NEW CLIENT FORM. 1. Client Investment Ownership. 2. Client Information

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1 NEW CLIENT FORM The completion of this New Client Form by the client does not constitute the opening of an investment with Democracy Funding. This form is for the express purpose meeting the requirements of FINRA rules 3310 and the PATRIOT Act (anti-money laundering), 2090 (Know Your Customer), 2111 (Suitability), and other applicable rules and regulations as may be applicable. 1. Client Investment Ownership Please check only one box. Individual Joint Tenants With Right of Survivorship (JTWROS) Your share of the investment will pass to a surviving owner in the event of your death. Tenants in Common Your share of the investment will pass to your estate in the event of your death. Community Property* Each spouse has a one-half interest in the investment assets and equal responsibility for investment activity. For married couples in selected states. Community Property With Rights of Survivorship* Your share of the investment will pass to your spouse in the event of your death. For married couples in selected states. Tenants by the Entirety* Spouses own the investment jointly. For married couples in selected states. It is your responsibility to determine if the ownership you selected is available in your state. * This type of ownership may not be available in your state. It is your responsibility to determine if the ownership you selected is available in your state. 2. Client Information Complete right-hand column if there is an additional investment holder. If there are more than two investment holders, please use an additional form. As required by federal law, Democracy Funding will use the information provided to verify the identity of all investment holders. We respect your privacy. Democracy Funding will use the information you provide to communicate with you and provide information about products and service. Read about our privacy policies at Name Title, First Name Title, First Middle Name Last, Suffix Name Last, Suffix Social Security Number Social Security Number 2015 Democracy Funding. All rights reserved. Middle Page 1 of 6

2 Are you known by another name? Are you known by another name? P.O. boxes. Regulations require that you provide us with your legal address. Include if different from home address. P.O. boxes may be used. Home/Legal Street Address Mailing Address Home/Legal Street Address Mailing Address Home Phone Home Phone Work Phone Ext. Work Phone Ext. Cell Phone Cell Phone Please provide your address. By providing your address, you consent to receiving from Democracy Funding. Address / / Date of Birth (mm/dd/yyyy) Address / / Date of Birth (mm/dd/yyyy) Please list all. Mother s Maiden Name Country(ies) of Citizenship: Mother s Maiden Name Country(ies) of Citizenship: Please check only one box. Country of Legal Residence: Country of Legal Residence: Photo Identification Please include a picture or scan of the front and back of a government issued picture ID Democracy Funding. All rights reserved. Page 2 of 6

3 Marital Status: Single Married Divorced Widowed Marital Status: Single Married Divorced Widowed Number of Dependents Number of Dependents Please check only one box. Securities industry regulations require that we collect this information. EMPLOYMENT INFORMATION Employed Self-Employed Retired Homemaker Student t Employed EMPLOYMENT INFORMATION Employed Self-Employed Retired Homemaker Student t Employed Employer Name / Business Name Employer Name / Business Name If you selected Employed or Self-Employed, please select one option that best describes your occupation. Occupation: Business Owner/Self-Employed Executive/Senior Management Medical Professional Legal Professional Accounting Professional Financial Services/Banking Professional Information Technology Professional Other Professional U.S. Government Employee (Federal/State/Local) Foreign Government Employee (n-u.s.) Military Educator Clerical/Administrative Services Trade/Service Career (Labor/Manufacturing/Production) Sales/Marketing Consultant Other: Occupation: Business Owner/Self-Employed Executive/Senior Management Medical Professional Legal Professional Accounting Professional Financial Services/Banking Professional Information Technology Professional Other Professional U.S. Government Employee (Federal/State/Local) Foreign Government Employee (n-u.s.) Military Educator Clerical/Administrative Services Trade/Service Career (Labor/Manufacturing/Production) Sales/Marketing Consultant Other: 2015 Democracy Funding. All rights reserved. Page 3 of 6

4 You must answer this question. If yes, please list all companies below. Are you affiliated with or employed by a stock exchange or member firm of an exchange or FINRA, or a municipal securities broker-dealer? Yes. You must attach a letter from your employer approving the investment transaction" and delete "when submitting this Application. Are you a director, 10% shareholder or policy-making officer in a publicly held company? Yes Are you affiliated with or employed by a stock exchange or member firm of an exchange or FINRA, or a municipal securities broker-dealer? Yes. You must attach a letter from your employer approving the investment transaction" and delete "when submitting this Application. Are you a director, 10% shareholder or policy-making officer in a publicly held company? Yes Securities industry regulations require that we collect this information. Please check only one box in each section. Your liquid net worth is the part of your net worth that can be easily turned into cash. Liquid net worth includes investments like stocks and mutual funds, but not assets like real estate. Other Investments FINANCIAL INFORMATION Investment Holder Investment Experience: ne Limited Good Extensive Annual Income: Under $15,000 $15,000 - $24,999 $100,000 or more Liquid Net Worth: Under $25,000 $100,000 - $249,999 $250,000 or more $ Please specify amount. Please list other investments held by you (include current market valuation): FINANCIAL INFORMATION Investment Holder Investment Experience: ne Limited Good Extensive Annual Income: Under $15,000 $15,000 - $24,999 $100,000 or more Liquid Net Worth: Under $25,000 $100,000 - $249,999 $250,000 or more $ Please specify amount. Please list other investments held by you (include current market valuation): Tax Status Indicate your tax Filing Status for the current tax year (e.g., single, married filing jointly, married filing separately, C corp., S corp., LLC, etc.): Indicate your tax Filing Status for the current tax year (e.g., single, married filing jointly, married filing separately, C corp., S corp., LLC, etc.): 2015 Democracy Funding. All rights reserved. Page 4 of 6

5 Please check all boxes that apply. OVERALL INVESTMENT OBJECTIVE(S) OF YOUR INVESTMENT Capital Preservation. You are seeking to minimize the potential of losing your initial investment. Income. You are seeking the continued receipt of current income while recognizing and accepting the risks of income-generating investments. Growth. You are seeking to increase the value of your investments over time while accepting price fluctuations and volatility. Speculation. You are willing to assume a higher risk of loss in exchange for potentially higher returns. In this section, we re collecting information about the categories ( sources ) of assets that will be held in your investment. Please select all of the sources of the assets that will be deposited or held in your investment, including the original sources of any assets that will be transferred into the investment from another firm. (Please check all that apply.) Source of Funds: Salary/Wages/Savings Social Security Benefits Sale of Property or Business Family/Relatives/Inheritance Investment Capital Gains Gifts Gambling/Lottery Other: (Please check all that apply.) Purpose of Investment: General Investing Investing for Estate Planning Investing for Tax Planning (e.g., municipal bonds, etc.) Investing for College Investing for Retirement Investment of Pooled Assets (e.g., funds from individual investors that are aggregated for investing purposes) Other Investment Time Horizon Please indicate your investment time horizon: Short Term (less than 3 years) MidTerm (3 to 10 years) Long Term (longer than 10 years) 2015 Democracy Funding. All rights reserved. Page 5 of 6

6 Liquidity Needs Please indicate your liquidity needs (i.e., the available funds you will need for short-term expenses and emergencies (money usually held in short-term vehicles such as CDs and money market funds): Please indicate your risk tolerance: Aggressive Moderate Moderately Aggressive Combination: Conservative Moderately Conservative 3. Special Handling Information Custodial Arrangement Please select custodian Name of Custodian(s) Custodian Phone Number Mailing Address Street City/State Zip To be completed by the custodian above Custodian Tax ID # Custodian Authorization: Custodian Investment # Are there any special handling instructions for the investment (e.g., settlement, fund transfer, position transfer instructions)? If so, please provide such instructions in writing to the Firm (such instructions will be subject to pre-approval by the Firm) Democracy Funding. All rights reserved. Page 6 of 6