Common use of Accredited Investor Certification Clause in Contracts

Accredited Investor Certification. Please check response A or B as appropriate: _____ A. I am not an accredited investor. _____ B. I am an accredited investor because I am (please check the appropriate response): _____ I have an individual net worth (or joint net worth with spouse) in excess of $1,000,000; or _____ I had an individual income (not including any amounts attributable to spouse or to property owned by spouse) of more than $200,000 in each of the previous two calendar years and a reasonable expectation to reach the same income level in the current year; or I had a joint income with spouse in excess of $300,000 in each of the previous two calendar years and a reasonable expectation to reach the same income level in the current year; or _____ I am a bank or savings and loan association, whether acting in its individual or fiduciary capacity; or _____ I am a broker-dealer registered pursuant to Section 15 of the Securities Exchange Act of 1934; or _____ I am an insurance company; or _____ I am an investment company registered under the Investment Company Act of 1940, as amended, or a business development company as defined in said Act; or _____ I am a Small Business Investment Company licensed by the U.S. Small Business Administration; or _____ I am a plan established and maintained by a state, its political subdivisions or any agency or instrumentality thereof, for the benefit of its employees, if such plan has total assets in excess of $5,000,000; or _____ I am an employee benefit plan within the meaning of Title I of the Employment Retirement Income Security Act of 1974 (“ERISA”), if the investment decision with respect to this investment is made by a plan fiduciary which is either a bank, savings and loan association, insurance company or registered investment advisor, or if the employee benefit plan has total assets in excess of $5,000,000, or if a self-directed plan, its investment decisions are made solely by persons who are accredited investors; or _____ I am a private business development company as defined in the Investment Advisors Act of 1940, as amended; or _____ I am a corporation, Massachusetts or similar business trust or partnership, or any tax exempt organization as defined in Section 501(c)(3) of the Internal Revenue Code, not formed for the specific purpose of acquiring Investor Securities, with the total assets in excess of $5,000,000; or _____ I am a trust with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring Investor Securities, whose purchase is directed.

Appears in 4 contracts

Samples: Subscription Agreement (Players Network), Subscription Agreement (Players Network), Subscription Agreement (Players Network)

AutoNDA by SimpleDocs

Accredited Investor Certification. Please check response A or B as appropriate: _____ A. I am not an accredited investor. _____ B. I am an accredited a credited investor because I am (please check the appropriate response): _____ I have an individual net worth (or joint net worth with spouse) in excess of $1,000,000; or _____ I had an individual income (not including any amounts attributable to spouse or to property owned by spouse) of more than $200,000 in each of the previous two calendar years and a reasonable expectation to reach the same income level in the current year; or I had a joint income with spouse in excess of $300,000 in each of the previous two calendar years and a reasonable expectation to reach the same income level in the current year; or _____ I am a bank or savings and loan association, whether acting in its individual or fiduciary capacity; or _____ I am a broker-dealer registered pursuant to Section 15 of the Securities Exchange Act of 1934; or _____ I am an insurance company; or _____ I am an investment company registered under the Investment Company Act of 1940, as amended, or a business development company as defined in said Act; or _____ I am a Small Business Investment Company licensed by the U.S. Small Business Administration; or _____ I am a plan established and maintained by a state, its political subdivisions or any agency or instrumentality thereof, for the benefit of its employees, if such plan has total assets in excess of $5,000,000; or _____ I am an employee benefit plan within the meaning of Title I of the Employment Retirement Income Security Act of 1974 (“ERISA”), if the investment decision with respect to this investment is made by a plan fiduciary which is either a bank, savings and loan association, insurance company or registered investment advisor, or if the employee benefit plan has total assets in excess of $5,000,000, or if a self-directed plan, its investment decisions are made solely by persons who are accredited investors; or _____ I am a private business development company as defined in the Investment Advisors Act of 1940, as amended; or _____ I am a corporation, Massachusetts or similar business trust or structure partnership, or any tax exempt organization as defined in Section 501(c)(3) of the Internal Revenue Code, not formed for the specific purpose of acquiring Investor Securities, with the total assets in excess of $5,000,000; or _____ I am a trust with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring Investor Securities, whose purchase is directed.

Appears in 2 contracts

Samples: Subscription Agreement (Players Network), Subscription Agreement (Players Network)

Accredited Investor Certification. Please check response A SOCIAL INVESTMENT HOLDINGS, INC. To Whom It May Concern, This information is being furnished to you in order for you to determine whether my investment in the Shares (the “Shares”) of Social Investment Holdings, Inc. (the “Company”) is exempt from registration pursuant to Section 4(2) of the Securities Act of 1933, as amended (the “Securities Act”) or B as appropriate: _____ A. Regulation D promulgated thereunder (collectively, the “Securities Laws”). I am understand that (a) you will rely on the information contained herein for the purposes of such determination, (b) the Shares I receive will not be registered under the Securities Laws in reliance upon an exemption from registration, and (c) this Questionnaire is not an accredited investoroffer to me of the Shares or any other securities. _____ B. In accordance with the foregoing, the following representations and data are hereby given (please initial where indicated): Accredited Investor Representation I certify that I am an accredited investor investor” as defined in Rule 501(a) of Regulation D under the Securities Act because I am (please check select one or more of the appropriate responsefollowing): _____ I have an individual a net worth (or joint joining net worth with my spouse) in excess of $1,000,000; or _____ 1,000,000 calculated without including the value of my personal residence. I have had an individual income (not including any amounts attributable to spouse or to property owned by spouse) in excess of more than $200,000 in each of the previous two calendar most recent years and a reasonable expectation to reach the same income level in the current year; (or I had a joint income with my spouse in excess of $300,000 in each of the previous two calendar years those years) and have a reasonable expectation to reach of reaching the same income level in the current year; or _____ . I am a bank an entity (LLC, partnership, corporation or savings and loan association, whether acting other business organization) in its individual or fiduciary capacity; or _____ which all of the equity owners are accredited. I am a brokeran IRA, Xxxxx, SEP-dealer registered IRA or other retirement account in which all of the beneficiaries are accredited. In Witness Whereof, I have executed this Accredited Investor Certification this day of , 20 , and declare under oath that it is truthful and correct. Signature of Purchaser Name of Purchaser ANNEX B Purchaser Suitability Questionnaire SOCIAL INVESTMENT HOLDINGS, INC. To Whom It May Concern, This information is being furnished to you in order for you to determine whether my investment in Shares (the “Shares”) of Social Investment Holdings, Inc. (the “Company”) is exempt from registration pursuant to Section 15 4(2) of the Securities Exchange Act of 1934; 1933, as amended (the “Securities Act”) or _____ Regulation D promulgated thereunder (collectively, the “Securities Laws”). I am an insurance company; or _____ understand that (a) you will rely on the information contained herein for the purposes of such determination, (b) the Shares I am an investment company receive will not be registered under the Investment Company Act Securities Laws in reliance upon an exemption from registration, and (c) this Questionnaire is not an offer to me of 1940the Shares or any other securities. In accordance with the foregoing, the following representations and data are hereby given: Please initial next to each of the following statements: I can afford the complete loss of this investment. A complete loss of this investment will not have a material adverse impact on my current life style nor will it have a material adverse effect on my financial plans for retirement. I have such knowledge in financial and business matters as amended, or a business development company to be capable of evaluating the relative merits and risks of an investment in the Shares. The information contained in this Questionnaire is offered as defined in said Act; or _____ evidence of such knowledge and experience. I am a Small Business Investment Company licensed by willing and able to bear the U.S. Small Business Administration; or _____ economic risk of an investment in the Shares in an amount equal to the total purchase price. In making this statement, consideration has been given to whether I am a plan established can afford the risks of loss inherent in investments in securities. I offer the information below in this Questionnaire as evidence of my ability to bear the economic risk. Any purchase of Shares will be solely for my own account and maintained by a state, its political subdivisions or any agency or instrumentality thereof, not for the benefit account of its employeesany other person or with a view to any resale or distributions thereof. My commitment to illiquid investments in relation to my net worth and the acquisition of the Shares (which are illiquid) will not cause my overall commitment to illiquid securities to be excessive. My financial resources are such that I can pay (without consideration of the amounts invested in the Shares) any taxes due on my allocable share of gains and income from the Shares. I represent that (a) the information herein is complete and accurate and may be relied upon by you, and (b) that I will notify you of any material change in any of such information occurring prior to acceptance of my subscription. In Witness Whereof, I have executed this Purchaser Suitability Questionnaire this day of , 20 , and declare under oath that it is truthful and correct. Signature of Purchaser Name of Purchaser Form W-9 (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Print or type See Specific Instructions on page 2. 2 Business name/disregarded entity name, if such plan has total assets in excess of $5,000,000different from above 3 Check appropriate box for federal tax classification; or _____ I am an employee benefit plan within the meaning of Title I check only one of the Employment Retirement Income Security Act of 1974 following seven boxes: 4 Exemptions (“ERISA”)codes apply only to Individual/sole proprietor or single-member LLC C Corporation S Corporation Partnership Trust/estate certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Limited liability company. Enter the investment decision with respect to this investment tax classification (C=C corporation, S=S corporation, P=partnership) a Note. For a single-member LLC that is made by a plan fiduciary which is either a bankdisregarded, savings and loan association, insurance company or registered investment advisor, or if do not check LLC; check the employee benefit plan has total assets in excess of $5,000,000, or if a self-directed plan, its investment decisions are made solely by persons who are accredited investors; or _____ I am a private business development company as defined appropriate box in the Investment Advisors Act of 1940, as amended; or _____ I am a corporation, Massachusetts or similar business trust or partnership, or any line above for the tax exempt organization as defined in Section 501(c)(3) classification of the Internal Revenue Codesingle-member owner. Other (see instructions) a Exemption from FATCA reporting code (if any) (Applies to accounts maintained outside the U.S.) 5 Address (number, not formed for the specific purpose of acquiring Investor Securitiesstreet, with the total assets in excess of $5,000,000; and apt. or _____ I am a trust with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring Investor Securities, whose purchase is directedsuite no.) Requester’s name and address (optional)

Appears in 1 contract

Samples: Subscription Agreement

AutoNDA by SimpleDocs

Accredited Investor Certification. Please check response A SOCIAL INVESTMENT HOLDINGS, INC. To Whom It May Concern, This information is being furnished to you in order for you to determine whether my investment in the Shares (the “Shares”) of Social Investment Holdings, Inc. (the “Company”) is exempt from registration pursuant to Section 4(2) of the Securities Act of 1933, as amended (the “Securities Act”) or B as appropriate: _____ A. Regulation D promulgated thereunder (collectively, the “Securities Laws”). I am understand that (a) you will rely on the information contained herein for the purposes of such determination, (b) the Shares I receive will not be registered under the Securities Laws in reliance upon an exemption from registration, and (c) this Questionnaire is not an accredited investoroffer to me of the Shares or any other securities. _____ B. In accordance with the foregoing, the following representations and data are hereby given (please initial where indicated): Accredited Investor Representation I certify that I am an accredited investor investor” as defined in Rule 501(a) of Regulation D under the Securities Act because I am (please check select one or more of the appropriate responsefollowing): _____ I have an individual a net worth (or joint joining net worth with my spouse) in excess of $1,000,000; or _____ 1,000,000 calculated without including the value of my personal residence. I have had an individual income (not including any amounts attributable to spouse or to property owned by spouse) in excess of more than $200,000 in each of the previous two calendar most recent years and a reasonable expectation to reach the same income level in the current year; (or I had a joint income with my spouse in excess of $300,000 in each of the previous two calendar years those years) and have a reasonable expectation to reach of reaching the same income level in the current year; or _____ . I am a bank an entity (LLC, partnership, corporation or savings and loan association, whether acting other business organization) in its individual or fiduciary capacity; or _____ which all of the equity owners are accredited. I am a brokeran XXX, Xxxxx, SEP-dealer registered XXX or other retirement account in which all of the beneficiaries are accredited. In Witness Whereof, I have executed this Accredited Investor Certification this day of , 20 , and declare under oath that it is truthful and correct. Signature of Purchaser Name of Purchaser ANNEX B Purchaser Suitability Questionnaire SOCIAL INVESTMENT HOLDINGS, INC. To Whom It May Concern, This information is being furnished to you in order for you to determine whether my investment in Shares (the “Shares”) of Social Investment Holdings, Inc. (the “Company”) is exempt from registration pursuant to Section 15 4(2) of the Securities Exchange Act of 1934; 1933, as amended (the “Securities Act”) or _____ Regulation D promulgated thereunder (collectively, the “Securities Laws”). I am an insurance company; or _____ understand that (a) you will rely on the information contained herein for the purposes of such determination, (b) the Shares I am an investment company receive will not be registered under the Investment Company Act Securities Laws in reliance upon an exemption from registration, and (c) this Questionnaire is not an offer to me of 1940the Shares or any other securities. In accordance with the foregoing, the following representations and data are hereby given: Please initial next to each of the following statements: I can afford the complete loss of this investment. A complete loss of this investment will not have a material adverse impact on my current life style nor will it have a material adverse effect on my financial plans for retirement. I have such knowledge in financial and business matters as amended, or a business development company to be capable of evaluating the relative merits and risks of an investment in the Shares. The information contained in this Questionnaire is offered as defined in said Act; or _____ evidence of such knowledge and experience. I am a Small Business Investment Company licensed by willing and able to bear the U.S. Small Business Administration; or _____ economic risk of an investment in the Shares in an amount equal to the total purchase price. In making this statement, consideration has been given to whether I am a plan established can afford the risks of loss inherent in investments in securities. I offer the information below in this Questionnaire as evidence of my ability to bear the economic risk. Any purchase of Shares will be solely for my own account and maintained by a state, its political subdivisions or any agency or instrumentality thereof, not for the benefit account of its employeesany other person or with a view to any resale or distributions thereof. My commitment to illiquid investments in relation to my net worth and the acquisition of the Shares (which are illiquid) will not cause my overall commitment to illiquid securities to be excessive. My financial resources are such that I can pay (without consideration of the amounts invested in the Shares) any taxes due on my allocable share of gains and income from the Shares. I represent that (a) the information herein is complete and accurate and may be relied upon by you, and (b) that I will notify you of any material change in any of such information occurring prior to acceptance of my subscription. In Witness Whereof, I have executed this Purchaser Suitability Questionnaire this day of , 20 , and declare under oath that it is truthful and correct. Signature of Purchaser Name of Purchaser Form W-9 (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Print or type See Specific Instructions on page 2. 2 Business name/disregarded entity name, if such plan has total assets in excess of $5,000,000different from above 3 Check appropriate box for federal tax classification; or _____ I am an employee benefit plan within the meaning of Title I check only one of the Employment Retirement Income Security Act of 1974 following seven boxes: 4 Exemptions (“ERISA”)codes apply only to Individual/sole proprietor or single-member LLC C Corporation S Corporation Partnership Trust/estate certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Limited liability company. Enter the investment decision with respect to this investment tax classification (C=C corporation, S=S corporation, P=partnership) a Note. For a single-member LLC that is made by a plan fiduciary which is either a bankdisregarded, savings and loan association, insurance company or registered investment advisor, or if do not check LLC; check the employee benefit plan has total assets in excess of $5,000,000, or if a self-directed plan, its investment decisions are made solely by persons who are accredited investors; or _____ I am a private business development company as defined appropriate box in the Investment Advisors Act of 1940, as amended; or _____ I am a corporation, Massachusetts or similar business trust or partnership, or any line above for the tax exempt organization as defined in Section 501(c)(3) classification of the Internal Revenue Codesingle-member owner. Other (see instructions) a Exemption from FATCA reporting code (if any) (Applies to accounts maintained outside the U.S.) 5 Address (number, not formed for the specific purpose of acquiring Investor Securitiesstreet, with the total assets in excess of $5,000,000; and apt. or _____ I am a trust with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring Investor Securities, whose purchase is directedsuite no.) Requester’s name and address (optional)

Appears in 1 contract

Samples: Subscription Agreement

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!