Bailard
Prospective Investor Questionnaire
This Web site (the "Site") contains information regarding various private investment funds that may only be viewed by prospective investors who qualify as "accredited investors" and"qualified clients"under applicable federal securities laws. In order to confirm that you meet the requirements to be an accredited investor and a qualified client, you must complete the following questionnaire. We may contact you to confirm your responses once we have received and reviewed your completed questionnaire. After verifying that you are an accredited investor and a qualified client, we will send you an active user name and password to permit you to access the information included on the Site.

Prospective Investor Questionnaire

  *required information  
  *Name  
  Address  
  *City  
  *State  
  Zip  
  *Phone  
  *Email  
    Are you completing this questionnaire
on behalf of
(please check one)
 
   
Yourself
Your organization
Both
 
    If you are completing this questionnaire on behalf of your organization, please indicate the name of your company and your position/title:  
  Company  
  Title  
    I have previously invested or currently invest in private funds. (please check one)  
   
Yes
No
 
    If yes, please give number of private funds in which you have invested:  
     
    Type(s) of funds in which you have invested (please check all that apply):  
   
Hedge funds
Real estate funds
Private equity funds
Other (please specify type below)
 
     
    Percentage of total portfolio in private funds:  
     
    In order to confirm that you meet the requirements to be an accredited investor (in accordance with Rule 501(a) of Regulation D of the Securities Act of 1933, as amended) you must be able to check one of the following:  
    *Please check one of the following:  
   
Respondent is a natural person who has individual net worth, or joint net worth with his/her spouse, that exceeds $1 million.
Respondent is a natural person with income exceeding $200,000 in each of the two most recent years or joint income with his/her spouse exceeding $300,000 in each of those years and a reasonable expectation of the same income level in the current year.
Respondent is an entity, not formed for the specific purpose of acquiring the securities offered, in which all of the equity owners are accredited investors.
Respondent is a bank, savings and loan association, broker-dealer, insurance company, registered investment company, "business development company" (as defined under Section 2 of the Investment Company Act of 1940, as amended), or "small business investment company" (as defined under the Small Business Investment Act of 1958, as amended).
Respondent is an employee benefit plan, within the meaning of the Employee Retirement Income Security Act, with total assets in excess of $5 million, and a bank, savings and loan association, insurance company, or registered investment adviser makes the investment decision.
Respondent is a corporation, business trust, or partnership, not formed for the specific purpose of acquiring the securities offered, with total assets exceeding $5 million.
Respondent is a trust with assets in excess of $5 million, not formed for the specific purpose of acquiring the securities offered, whose purchases are directed by a "sophisticated person" as defined under Rule 506 of the Securities Act of 1933, as amended.
Respondent is a private business development company as defined in Section 202 of the Investment Advisers Act of 1940, as amended.
Other -- please contact me to confirm my qualified client status.
 
    In order to confirm that you also meet the requirements to be a qualified client (in accordance with Rule 205-3 under the Advisers Act of 1940, as amended) please check one of the following:  
    *Please check one of the following:  
   
Respondent is a natural person who has individual net worth, or joint net worth with his/her spouse, that exceeds $1.5 million.
Other -- please contact me to confirm my qualified client status.
 
    View fund risks and other disclosures  
    By pressing the "Submit" button below, you agree that you have completed this questionnaire truthfully and accurately in all respects and that you have read and agreed to the terms of the Privacy Policy and Legal Notices of this Site, which you should read carefully.