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Full Name*

Email*

Telephone*

Date of Birth*

dd/mm/yyyy

General Health*

Poor Fair Good

Financial Situation

Marital Status*

Single Married Civil Divorced Widowed

Number of Dependants

Employment Status*

Employed Self Employed Retired Semi-Retired Career Break Unemployed

Is your employer an investment firm regulated by the Financial Conduct Authority?*

Yes No

Current Occupation*

Have you worked in finance industry?*

Yes No

Do you have degree level qualification?*

Yes No

Income and Expenses

Annual Employment Income
(net of tax)

Annual Interest and dividend Income

Annual Pension Income

Annual Other Income

Monthly mortgage/rent

Other monthly expenditure

Assets and Liabilities

Property Ownership*

Home Owner Tenant Other

Assets

Main Residence

Listed Shares

Unlisted Shares

Savings

Liabilities

Outstanding mortgage

Personal loans

Credit card loans

Other liabilities

Are your assets and liabilities jointly owned?*

Yes No

Investment Objectives and Risks

Please indicate your investment objectives*

Growth Income Income & Growth

Available funds for speculative/high risk investments

What do you consider as your overall attitude towards investment risk?*

Low Medium Low Medium Medium High High

Knowledge and Experience

How many years active experience do you have investing in:

Listed Shares

None Less than a year 1-2 years 3-4 years Over 5 years

Unlisted Shares

None Less than a year 1-2 years 3-4 years Over 5 years

Bonds

None Less than a year 1-2 years 3-4 years Over 5 years

CFDs

None Less than a year 1-2 years 3-4 years Over 5 years

Spread Betting

None Less than a year 1-2 years 3-4 years Over 5 years

Foreign Exchange

None Less than a year 1-2 years 3-4 years Over 5 years

Other

None Less than a year 1-2 years 3-4 years Over 5 years

Sophisticated Investor

At least one of the following should apply:

A member of a network or syndicate of business angels and have been so for at least the last six months before the date you self-certify.
You have made more than one investment in an unlisted company in the two years before the date you self-certify.
You are working, or have worked in the two years before the date you self-certify, in a professional capacity in the private equity sector, or in providing finance for small and medium enterprises.
You are currently, or have been in the two years before the date you self-certify, a director of a company with an annual turnover of at least £1 million.

Please tick this box to self certify yourself as a sophisticated investor.

Please provide any other information that you may feel is relevant to the service we provide:

I/we confirm and agree the information supplied by me/us is true and correct. Further, I/We undertake to notify Commodity Index Ltd if there is any change to my/our status such that anyone of the statements in the declaration becomes untrue.

Please tick this box as an alternative to signing.

I have read and understood the Risk Disclosures along with the Terms and Conditions describing the nature of the products and the potential risks associated with them. click here to see terms