Passive Income Interest Form Passive Income Interest Form Name(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Preferred Language(Required)EnglishFrenchSpanishMandarinBulgarianHow did you hear about us(Required)WebsiteInternet SearchChurchFriendEmailPhoneDirect MailEventFacebookInstagramLinkedInTwitterYouTubeSocial MediaChristian ChamberRadioOtherAnnual Income(Required)< $100K$100K to $250K$250K to $500K$500K to $1M>$1MHow would you define Passive Income?How much Passive Income do you want to generate on a monthly basis?What is the timeframe that you would like to set for you to achieve the goal stated in the question above?Why do you want to achieve Passive Income freedom?Do you currently own any real estate? Yes No Do you have any experience investing in the following areas?(Select the ones that you have experience with) Real estate Stocks Notes Funds/ Mutual Funds Private Equity Peer-to-peer Lending Precious Metals Commodities Cryptocurrency Are you an accredited investor?To qualify as an accredited investor, you must have a household income of over $250,000 and possess an accredited investor certificate Yes No If you are, how would you define what an accredited investor is?(Required)Have you had an investor risk assessment? Yes No Do you currently have personal debts?(Credit card, school, automotive, etc.) Yes No Do you own your own home? Yes No How much do you plan to invest on a monthly basis?Do you have an asset or fund? Yes No Have you ever had a passive income coach? Yes No If yes, how was your experience with the coach?(Required)Have you ever worked with a financial planner? Yes No Do you currently have a financial planner that you work with? Yes No If yes, how was/is your experience with the financial planner?(Required)Are you enrolled in any coaching package offered by Nehemiah Project International Ministries, Inc. (NPIM)? Yes No If yes, who is currently your coach?(Required)This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
