Document:

Form of Stock Subscription Agreement (Non-U.S.)

 Exhibit 10.24 
  
 STOCK SUBSCRIPTION AGREEMENT 
 (Foreign Investors) 
 STERLING MINING COMPANY, INC. 
  
 THIS SUBSCRIPTION AGREEMENT dated as of the _____ day of _______________, 200__,
BETWEEN: 
  
 Sterling Mining Company, Inc., an Idaho (U.S.A.)
corporation with an address at 2201 North Government Way, Professional Plaza Suite E, Coeur d’Alene ID 83814, U.S.A., (the “Issuer”) 
  
 AND: 
  

	
	
	  
	 Name of Purchaser

  

 Mailing Address 
 (the “Investor”) 
  
 WITNESS THAT WHEREAS:

  

	A.	The Issuer is subject to the regulatory jurisdiction of the U.S. Securities and Exchange Commission and any other securities commission of any State of the United States in which
the shares of the Issuer are offered (collectively the “Commissions”). 

  

	B.	The Investor has agreed to purchase shares of stock of the Issuer, expressed as “Units” in accordance with the terms and conditions set forth herein.

  
 NOW THEREFORE, in consideration of the foregoing and the
mutual covenants and agreements herein contained, the parties agree as follows: 
  

	1.	PURCHASE AND SALE OF UNITS 

  

	1.1	The Investor hereby subscribes for and pays for in accordance with the terms of this Agreement, _____________________ Units at a price of U.S. $__________________ per Unit.
Each Unit consists of one share of common stock of the Issuer, and _____________________ Warrant(s) with an exercise price of U.S. $_________________ per share and with a term to _____________________. 

  

	1.2	The Investor: _________________ Shall deliver, or, ______________ Has delivered, the sum of U.S. $_______________ to the Issuer. 

  

	1.3	Subscriptions delivered to the Issuer are not subject to revocation by the Investor. The Investor acknowledges and agrees that this Agreement shall not be binding on the Issuer
until this Agreement, along with all other requisite documents and funds, have been delivered to Sterling Mining Company, Inc., 2201 North Government Way, Professional Plaza Suite E, Coeur d’Alene, ID 83814, and the Issuer has accepted the
Agreement upon satisfying itself that all applicable securities laws have been compiled with, and that, if applicable, the Investor is a sophisticated purchaser or accredited investor. 

	2.	REPRESENTATION AND WARRANTIES 

  

	2.1	The Investor represents and warrants to the Issuer that: 

  

	 	(a)	the Investor is purchasing the Units/Shares as principal and not on behalf of any third party; 

  

	 	(b)	the Investor knows that the Units/Shares are being acquired pursuant to exemptions under the United States Securities Act of 1933, as amended (the “Securities Act”);

  

	 	(c)	the Investor is not a “U.S. Person” as defined in Regulation S of the Securities Act and is not acquiring the Units/Shares for the account or benefit of a U.S. Person;

  

	 	(d)	the Investor is acquiring the Units/Shares in an “offshore transaction” as defined by Rule 902(h) of Regulation S; and 

  

	 	(e)	the Investor is not acquiring the Units/Shares as a result of any information about the affairs of the Issuer that is not generally known to the public other than knowledge of this
particular transaction. 

  

	2.2	The Issuer represents and warrants to the Investor that: 

  

	 	(a)	the Issuer is a corporation duly incorporated and in good standing under the laws of the State of Idaho; and 

  

	 	(b)	this Agreement has been duly authorized by the necessary corporate action on the part of the Issuer and it constitutes a valid obligation of the Issuer duly binding upon it and
enforceable in accordance with its terms. 

  

	3.	COVENANTS 

  
 The Investor covenants with the Issuer to execute and deliver such further documents and do all such further acts and things as may be necessary to comply with the Commissions’ requirements for this private
placement and to carry out the intent of this Agreement. 
  

	4.	SECURITIES LAW MATTERS 

  

	4.1	The Investor is aware of an acknowledges to and agrees with the Issuer as follows: 

  

	 	(a)	the Units/Shares have not been and will not be registered under the Securities Act in reliance on the exemptions under the Act; 

  

	 	(b)	the holder thereof, by purchasing such securities agrees for the benefit of the Issuer that such Units/Shares may be offered, sold, pledged or otherwise transferred only (i) in
accordance with the provisions of Regulation S and Rule 144 (if applicable) under the Securities Act, (ii) pursuant to registration under the Securities Act or (iii) pursuant to an available exemption from the registration requirements of
the Securities Act; 

  

	 	(c)	the holder will not engage in hedging transactions with regard to the Units/Shares unless in compliance with the Securities Act; 

	 	(d)	any person to whom any of the Units/Shares, or any interest therein, are transferred will, in turn, be subject to applicable retransfer restrictions; the Investor fully comprehends
that the Issuer is relying to a material degree on the representations, warranties and agreements contained herein and in his or her Investment Representation Letter and Investor Questionnaire submitted to the Company, and with such realization,
authorizes the Issuer to act as it may see fit in full reliance hereon, including the placement on the certificates or other documents evidencing the Units/Shares of the following legend and any legends required by any applicable state securities
laws: 

  
 THE UNITS/SHARES REPRESENTED BY THIS
CERTIFICATE ARE RESTRICTED SECURITIES AS THAT TERMS IS DEFINED IN RULE 144 OF THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”) AND HAVE NOT BEEN REGISTERED UNDER THE ACT. THEY MAY NOT BE OFFERED FOR SALE, SOLD OR TRANSFERRED UNLESS SO
REGISTERED, IN ACCORDANCE WITH REGULATION S AND RULE 144 UNDER THE ACT OR AN EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE ACT IS AVAILABLE. HEDGING TRANSACTIONS WITH REGARD TO THESE SHARES MAY NOT BE CONDUCTED UNLESS IN COMPLIANCE WITH THE
ACT. THE ISSUER MAY REQUIRE AN OPINION OF COUNSEL SKILLED IN SECURITIES MATTERS AND OTHER EVIDENCE OF COMPLIANCE WITH THE ACT PRIOR TO PERMITTING A TRANSFER OF THESE SHARES. 
  
 BY ITS ACQUISITION HEREOF, THE HOLDER (1) REPRESENTS THAT IT IS NOT A U.S. PERSON AND IS ACQUIRING THE SECURITIES IN
AN OFFSHORE TRANSACTION, (2) AGREES THAT IT WILL NOT RESELL OR OTHERWISE TRANSFER THE SECURITIES EXCEPT (A) PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE ACT, (B) IN ACCORDANCE WITH THE PROVISIONS OF REGULATION S AND RULE
144 (C) PURSUANT TO ANY OTHER EXEMPTION FROM REGISTRATION UNDER THE ACT (IF AVAILABLE), (3) AGREES IT WILL NOT CONDUCT ANY HEDGING TRANSACTIONS INVOLVING THE SECURITIES UNLESS IN COMPLIANCE WITH THE ACT, AND (4) AGREES THAT IT WILL
GIVE TO EACH PERSON TO WHOM THE SECURITIES ARE TRANSFERRED A NOTICE SUBSTANTIALLY TO THE EFFECT OF THIS LEGEND. AS USED HEREIN, THE TERMS “OFFSHORE TRANSACTION,” “UNITED STATES” AND “U.S. PERSON” HAVE THE MEANINGS GIVEN
TO THEM BY REGULATION S UNDER THE ACT. 
  
 The Investor fully
comprehends that the Issuer is relying to a material degree on the representations, warranties and agreements contained herein and in his or her 
  

	 	(f)	the Investor agrees that the Issuer may require than none of the Units/Shares or any interest therein may be sold, transferred or otherwise disposed of unless registered under the
Securities Act, without his or her having first presented to the Issuer or its counsel a written opinion of counsel experienced in securities law matters indicating that the proposed disposition will not be in violation of any of the registration
provisions of the Securities Act and the rules and regulations promulgated thereunder, and the Company will refuse to register any transfer of the Shares not made in accordance with the provisions of Regulation S, pursuant to registration under the
Securities Act or pursuant to an exemption from registration; and 

	 	(g)	the Investor acknowledges that the foregoing is not a complete statement of the law applicable to resale of the Units/Shares, but merely an outline of some of the more salient
features. For legal advice in these matters, the Investor will continue to rely on its own legal counsel as the Investor has throughout this transaction concerning the purchase of the Units/Shares. 

  

	5.	INDEMNIFICATION 

  

	5.1	The Investor hereby indemnifies and holds harmless the Issuer and its officers, directors, shareholders, agents, employees, attorneys, successors, and assigns from and against all
damages, losses, costs, liabilities, and expenses (including costs of investigation, defense, and attorneys’ fees) incurred by reason of the failure of the Investor to fulfill any of the Investor’s obligations hereunder or by reason of any
breach or inaccuracy of any of the representations or warranties made by the Investor herein. 

  

	6.	GENERAL 

  

	6.1	This Agreement is subject to the approval of such regulatory authorities that have jurisdiction over the Issuer, including all Commissions. 

  

	6.2	Neither the Investor nor the Issuer may assign all or any part of his, her or its interest in or to this Agreement without the written consent of the other and any purported
assignment without such consent will be void. 

  

	6.3	This Agreement is to be governed and interpreted according to the laws of the State of Idaho without regard to conflict of laws or principles. 

  

	6.4	This Agreement shall enure to the benefit of and be binding upon the parties and their successors, personal representatives and permitted assigns. 

  

	6.5	Time is of the essence of this Agreement. 

  

	6.6	The parties to this Agreement may amend this Agreement only in writing. 

  

	6.7	The parties to the Agreement will execute and deliver such investor questionnaires, documents, transfers, assurances, share certificates and procedures necessary for the purposes of
giving effect to or perfecting the transactions contemplated by this Agreement. 

  

	6.8	All notice or other communications given or made hereunder shall be in writing and shall be delivered or mailed by registered or certified mail, return receipt requested, postage
prepaid, to the address given above, and such notice will be deemed to be given on the date of receipt. 

  
 IN WITNESS WHEREOF the parties hereto have hereunder set their hands as of the date first state above. 
  

			
	STERLING MINING COMPANY, INC.
		
	BY:	 	 
	 	 	, President

					
	If Investor is an individual:	 	 	 	 
			
	  	 	 	 	  
	 Name of Investor
	 	 	 	 Signature of Investor

			
	  	 	 	 	  
	 Name of Witness
	 	 	 	 Signature of Witness

			
	  	 	 	 	  
	 Address of Investor
	 	 	 	 
			
	  	 	 	 	  
	 Occupation
	 	 	 	 

  
 OR 
  

			
	If Investor is a corporation, trust or other entity:
	
	 
	Name of Corporation
		
	By:	 	 
	 Name:
	 	 
	
	 
	 Title:
	 	 

 INVESTMENT REPRESENTATION LETTER 
 (Foreign Investors) 
 STERLING MINING COMPANY, INC. 
  
 Sterling Mining Company 
 2201 North Government Way 
 Professional Plaza Suite E 
 Coeur d’Alene, ID 83814, U.S.A. 
  
 Attention: Ray DeMotte, President 
  
 Gentlemen and Ladies: 
  
 The undersigned proposes to acquire “Units” issued by Sterling Mining Company, Inc., an Idaho Corporation. The Unit price is U.S.
$            . Each Unit consists of one share common stock, and __________ Warrants with an exercise price of $__________ per share and a term to __________. 
  
 The undersigned understands that the Units will be issued to the undersigned without
registration under the Securities Act of 1933, as amended (the “Securities Act”), or qualification under any state securities laws. 
  
 As an inducement for the Company to complete the sale and issuance of the Units to the undersigned, the undersigned hereby agrees, represents and warrants to the Company
as follows: 
  

	 	a.	The undersigned is not a “U.S. Person” and is not acquiring the Units for the account or benefit of a U.S. Person. “U.S. Person” is defined in Regulation S under
the Securities Act; 

  

	 	b.	The undersigned is acquiring the Units in an “offshore transaction” as defined by Rule 902(h) of Regulation S under the Securities Act; 

  

	 	c.	The undersigned may resell any Shares acquired only in accordance with the provisions of Regulation S under the Securities Act, pursuant to registration under the Securities Act or
pursuant to an available exemption from the registration requirements of the Securities Act; 

  

	 	d.	The undersigned will not engage in hedging transactions with regard to the Units unless in compliance with the Securities Act; 

  

	 	e.	The undersigned is an experienced investor, having had prior experience with investments in companies of similar risk to the Company; 

  

	 	f.	The undersigned, either alone or with his professional advisors, if any, has such knowledge and experience in financial and business matters that he is capable of evaluating the
merits and risks of the proposed purchase of the Units/Shares and the investment in the Company; 

  

	 	g.	 The undersigned understands that the acquisition of the Units/Shares involves substantial risk and the undersigned has carefully analyzed and is aware of all of the
risk factors related to the ownership of the Shares and has the ability to bear the economic risk of his 

	 	 
proposed investment in the Company, and the undersigned can hold the Shares indefinitely and could afford a complete loss on the Shares;

  

	 	h.	The undersigned has obtained and reviewed all information about the Company that he desires and which he feels is necessary to enable him to recognize and evaluate the merits and
risks of his purchase of the Units and investment in the company and the undersigned has had a reasonable opportunity to ask questions of and receive answers from the Company’s officers, or a person or persons acting on their behalf, concerning
the Company and the Shares and all such questions have been answered to the undersigned’s full satisfaction; 

  

	 	i.	The undersigned has relied on his own tax and legal advisor and his own investment counselor with respect to the income tax and investment considerations of ownership of the Units;

  

	 	j.	solicitation of an offer to acquire the Units was directly communicated to the undersigned and any Purchaser Representative(s) that the undersigned may have. At no time was the
undersigned presented with or solicited by or through any leaflet, public promotional meeting, circular, newspaper or magazine article, radio or television advertisement or any other form of general advertising in connection with such communicated
offer; and 

  

	 	k.	The Units and Warrants are being acquired and will be held by the undersigned for personal investment and the undersigned has no present intention of distributing any of the Units
or any interest therein to others. 

  
 The undersigned acknowledges
that the offer and sale of the Units has not been registered under the Securities Act, or qualified under the securities law of any state, and that the Units thus are not freely tradable. The undersigned further acknowledges and agrees as follows:

  

	 	1.	All of the information contained in the Investor Questionnaire being delivered by the undersigned to the Company simultaneously herewith is complete and correct; and the undersigned
understands that in determining that exemptions from the registration and qualification provisions of the Securities Act and any applicable state securities laws, the Company is relying in part upon the presentations, warranties and agreements made
by the undersigned herein and in the Investor Questionnaire referred to above; and 

  

	 	2.	The undersigned hereby indemnifies and agrees to hold the Company, and each of its officers, directors, employees and agents, harmless from and against any and all damages
suffered and liabilities incurred (including costs of investigation, defense and attorneys’ fees) by reason of or arising out of any inaccuracy in the agreements, representations, and warranties which the undersigned has made herein.

  
 The undersigned understands that the foregoing is not
intended to be a complete statement of the law applicable to resale of the Shares, but merely an outline of some of the more salient features. For legal advice in these matters, the undersigned will rely on his or her own legal counsel concerning
his purchase of the Units. 

 Dated:
                     
  

					
	 Very truly yours,
	 	 	 	 
			
	 If Investor is an individual:
	 	 	 	 
			
	  	 	 	 	  
	 Signature
	 	 	 	 Name (please print)

			
	 If Investor is a corporation, trust or other entity:
	 	 	 	 
			
	  	 	 	 	  
	 Name of Entity
	 	 	 	 
			
	  	 	 	 	  
	 Address of Entity
	 	 	 	 

  

			
		
	By:	 	 
	 Name:
	 	 
		
	 Title:Form of Stock Subscription Agreement (U.S.)

 Exhibit 10.25 
  
 STOCK SUBSCRIPTION AGREEMENT 
 FOR 
 STERLING MINING COMPANY 
 an Idaho corporation 
  

	1.	SUBSCRIPTION: The undersigned,
                                        
             (the “Subscriber”) hereby subscribes for the purchase of
                                        
                         (            ) shares of Common
Stock of STERLING MINING COMPANY (the “Company”), an Idaho corporation, in consideration of the sum of
                                        
             ($                ) and
                                 has paid, or
                         agrees to pay 100% of the total subscription price upon submission of this subscription
agreement. Such subscription is subject to the following terms and conditions: 

  

	 	a.	No certificate(s) for shares shall be issued to the undersigned until the entire stock subscription price is paid; 

  

	 	b.	The Company reserves the right to reject, reduce or allot all subscriptions received; 

  

	 	c.	The Company reserves the right to increase the aggregate number of shares being sold by it; 

  

	 	d.	The certificate(s) representing the shares delivered pursuant to this subscription agreement shall bear a legend in the following form: 

  
 The shares represented by this certificate have not been registered under
the Securities Act of 1933 (“Act”), as amended, or any other applicable federal or state securities act; and are “restricted securities” as defined by Rule 144 of the Act. The shares may not be transferred, sold or otherwise
disposed of unless; (1) a registration statement with respect to the shares shall be effective under the Act or any other federal or state securities acts or an exemption from registration requirements under the Act is effective, and
(2) the Company shall have received an opinion of Counsel for the Company that no violations of any securities acts will be involved in any transfer. 
  

	 	e.	If the shares represented by this certificate have been held for a period of at least one (1) year and if Rule 144 of the Securities Act of 1933, as amended (the
“Act”), is applicable, then the undersigned may make sales of the shares only under the terms and conditions prescribed by Rule 144 of the Act. 

  

	2.	REPRESENTATIONS AND WARRANTIES: The undersigned Subscriber hereby represents and warrants to the Company: 

  

	 	a.	 The undersigned Subscriber understands that the Company’s STOCK HAS NOT BEEN APPROVED OR DISAPPROVED BY THE UNITED STATES 

  

 1 

	 	 
SECURITIES AND EXCHANGE COMMISSION OR ANY STATE SECURITIES AGENCY; 

  

	 	b.	The undersigned Subscriber is not an underwriter and would be acquiring the Company’s stock solely for investment for his or her own account and not with a view to, or for,
resale in connection with any distribution with in the meaning of the federal securities act, the state securities acts or any other applicable state securities acts; 

  

	 	c.	The undersigned Subscriber understands the speculative nature and risks of investments associated with the Company, and confirms that the stock would be suitable and consistent:
with his or her investment program and that his or her financial position enable him or her to bear the risks of this investment; and that there is not any public market for the stock subscribed for herein; 

  

	 	d.	The stock subscribed for herein may not be transferred, encumbered, sold, hypothecated, or otherwise disposed of to any person, without the express prior written consent of the
Company and that prior opinion of counsel for the Company that such disposition will not violate federal and/or state securities acts. Disposition shall include, but is not limited to acts of selling, assigning, transferring, pledging, encumbering,
hypothecating, giving, and any form of conveying, whether voluntary or not; 

  

	 	e.	To the extent that any federal, and/or state securities laws shall require, the Subscriber hereby agrees that any stock acquired pursuant to this Agreement shall be without
preference as to assets; 

  

	 	f.	The Company is under no obligation to register or seek an exemption under any federal and/or state securities acts for any stock of the Company or to cause or permit such stock to
be transferred in the absence of any such registration or exemption and that the Subscriber herein must hold such stock indefinitely unless such stock is subsequently registered under federal and/or state securities acts or an exemption from
registration is available; 

  

	 	g.	The Subscriber has had the opportunity to ask questions of the Company and receive additional information from the Company to the extent that the Company possessed such information,
necessary to evaluate the merits and risks of any investment in the Company. Further, the Subscriber has been given: (1) All material books, records and financial statements of the issuer; (2) all material contracts and documents relating
to the proposed transactions; (3) all reports filed with the United States Securities and Exchange Commission; and, (4) an opportunity to question the appropriate executive officers or partners; 

  

	 	h.	The Subscriber has adequate means of providing for his current needs and personal contingencies and has no need to sell the shares in the foreseeable future (that is at the time of
the investment, Subscriber can afford to hold the investment for an indefinite period of time); and, 

  

 2 

	 	i.	The Subscriber has sufficient knowledge and experience in financial matters to evaluate the merits and risks of this investment and further, the Subscriber is capable of reading,
and interpreting financial statements. 

  

	3.	LIMITED POWER OF ATTORNEY: The undersigned Subscriber hereby constitutes and appoints and grants to Ray De Motte, President of the Company, his limited
attorney-in-fact and agent to sign for him and act in his name, place and stead, in any and all capacities to execute any or all documents to be filed with the United States Securities and Exchange Commission and any governmental agency, federal,
state or otherwise in connection with any securities flags, including, but not limited to: amendments, exhibits, agreements, concerning shareholders granting, said limited attorney-in-fact and agent, full power and authority to do and perform each
and every act and thing requisite and necessary to be done in and about the premises, as fully and to all intents and purposes as he might or could do in person, hereby ratifying and confirming, all that each said limited attorney-in-fact and agent
or his substitute or substitutes, may lawfully do or cause to be done by virtue hereof. 

  

	4.	STATUS OF PURCHASER: 

  

	 	 ̈	I am not a member of, or an associate or affiliate of a member of the National Association of Securities Dealers. 

  

	 	 ̈	I am a member of, or an associate or affiliate of a member of the National Association of Securities Dealers. Attached is a copy of an agreement signed by the principal of the firm
with which I am affiliated agreeing to may participation in this investment. 

  

	5.	MISCELLANEOUS: This Subscription Agreement shall be binding upon the parties hereto, their heirs, executors, successors, and legal representatives. The law of the
State of Idaho shall govern the rights of the parties to this Agreement. This Agreement is not assignable without the prior written consent of the Company, and any attempt to assign any rights, duties or obligations which arise under this Agreement
without the Company’s prior express written consent shall be void. 

  
 The undersigned Subscriber hereby declares and affirms that he or she has read the within and foregoing Subscription Agreement, is familiar with the contents thereof and agrees to abide by there terms and conditions
therein set forth, and knows the statements therein to be true and correct. 
  
 I hereby consent to the use of my name in any prospectus or registration statement which may be filed in connection with any public offering of the Company’s securities. 
  
 IN WITNESS WHEREOF, the parties have executed this Subscription
Agreement this                  day of
                             at
                                        
                ,
                            . 
  

	
	SUBSCRIBER
	
	 
	 

  

 3 

	
	 Signature

	
	 
	 Spouse’s Signature (if applicable)

	
	 
	 Address

	
	 
	 City, State and Zip Code

	
	 
	 Area Code and Telephone Number

  

			
	ACCEPTED BY:
	
	 STERLING MINING COMPANY
 an Idaho corporation

		
	BY:	 	 
	 	 	Ray De Motte, President

  

 4 

  
 PURCHASER QUESTIONNAIRE

  
 Sterling Mining Company 
  

 5 

  
 PURCHASER QUESTIONNAIRE

  
 THIS QUESTIONNAIRE MUST BE ANSWERED FULLY AND RETURNED ALONG WITH YOUR
COMPLETED SUBSCRIPTION AGREEMENT IN CONNECTION WITH. YOUR PROSPECTIVE PURCHASE OF SECURITIES FROM GOLD BOND RESOURCES, INC. (THE “COMPANY”). 
  
 THE INFORMATION SUPPLIED IN THIS QUESTIONNAIRE WILL BE HELD IN STRICT CONFIDENCE. NO INFORMATION WILL BE DISCLOSED EXCEPT TO THE EXTENT THAT SUCH DISCLOSURE IS REQUIRED
BY LAW OR REGULATION, OTHERWISE DEMANDED BY PROPER LEGAL PROCESS OR IN LITIGATION INVOLVING THE COMPANY AND ITS CONTROLLING PERSONS. 
  
 PART I-INDIVIDUALS 
  

	1.	Personal Data 

  
 Name
                                        
                             
  
 Residence Address
                                        
                         
 [Street, City, State, Zip Code] 
  
 Business Address
                                        
                         
 [Street, City, State, Zip Code] 
  
 State of residence, if different
                                        

  
 Telephone: Residence
                             Business
                             
  
 Age:
                     Citizenship:
                             
  
 In what state are you registered to vote:
                                        

  
 Social Security or Taxpayer No.:
                                        
     
  
 Send all correspondence to:
Residence                              Business
                             
  

	2.	Investor Status 

  
 (a) State your personal net worth (inclusive of the net worth of your spouse and the value of your principal residence, furnishings therein and personal
automobiles). 
  
  ̈ Less than $100,000 
  
  ̈ $100,001 to $300,000 
  

 6 

  ̈ $300,001 to $500,000 
  
  ̈ $500,001 to $750,000 
  
  ̈ $750,001 to $1,000,000 
  
  ̈ $1,000,001 to $2,000,000 
  
  ̈ $2,000,001 and over 
  
 (b) Indicate below your income from all sources for the two preceding calendar years and reasonably anticipated income for the current calendar year. Do
not include your spouse’s income. 
  
 Year

  
 2000
                                     
  
 2001
                                     
  
 2002
                                     
  
 (c) Indicate below your income from all sources for the two preceding
calendar years and reasonably anticipated income for -the current calendar year. Please include your spouse’s income. 
  
 Year 
  
 2000
                                     
  
 2001
                                     
  
 2002
                                     
  
 (d) Does your prospective investment in the Company exceed 10% of your net
worth or joint net worth with your spouse? 
  
 ( ̈ Yes  ̈ No). 
  
 (e) Are you a director or executive officer of the Company? 
  
 ( ̈ Yes  ̈ No). 
  

 7 

 PART II-PURCHASERS WHO ARE NOT INDIVIDUALS 
  

	1.	General Information 

  
 Name of Entity:
                                        
                         
  
 Address of Principal Office:
                                        
             
  
 ________________________________________________ 
  
 Type of Organization:
                                        
                 
  
 Date and Place of Organization:
                                        

  
 Taxpayer No.:
                                        
                             
  

	2.	Investor Status 

  
 Please check the appropriate description which applies to you. 
  
  ̈ (a) A bank, as defined in Section 3(a)(2) of the
Securities Act of 1933 or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act of 1933, whether you are acting in an individual or fiduciary capacity. 
  
  ̈ (b) Any broker dealer registered pursuant to Section 15 of the Securities. Exchange Act of 1934. 
  
  ̈ (c) An insurance company, as defined in Section 2(13)
of the Securities Act of 1933. 
  
  ̈ (d) An investment company registered under the Investment Company Act of 1940. 
  
  ̈ (e) A business development company, as defined in
Section 2(a) (48) of the Investment Company Act of 1940. 
  
  ̈ (f) A small business investment company licensed by the U.S. ‘Small Business Administration under Section 301
(c) or (d) of the Small Business Investment Act of 1958. 
  
  ̈ (g) Any plan established and maintained by a state, its political subdivisions, or any agency or instrumentality of a state or
its political subdivisions, for the benefit of its employees, if such plan has total assets in excess of $5 million. 
  
  ̈ (h) An employee benefit plan within the meaning of the
Employee Retirement Income Security Act of 1974 and the investment decision is made by you as a plan fiduciary, as defined in Section 3(21) of such Act, and you are a bank, savings and loan association, an insurance company, or a registered
investment adviser, or the employee benefit plan has total assets in excess of $5 million, or, if a self-directed plan, with investment decisions made solely by persons that are accredited investors. 
  
 If you checked (h), and the employee benefit plan is a self-directed plan,
have each person who makes investment decisions respond individually to Part I of this Questionnaire. 
  
  ̈ (i) A private business
development company, as defined in Section 202(a)(22) of the Investment Advisers Act of 1940. 
  

 8 

  ̈ (j) An
organization described in Section 501(c)(3) of the Internal Revenue Code, corporation, Massachusetts or similar business trust, or partnership, not formed for the specific purpose of acquiring the securities offered, with total assets in excess
of $5 million. :` 
  
  ̈ (k) A trust with total assets in excess of $5 million not formed for the specific purpose of acquiring the securities offered, whose purchase is directed by a sophisticated
person as described in Rule 506(b)(2)(ii) under the Securities Act of 1933. 
  
 If you checked (k), have such person who directs the purchase of the securities being offered complete Part I of this Questionnaire. 
  
  ̈ (l) An entity in which all
of the equity owners are accredited investors. If you checked (l), please complete the following part of this question: 
  

	 	(1)	List all equity owners: 

  
 ___________________________ 
  
 ___________________________ 
  

	 	(2)	What is the type of entity? 

  
 ___________________________ 
  

	 	(3)	Attach a copy of your resolutions or other evidence of the entity’s authority to make this investment. 

  

	 	(4)	Have each equity owner respond individually to Part I of this Questionnaire. 

  

[remainder of page intentionally left blank] 
  

 9 

 The foregoing answers are true and complete. 
  

	
	Individual
	
	 
	 Name of Individual (please type or print)

	
	 
	 Signature of Individual

  
 Date ___________________________ 
  

			
	Partnership, Corporation or Other Entity
	
	 
	 Print or Type Name

		
	By:	 	 
	 	 	 Print or Type Name and Title

	
	 
	 Signature

  
 Date ___________________________ 
  

 10

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00094-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00094-of-00352.parquet"}]]