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HashCash Resources - Templates

Investor Questionnaire

A standard investor questionnaire template used to evaluate prospective investor eligibility, accredited investor status, and KYC/AML/sanctions compliance for a proposed digital asset offering.

QuestionnaireDocument type
8Sections
61Selection options
38Fields to complete

Use this questionnaire as the starting point for investor onboarding. Selections made on this page are for preview only and are not submitted or stored.

Questionnaire Template

Investor Questionnaire

Issuer[●]
Offering[●]
Date[●]

Introduction

This Investor Questionnaire (the "Questionnaire") is provided in connection with the proposed offering of securities and/or digital assets by [Issuer Name] (the "Issuer").

The information provided in this Questionnaire will be used by the Issuer to evaluate the prospective investor's eligibility to participate in the offering, comply with applicable securities laws, and satisfy applicable know-your-customer ("KYC"), anti-money laundering ("AML"), sanctions screening, and other regulatory requirements.

The Issuer may request additional information or supporting documentation where necessary to verify the information provided in this Questionnaire.

1Investor Information

InformationDetails
Full Legal Name
Entity Name (if applicable)
Investor Type
Jurisdiction of Residence / Incorporation
Registered Address
Mailing Address (if different)
Contact Person (if applicable)
Email Address
Telephone Number
Tax Identification Number (TIN)
Authorized Signatory (if applicable)

2Investor Classification

A. Investor Type

Please select the category that best describes the Investor.

Individual
Corporation
Limited Liability Company (LLC)
Partnership
Limited Partnership (LP)
Trust
Family Office
Investment Fund
Bank
Insurance Company
Pension Fund
Government Entity
Charitable Organization
Foundation
Other:

B. Entity Information (if applicable)

InformationDetails
Jurisdiction of Formation
Date of Formation
Registration Number
Publicly Traded Yes No
Principal Business Activity

C. Beneficial Ownership

Is the Investor acting for its own account?

Yes
No

If No, provide the name of the beneficial owner(s):

3Accredited Investor Status

The Investor represents that it qualifies as an Accredited Investor under applicable securities laws by virtue of one or more of the following categories.

Please check all applicable boxes and provide supporting information where requested.

A. Individual Investors

Net Worth TestThe Investor is a natural person whose individual net worth, or joint net worth with his or her spouse or spousal equivalent, exceeds the applicable regulatory threshold, excluding the value of the Investor's primary residence.
Income TestThe investor is a natural person whose individual income, or joint income with his or her spouse or spousal equivalent, exceeds the applicable regulatory threshold for the required period and who reasonably expects to maintain such income level during the current year.
Professional CertificationThe Investor holds one or more professional certifications, designations or credentials recognized by the applicable securities regulator for purposes of Accredited Investor qualification.Certification(s):
Knowledgeable EmployeeThe Investor qualifies as a knowledgeable employee of a qualifying private investment fund under applicable securities laws.
OtherPlease specify:

B. Entity Investors

Corporation, Partnership, Limited Liability Company or TrustThe Investor is an entity qualifying as an Accredited Investor under applicable securities laws.
Investment Company / Investment AdviserThe Investor is a registered investment company, registered investment adviser, exempt reporting adviser or rural business investment company.
Bank or Financial InstitutionThe Investor is a bank, savings and loan association, credit union or other qualifying financial institution.
Insurance CompanyThe Investor is a qualifying insurance company.
Employee Benefit PlanThe Investor is an employee benefit plan satisfying the applicable requirements for Accredited Investor status.
Family OfficeThe Investor is a qualifying family office and satisfies the applicable regulatory requirements.
Governmental BodyThe Investor is a governmental body or governmental agency qualifying under applicable securities laws.
Investment FundThe Investor is an investment fund, private fund or similar pooled investment vehicle qualifying as an Accredited Investor.
Assets TestThe Investor owns investments or assets meeting the applicable regulatory threshold required for Accredited Investor status.
Other CategoryPlease specify the applicable exemption or category:

C. Supporting Documentation

The Issuer may request documentary evidence supporting the Investor's Accredited Investor status, including, where applicable:

  • Government-issued identification
  • Organizational documents
  • Financial statements
  • Professional certifications
  • Regulatory registrations
  • Other supporting documentation reasonably requested by the Issuer

D. Additional Information (Optional)

Please provide any additional information relevant to the Investor's Accredited Investor status.

4Investment Suitability & Compliance

Please answer the following questions by checking the appropriate box.

QuestionYesNo
1. Is the Investor acquiring the securities and/or digital assets for its own account and not on behalf of any undisclosed person?
2. Does the Investor have sufficient knowledge and experience to evaluate the merits and risks of the proposed investment?
3. Is the Investor capable of bearing the economic risk of this investment, including the possible loss of the entire investment?
4. Has the Investor made an independent investment decision without relying solely on the Issuer or its representatives?
5. Has the Investor had an opportunity to ask questions and obtain additional information regarding the proposed investment?
6. Is the Investor acting as principal and not as nominee or agent for another person, except as disclosed in this Questionnaire?
7. Is the Investor subject to any legal or contractual restriction that would prohibit participation in this offering?

Anti-Money Laundering (AML) & Sanctions

QuestionYesNo
8. Are the funds used for this investment derived from lawful sources?
9. Is the Investor, or any beneficial owner, subject to applicable economic or trade sanctions?
10. Is the Investor, or any beneficial owner, listed on any applicable sanctions or restricted persons list?
11. Is the Investor a Politically Exposed Person (PEP), or an immediate family member or close associate of a PEP?
12. Has the Investor been convicted of, or is the Investor currently subject to, any investigation involving fraud, money laundering, terrorist financing or similar financial crimes?

If Yes to any of Questions 9–12, please provide details.

Source of Funds

Please indicate the primary source of funds for the proposed investment.

Employment Income
Business Income
Investment Income
Sale of Assets
Inheritance / Gift
Capital Contributions
Institutional Assets
Fund Assets
Other:

Additional Information

Please provide any additional information that may assist the Issuer in completing its suitability, compliance or regulatory review.

5Tax & AML Information

A. Tax Residency

Please provide the following information.

InformationDetails
Country of Tax Residence
Tax Identification Number (TIN)
Additional Country(ies) of Tax Residence (if any)

B. FATCA / CRS Status (if applicable)

Please indicate the Investor's status, where applicable.

U.S. Person
Non-U.S. Person
FATCA Reporting Entity
CRS Reporting Entity
Exempt Entity
Not Applicable

C. Beneficial Ownership

Where required by applicable law, please provide the following information regarding the ultimate beneficial owner(s).

InformationDetails
Name
Nationality
Ownership Percentage

If there are multiple beneficial owners, please attach additional pages as necessary.

D. Supporting Documentation

The Issuer may request one or more of the following documents to verify the information provided in this Questionnaire:

  • Government-issued identification.
  • Certificate of incorporation or organizational documents.
  • Proof of address.
  • Tax documentation.
  • Beneficial ownership documentation.
  • Corporate authorization documents.
  • Any additional documentation reasonably requested to satisfy applicable KYC, AML or regulatory requirements.

6Certifications

By signing below, the Investor certifies that:

  1. The information contained in this Questionnaire is true, accurate and complete to the best of the Investor's knowledge.
  2. The Investor has provided this information for the purpose of enabling the Issuer to determine the Investor's eligibility to participate in the proposed offering and to satisfy applicable legal and regulatory requirements.
  3. The Investor agrees to promptly notify the Issuer of any material change to the information provided in this Questionnaire before the completion of the proposed transaction.
  4. The Investor understands that the Issuer may rely upon the information contained in this Questionnaire in determining the Investor's eligibility for the proposed offering.
  5. The Investor acknowledges that the Issuer may request additional information or documentation to verify the information contained in this Questionnaire or to comply with applicable legal, regulatory, KYC or AML requirements.

Signature

Individual Investor

InformationDetails
Investor Name
Signature
Date

Entity Investor

InformationDetails
Entity Name
Authorized Signatory
Title
Signature
Date

Need This Template Customized?

This Investor Questionnaire provides a standard starting point for evaluating investor eligibility and compliance. Our team can help tailor it to your jurisdiction, offering type, and regulatory framework.

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