Majestic State Holdings Limited Investments Consultant (required)

Majestic State Holdings Limited Investments Account No.

Title

First Name

Middle Name

Surname

Title

First Name

Middle Name

Surname

Residential Address

Residential Phone No.

Residential Fax No.

Personal Mobile No.

Personal Email Address (required)

Occupation/Title

Company Name

Company Address

Company Phone No.

Company Fax No.

Ext No.

Company Mobile No

Company Email Address (required)

Please tick your preffered Mailing address for Statement, Mail & Confirmation
ResidentialOfficeOther

Please tick your choice of
phone communication
ResidentialOfficeOther

Do you have an account with a financial management company or local brokerage?
YESNO

Do you have an online
ccount?
YESNO

Do you track your investments online?
YESNO

Your financial requirements are?
GROWTHINCOME

Type of Investor
CONSERVATIVEMODERATEAGGRESSIVE

Your investment time frame
up to 1 YEAR1-3 years3-5 years5 years and above

Rate your investment experience
NoneLimitedGoodExtensive

Do you travel regularly overseas?
YESNO

Most frequent destinations? (if applicable)

Are you a Director or Chief Executive Officer of a Publicly Traded Company?
YESNO

Name of Company (if Applicable)