Case File
efta-01452235DOJ Data Set 10OtherEFTA01452235
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01452235
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
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SOF III - 1081 Southern Financial LLC
INVESTOR QUESTIONNAIRE FOR INDIVIDUALS
INDIVIDUALS: Please complete Parts I through VI of this Questionnaire and then proceed to
"Form PF."
1.
General Information.
A.
Investor Contact Information (all fields required'.
I) Print Full Legal Name of Investor.
2) Social Security Number. Tax Identification Number or other Government-Issued Identification
Number (required):
3) Primary• Contact for All Correspondence:
Address:
4) Telephone Number (home)
(work)
(other)
5) Facsimile Number
6) E-mail Address (required):
7) Permanent Address:
(if different from above)
B.
Birth Information.
1) Date of Birth:
(Please provide month, date and year.)
2) Country of Origin or Birth:
3) Country of Citizenship:
C.
Additional Interested Party.
In addition to the Primary Contact listed above, correspondence from the Onshore Feeder Fund will also
be sent, at the Investor's option, to one additional interested party (e.g., Investor's financial advisor,
accountant, attorney, etc.). Please note that correspondence will only be sent via the online reporting tool.
Please provide relevant information listed below if applicable:
Name of Interested Party:
Telephone Number:
E-mail Address:
Investor Questionnaire - 1
Confidential
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0109150
CONFIDENTIAL
SDNY_GM_00255334
EFTA01452235
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