1. Personal Information

Full Legal Name *

Date of Birth *

African Country of Origin *

Current Country of Residence *

Phone Number *

Email Address *

2. Identification

ID Type *
PassportNational IDResidence PermitOther

ID / Passport Number *

Issuing Country *

Expiry Date *

3. Diaspora & Connection to Africa

Years Living Abroad *
Under 2 years2–5 years5–10 years10+ years

Do you send remittances?
Yes – regularlyYes – occasionallyNo

Do you own assets in Africa?
YesNoPlanning to

Preferred Investment Region

4. Investment Details

Investment Amount *

Preferred Currency *
EURUSDGBPLocal African Currency

Investment Horizon *
1–3 years3–5 years5–10 years10+ years

Risk Appetite *
ConservativeModerateGrowth-Oriented

Investment Goal *
Real EstateStartup FundingInfrastructurePortfolio Diversification

5. Source of Funds

Source of Funds *
Employment IncomeBusiness ProfitsSavingsInheritance / GiftOther

Employer / Business Name

6. Service Preferences

Preferred Language
EnglishFrenchPortugueseArabic

Preferred Communication
EmailWhatsAppPhoneVideo Call

Reporting Frequency
MonthlyQuarterlySemi-Annual

7. Referral

How did you hear about us?
Diaspora CommunitySocial MediaEventReferralWebsite

Referral Name / Code

Declaration

I confirm that the information provided is accurate and complete. I agree to the Terms & Conditions and Privacy Policy.

Signature (Type Name)

Date