Personal Information Full Name * First Name Last Name Corp Name (if Applicable) SIN Number * Date of Birth * MM DD YYYY Telephone * (###) ### #### Email * Referral Source *Please be advised that there may be a referral fee payable to the individual who made the introduction to us! This referral fee ranges from 0.25-0.50% of your total invested amount. Without referrals, we could not do what we do! Method of Investment Cash Registered Street Address City, Province Postal Code Emergency Contact Emergency Contact Number (###) ### #### Financial Information Place of Employment Job Title Annual Income Length of Employment Pursuant to the Government of Canada’s Proceeds of Crime (Money Laundering) and Terrorist Financing Act, in addition to FINTRAC laws, please read and attach the necessary and required information below to the back of the completed application form. FINTRAC of Canada Guidelines Rule 6B Section 3.3 – Receipt of Funds Record is Mandatory. The following information is required to show source of funds: The amount and currency of the funds received; The name, date of birth and address of the individual from whom you received the funds and that individual's principal business or occupation; The date of the transaction; The purpose, details and type of transaction (for example, the funds were for a deposit on the purchase of a house, etc.), including whether any other individuals or entities were involved in the transaction; If the funds received were cash, how the cash was received (for example, in person, by mail, by armored car, or any other way). Verification of Identification: Acceptable identification documents: Birth Certificate, Driver’s License, Provincial Health Insurance card (not acceptable if from Ontario, Manitoba or Prince Edward Island), Passport, Record of Landing, Permanent Resident card, Old Age Security card, a certificate of Indian status or SIN card (although SIN numbers are not to be included on any report sent to FINTRAC). Other acceptable identification documents: Provincial or Territorial identification card issued by the Insurance Corporation of British Columbia, Alberta Registries, Saskatchewan Government Insurance, the Department of Service Nova Scotia and Municipal Relations, the Department of Transportation and Public Works of the Province of Prince Edward Island, Service New Brunswick, the Department of Government Services and Lands of the Province of Newfoundland and Labrador, the Department of Transportation of the Northwest Territories or the Department of Community Government and Transportation of the Territory Nunavut. If identification document is from a foreign jurisdiction, it must be equivalent to one of the above-mentioned identification documents. Please attach all Bank and Financial statements to prove source of funds pertaining to your investment as required by law. Thank you! Investor Application Investor Risk Profile Questionnaire Full Name * First Name Last Name Address * Date * MM DD YYYY This questionnaire is meant to assess your risk with respect to mortgage investments and your understanding. How many years do you expect to maintain at least your current income level? * 5 years or less 5 to 10 years 10 years or more Your financial stability is important when determining how much risk you can tolerate in your investments. Do you feel that your current financial situation is: * Very secure Relatively secure Secure Not secure Your age is: * Under 30 30 to 42 43 to 54 55 to 64 Over 64 Investment Objectives and Goals When investing, you may chose investments that provide a regular stream of income and/or investments that offer the potential for growth. Currently you need this investment to: * Not decrease from your initial investment Provide a stream of income Provide a mix of income and growth Grow, since income is not important to you at this time Grow as much as possible How many years will you keep this investment before you need to make withdrawals from the original amount? * 3 years or less 3 to 8 years 8 to 12 years 12 years or more Risk Tolerance It is important to me to choose which properties I lend my funds on, versus being put in a pool of mortgages whereby I do not have a choice * True False You have decided to lend on a first mortgage whereby the borrower has defaulted, and the property has since been sold and there was a 5% loss in your initial investment. What is your reaction? * I would never lend on a private mortgage again I would lend my funds again, deal dependent. I would lower my overall investment into private mortgages but continue to lend in mortgages Which statement best applies to you? * I must achieve my financial goal by my target date I would like to come close to achieving my financial goal by my target date I have flexibility to move the target date further into the future if my investment value is below my goal I re-evaluate my financial goal and my target date regularly and have the flexibility to adjust either to align them with the performance of my investments Which statement best describes your preferred approach to investing? * I would rather accept a lower rate of return to avoid fluctuations in the value of my account I am willing to accept some fluctuation in my investment to earn a higher return I do not have a preferred approach The Investor Risk Profile reflects your investment objectives, risk tolerance, investment time horizon and personal circumstances that you provided to us. StoneRidge Lending Inc. uses your Risk Profile to ensure your transactions are suitable Name * License #12606 | (T) +1 (905) 971-4777) | 301 Fruitland Road, Stoney Creek, ON | (E) info@stoneridgelending.com Thank you!
