Managed Account Registration Form - WorldCapitalManagement

Account Registration Form

Account Number

Value$

Net worth$

Type of Account

Account Holder Name

Date of Birth(mm/dd/yyyy)

Social Security

Citizenship

2nd AccountHolderName (if Joint)

Date of Birth(mm/dd/yyyy)

Social Security

CitizenshipJointHolder

Residence Address

City

State

ZipCode

Mailing Address

City

State

ZipCode

Home Phone#

Bussines Phone#

Occupation

Yearly household income$

UserName(The username must be 8-32 characters long, cannot contain symbols or spaces, and is not case sensitive. It is permanent and cannot be changed.)

Password

Delivery Method (Email or Mail(for annual fee)

Advisor

CPA

Lawyer

Bank Name

Bank Address

Phone

Account Number (for wire transfer)

Custodian Name

Custodian Address

Client Funds(please check a or b)

(a) separate account in client's name (b) under advisor's name if held in limited partnership for client_Custodian sends monthly and/or quarterly statements directly to client or their independent representative

Primary objective of this investment is

Time willing to keep funds invested to achieve objective is:

Please indicate any additional information regarding your investment objectives, risk tolerance, and financial needs

Investment Experience

I invest in stocks and/or mutual funds for myself

Yes No

Total amount invest in the stock market