative Investments Page 6 of 6
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