Full Name:
Date of Birth:
Citizenship:
Phone:
Email:
Are you married?
 Yes  
 No 
Begin Investor Assessment Section
Have you owned a business in the last five years?
 Yes 
 No 
Have you managed a business in the last five years?
 Yes 
 No 
What time of business do/did you manage?
(If more than one, answer the largest)
How many employees does/did your business have?
How many employees do/did you manage?
What type of business do you plan to operate in BC.?
Where do you plan to operate your business in BC.?
Have you visited British Columbia?
 Yes 
 No 
Do you have relatives or friends in BC.?
 Yes 
 No 
Do you have personal assets of more than $800,000?
 Yes 
 No 
Do you have personal assets of more than $1,600,000?
 Yes 
 No 
Can you invest more than $200,000?
 Yes 
 No 
Can you invest more than $400,000?
 Yes 
 No 
Can you invest more than $800,000
 Yes 
 No