Confidential Investor Questionnaire

This Questionnaire is being given to each person who has requested information regarding CA Partners and its investment products. The purpose of this Questionnaire is to determine whether you meet the standards determined by CA Partners to receive this information. Your answers will be kept confidential. Once we have received and processed your Questionnaire and the other responses you have provided, we will determine whether you qualify to receive information about us. If you do qualify, we will send you electronically a User ID and Password to visit the confidential portions of our Web Site.

Name (first and last):
Address:
Telephone (day):
Fax:
E-mail Address:
Residence or state/country where registered to vote or have driver's license (if different from mailing address):
Age (if an individual):
Federal Tax Identification Number:
If an individual, describe your employment for the last five years, including the company by which you are currently emplyed its principal business, and your title:
For all Investors, What is the source of the funds that will be used to invest with CA Partners?
For all Investors, would you be investing on behalf of another person/entity? YesNo
Are you relying on the knowledge and experience of another person in making investments? YesNo
If the investor is a corportaion, partnership, limited liability company, association, trust or unincorporated organization, please supply the following information:
(a) Type of entity and jurisdiction of formation:
(b) Date organized:
(c) Number of partners, shareholders, members of beneficiaries:
(d) Purpose of organization:
(e) Is the investor an "investment company" as defined in the Investment Company Act? YesNo
(f) Is the Investor excluded from the definition of an investment company under the exceptions provided for in Sections 3(c)(1) or 3(c)(7) of the Investment Company Act? YesNo



Accredited Investor Status:

Each Investor in CA Partners products must be an "accredited investor" as the term is defined in Regulation D under the Securities Act. In order to determine your status, please complete the requested information below:
For Individuals, answer (a), (b) and (c) only.
(a) Is your net worth (jointly with your spouse, if any) including homes, home furnishings and automobiles, in excess of $1,500,000 (valuing your assets on the basis of their current fair market value)? YesNo
(b) Was your individual income for each of the past two full calendar years and is your anticipated individual income for the current year in excess of $200,000? YesNo
(c) Was your joint income with your spouse for each of the two past full calendar years and is your anticipated income for the current year in excess of $300,000? YesNo
For entities other than Individuals, answer (d) and/or (e), as appropriate, and (f)
(d) If the Investor is a corporation, limited liability company, business or other trust, unincorporated organization or partnership not formed for the specific purpose of acquiring the securities offered, are its total assets in excess of $5,000,000? YesNo
(e) ERISA Plans: If the Investor is an employee benefit plan, within the meaning of the Employee Retirement Income Security Acto of 1974 ("ERISA"), are (i) its investment decisions made by a bank, insurance company, or registered investment adviser, (ii) its total plan assets in excess of $5,000,000, or (iii) if a self-directed plan, its investment decisions made solely by persons who are accredited investors? YesNo
(f) Is the Investor an entity of all beneficial owners can answer "Yes" to (a), (b), (c), (d), or (e) above? YesNo


Web site access information
Please note that each form is hand approved and may take up to 2 business days for approval.