citizenship (for individuals) or principal place of business (for entities).
X.
ADDITIONAL INFORMATION.
A TRUST MUST ATTACH A COPY OF ITS DECLARATION OF TRUST OR OTHER
GOVERNING INSTRUMENT, AS AMENDED, AS WELL AS ALL OTHER DOCUMENTS THAT AUTHORIZE
THE TRUST TO INVEST IN THE SECURITIES.
ALL RESOLUTIONS AND DOCUMENTATION MUST
BE COMPLETE AND CORRECT AS OF THE DATE HEREOF.
XI.
INFORMATION VERIFICATION CONSENT.
BY SIGNING THIS SUBSCRIPTION AGREEMENT, SUBSCRIBER HEREBY GRANTS THE
PLACEMENT AGENT PERMISSION TO REVIEW ALL PUBLICLY AVAILABLE INFORMATION
REGARDING SUBSCRIBER, INCLUDING, BUT NOT LIMITED TO INFORMATION PROVIDED BY THE
OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") FOR THE PURPOSE OF VERIFYING
INFORMATION PROVIDED BY SUBSCRIBER HEREIN.
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INVESTOR QUESTIONNAIRE EXECUTION PAGE
Signature
Signature (if purchasing jointly)
Name Typed or Printed
Name Typed or Printed
Entity Name
Entity Name
Address
Address
City, State and Zip Code
City, State and Zip Code
FOR INTERNAL USE ONLY
Reviewed by Placement Agent:
o
Yes
o
No
Date Reviewed:
_____________________________________
Review Conducted by: ________________________________
(Print Name)
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