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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):
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 firmthat 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 J oint Owner/Co-Trustee Signature
Date Signed
SECTION 3:
SECTION 2:
SECTION 1:
Use the following formula to help determine allowable amount to be invested in any Direct Participation Program:
Concentration Formula
Total Assets Net Worth (A+B) / C 10%
Minus Primary Residence minus all net assets other thancash,
Minus Home Furnishings 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
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.
A = investors current aggregate investment in securities of the Issuer,
affiliates or the Issuer, and other similar non-traded DPPs;
B = amt. of the prospective addl. purchase of securities of the Issuer,
Affiliates of the Issuer, or other similar non-traded DPPs;
C = investors Liquid Net Worth immediately prior to the purchase of B.
It may be unsuitable for an investors 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.
( + )
$
Enter results here % (must 10%)
Please complete this formfor each of the clients non-traded REIT & BDC purchase(s).
Page 6 of 6 KC Rev_070113 Final
AlternativeInvestmentsWorksheet(optional)
CLIENT NAME: Date:
ClientsTotalPortfolioValue(excludingResidence):$ LiquidNetWorth:$
PleaselistcurrentalternativeInvestmentsandthedollaramounts:
NontradedREITs:
$ $
$ $
$ $
$ $
TOTALREITs $ %ofTotalPortfolio %
EquipmentLeasing/Finance:
$ $
$ $
TotalEquip.Leasing/Finance $ %ofTotalPortfolio %
BusinessDevelopmentCompanies(BDC)
$ $
$ $
$ $
$ $
TOTALBDCs $ %ofTotalPortfolio %
PrivateEquity/VentureCapital:
$ $
$ $
TOTALPE/VC $ %ofTotalPortfolio %
EnergyPrograms(Drilling/Royaltyorotherincomegeneratingprograms):
$ $
$ $
$ $
TOTALEnergy $ %ofTotalPortfolio %
OtherAlternativeInvestments/Reg.Dprograms:
$ $
$ $
$ $
TOTALOtherALTs $ %ofTotalPortfolio %
Total%ofPortfolioValueAllocatedtoAlternativeInvestments %