SMP Asset Management - Santa Monica Partners

Santa Monica Partners - SMP Asset Management, LLC

Investor Questionnaire - Request for Website Access

SMP ASSET MANAGEMENT

INVESTOR QUESTIONNAIRE

INSTRUCTIONS: The purpose of this Questionnaire is to assist SMP Asset Management, LLC ("SMPAM") in complying with the requirements of the Securities Act of 1933, as amended (the "Securities Act"), the Investment Company Act of 1940, as amended (the "Investment Company Act") , and state securities laws. The limited partnership interest which may be offered and sold to you pursuant to a subscription agreement has not been, and will not be, registered under the Securities Act, the Investment Company Act or state securities laws and is being sold in reliance upon exemptions from the registration thereof. The information to be supplied herein will be relied upon in connection with the offering and sale of the limited partnership interest in compliance with the aforesaid exemptions.

The limited partnership interests offered by SMPAM are available only to accredited investors. This questionnaire is required before we are able to furnish you information about our firm and funds.

All information supplied will be treated in confidence, except that this Investor Questionnaire may be presented to such parties as deemed appropriate or necessary to establish the availability of an exemption from registration under the Securities Act, the Investment Company Act or state securities laws.

Please send completed and signed copy to Anne Arnold via email to:  aarnold@smplp.com.

PLEASE ANSWER EACH QUESTION. If the answer to any question is "None" or "Not Applicable", please so state. [all fields are required fields]






Please respond to the following questions by selecting next to the appropriate answer. The primary purpose of these questions is to determine whether you are an "accredited investor" under Rule 501(a) of Regulation D under the Securities Act and a "qualified purchaser" for the purposes of Section 3(c)(7) of the Investment Company Act.

A. Identify the nature of ownership of the proposed investment in the Fund:

 Single ownership
 Tenancy by the entirety (spouses only)
 Joint Tenancy with the right of survivorship
 Tenancy in common
 Other (please specify)

B. Is your current net worth (or joint net worth with that of your spouse, if applicable) as of the date of this subscription in excess of $1,500,000 excluding homes, furnishings, personal automobiles?

C. Did your individual income without regard to that of your spouse exceed $200,000 in each of the last two full calendar years and do you reasonably expect such individual income to exceed $200,000 in the current year? For the purpose of this question, income includes earned income, as well as other items of ordinary income, such as dividends, interest and royalties, but excludes capital gains.

D. Did your joint income with your spouse exceed $300,000 in each of the last two full calendar years and do you reasonably expect such joint income to exceed $300,000 in the current year? For the purpose of this question, income includes earned income, as well as other items of ordinary income, such as dividends, interest and royalties, but excludes capital gains.

E. List in the space provided below the state(s) in which you have maintained a residence during the past two years and the dates during which you resided in each state, and the state(s), if any, in which you are required to pay income taxes:



F. Do you own at least $5,000,000 in investments (net of any currently outstanding indebtedness incurred in connection with acquiring such investments) including, if applicable, any investments held jointly by your spouse or investments in which you share with your spouse a community property or similar shared-ownership interest. For this purpose, the term "investments" includes: (i) securities of public companies, securities of non-public companies that have shareholders' equity of at least $50 million, or securities of other non-public companies that you do not control, shares in registered investment companies such as mutual funds and publicly-traded closed-end funds, and shares in private investment companies such as private investment funds that are exempt from registration under the Investment Company Act, (ii) real estate, commodity futures contracts, options on commodity futures contracts, physical commodities, options on physical commodities, or cash or cash equivalents held for investment purposes, and (iii) certain financial contracts entered into for investment purposes. In addition, the term "investment" specifically excludes real estate used for personal purposes such as a residence, property used as a place of business or in connection with a trade or business, and other investments such as jewelry, antiques and artwork. You can include investments held in your IRA or 401(k) accounts, or other retirement accounts, if you make the investment decisions with respect to those accounts. You may also include investments held by a so-called "alter ego" or wholly-owned entity.

I hereby represent that all the information supplied herein is true, correct and complete as of the date hereof . I agree to notify SMP Asset Management immediately of any material change in the foregoing answers.

IN WITNESS WHEREOF, the undersigned has executed this Investor Questionnaire on and declares that it is truthful and correct.


Please print this document, sign below and fax to SMP Asset Management at (914) 833-1068
OR scan and email to aarnold@smplp.com.
A user name and password will be emailed to you upon receipt.

_______________________________________________
Signature

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