1.- Identification of the person attending you:
Name :____________________________________
Phone :____________________________________

2.- Identification of the Entity
Name :____________________________________
City :____________________________________

3.-
Date :____________________________________
Hour   :____________________________________

4.- How was the contact?
Telephone call __________________
Meeting     __________________     Place:_____________________

5.- It was recommended to: Buy         Sell
Name of the instrument:____________________________________

6.- How do these recommendations adjust to my objectives?
______________________________________________________________________
______________________________________________________________________

7.- Which are the specific reasons of why should I invest or sell the instrument?
______________________________________________________________________
______________________________________________________________________

8.- Which are the specific risks if I invest in the instrument?
______________________________________________________________________
______________________________________________________________________

9.- Did I ask for information about the investment or sale of the instrument before taking a decision?
yes     no
I requested:
___ Prospects
___ The more recent annual report
___ Last available Financial Statement
___ Some other type of written information available
___Others ____________________________________

10.- After revising the material, I decided:
___Do nothing
___Buy
___Sell
How much?      ___________________________
At what price? ___________________________

11.- The total cost of the transaction will amount to: : ___

12.- Other notes:
______________________________________________________________________
______________________________________________________________________