Accredited Investor Status for Entities Sample Clauses

Accredited Investor Status for Entities. Check all boxes which apply (XXX Entities can skip this question and go to (b)): o The Entity was not formed for the specific purpose of investing in the Company o The Entity has total assets in excess of $5 million dollars

Accredited Investor Status for Entities. (INVESTORS WHO ARE INDIVIDUALS SHOULD IGNORE THESE QUESTIONS.) (a) The entity is a (please check the applicable response): ¨ Corporation ¨ Limited Liability Company ¨ Partnership ¨ Revocable Trust ¨ Irrevocable Trust (If the Investor is an Irrevocable Trust, a supplemental questionnaire, which is contained on the page following the Entity Investor signature page of this Subscription/Registration Rights Agreement, must be completed by the person directing the investment decision for the trust.) ¨ Employee Benefit Plan Trust ¨ Individual Retirement Account (If you are an IXX, skip (b)) ¨ Other (please indicate): _____________________________ (b) Check all responses that apply: ¨ The Entity was not formed for the specific purpose of investing in the Company. ¨ The Entity has total assets in excess of $5 million. ¨ For Employee Benefit Plan Trusts Only: The decision to invest in the Company was made by a plan fiduciary, as defined in Section 3(21) of ERISA, who is either a bank, insurance company or registered investment advisor. (c) If you did not check the first two of the three boxes in Question (b) or if the Entity is an Individual Retirement Account or a Self-directed Employee Benefit Plan Trust, list the name of each person who: (i) owns an equity interest in the Entity (i.e., each shareholder if the Entity is a corporation, each member if the Entity is a limited liability company and each partner if the Entity is a partnership); or (ii) is a grantor for the revocable trust or Individual Retirement Account; or (iii) is the person making the investment decision for a self-directed Employee Benefit Plan Trust. ___________________________ __________________________ ___________________________ __________________________

Accredited Investor Status for Entities. Check all boxes which apply: o The Entity was not formed for the specific purpose of investing in the Company o The Entity has total assets in excess of $5 million dollars (Both statements above need to apply in order for an entity to qualify as an Accredited Investor) The undersigned Investor hereby confirms the information set forth above is true and correct in all respects as of the date hereof and will be on the date of the purchase of Common Stock. INVESTOR: ________________________ Signature of Authorized Signatory Name: _____________________________ Title: ______________________________ Date: ______________________________ The foregoing subscription is accepted and the Company hereby agrees to be bound by its terms. XXXXXXXXXXXXXXX.XXX INC. By: _________________________________ Name: _______________________________ Title: ________________________________ Date: ________________________________ Please T/T remit USD funds to the following: Pay to : For Account of : In Favor of : Payment details : Message : MAS (Monetary Authority) implementation wef 1Jul07 - All incoming funds from all over the world, the remitting bank must provide under field 50K "ordering customer" the following information: