Assessment Form – Global Citizen Capital

FIRST NAME *

LAST NAME *

EMAIL *

PHONE

🇵🇰 +92

DATE OF BIRTH

SEX * (optional)

MALE

FEMALE

MARITAL STATUS * (optional)

SINGLE

MARRIED

DIVORCED/SEPARATED

TOTAL NET WORTH?* (optional)

FIXED ASSESTS

LIQUID ASSESTS / CASH

NATIONALITY * (optional)

CURRENT COUNTRY OF RESIDENCE * (optional)

TOTAL VALUE OF YOUR ASSETS, IN CANADIAN DOLLARS. MINIMUM $1,600,000 (QUEBEC IIP). MIN €1,000.000 EUROS FOR BULGARIA-EU IIP.* (optional)

GLOBAL CITIZEN PROGRAM OF INTEREST* (optional)

HOW DO YOU WANT US TO CONTACT YOU? * (optional)

PHONE

FAX

HOW DID YOU FIND OUT ABOUT OUR PROGRAMS? * (optional)

QUESTIONS OR COMMENTS (optional)