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Name
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First
Last
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Email
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Age
Nationality
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Afghanistan
Akrotiri
Albania
Algeria
American Samoa
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Angola
Anguilla
Antarctica
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Aruba
Ashmore and Cartier Islands
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Bahrain
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Bolivia
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Chile
China
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Colombia
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Congo, Republic of the
Cook Islands
Coral Sea Islands
Costa Rica
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Croatia
Cuba
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Gaza Strip
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Greenland
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Iraq
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Moldova
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Netherlands Antilles
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Nigeria
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Sao Tome and Principe
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Serbia and Montenegro
Seychelles
Sierra Leone
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Slovenia
Solomon Islands
Somalia
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Switzerland
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Tanzania
Thailand
Timor-Leste
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Tokelau
Tonga
Trinidad and Tobago
Tromelin Island
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
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United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands
Wake Island
Wallis and Futuna
West Bank
Western Sahara
Yemen
Zambia
Zimbabwe
Country of Residence
Select Country
Afghanistan
Akrotiri
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Ashmore and Cartier Islands
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Bassas da India
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Clipperton Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Coral Sea Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Dhekelia
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Europa Island
Falkland Islands (Islas Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia, The
Gaza Strip
Georgia
Germany
Ghana
Gibraltar
Glorioso Islands
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Jan Mayen
Japan
Jersey
Jordan
Juan de Nova Island
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Namibia
Nauru
Navassa Island
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paracel Islands
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Spratly Islands
Sri Lanka
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tromelin Island
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands
Wake Island
Wallis and Futuna
West Bank
Western Sahara
Yemen
Zambia
Zimbabwe
Your personal net worth includes all your assets and those of your spouse or common-law partner (if applicable), less any liabilities including mortgages and personal debts. Currency
US Dollar USD
European Euro EUR
Japanese Yen JPY
British Pound GBP
Australian Dollar AUD
Canadian Dollar CAD
Swiss Franc CHF
Chinese Yuan Renminbi CNY
Swedish Krona SEK
Mexican Peso MXN
New Zealand Dollar NZD
Singapore Dollar SGD
Hong Kong Dollar HKD
Norwegian krone NOK
South Korean Won KRW
Turkish lira TRY
Indian Rupee INR
Russian Ruble RUB
Brazilian Real BRL
South African Rand ZAR
Amount
Less than 10,000
Between 10,000 and 25, 000
Between 25,000 and 100,000
Between 100,000 and 300,000
Between 300,000 and 500,000
Between 500,000 and 1,000,000
Between 1,000,000 and 2,000,000
More than 2,000,000
Your management experience may have been gained in a private or public business, international agency, government or government department, professional practice, or farming. During any two of the last five years: Do you have management experience?
*
Select Option
Yes
No
Have you owned a business
*
Select Option
Yes
No
For the business you most recently owned, please provide the following information Ownership Percentage
For the business you most recently owned, please provide the following information Ownership Percentage
Select
2 or More fulltime employees
Less than 2 full time employees
Select Currency
Select
CAD
USD
Annual Sales
*
Annual Net Profit after Tax
Networth of Comapany
Did you own and manage any other business(es) during the last five years?
Select
Yes
No
Questions and Comments: Please use this space to send any specific questions, comments or additional information that may be relevant to your inquiry.
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