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This is a password protected website. Access to this website is restricted to persons meeting certain requirements imposed by the securities laws of the United States. The information requested in this Questionnaire is needed in order for Himelsein Mandel Fund Management. (the "Company") to determine your eligibility to receive a password and gain access to this website.

Persons interested in receiving a password (hereinafter referred to as an "Applicant") must complete the Questionnaires set forth below. The Company reserves the right to deny any person access to this website at any time and for any reason.

The Company may request from you such additional information as it may deem necessary to evaluate your eligibility to access this website and may request from time to time such information as it may deem necessary to determine your continued eligibility to access this website or to enable the Company to determine its compliance with applicable laws and regulatory requirements. By submitting this Questionnaire you represent and warrant to the Company that the information provided by you is true and correct.

Although the Company will use its best efforts to keep the information provided in the answers to this Questionnaire strictly confidential, the Company may present this Questionnaire and the information provided in answers to it to such parties as the Company deems advisable if called upon to establish the availability under any applicable law of an exemption from registration or if the contents thereof are relevant to any issue in any action, suit or proceeding to which the Company or any of its affiliates is a party or by which the Company or any of its affiliates is or may be bound.

Click Here if the Applicant is an Individual

Click Here if the Applicant is a Corporation, Limited Liability Company or Partnership

Click Here if the Applicant is a Trust

Click Here if the Applicant is a Bank, Savings and Loan or Similar Organization

Click Here if the Applicant is an Insurance Company