Additional Subscriber Information. The subscriber, named above, certifies the following under penalties of perjury:
Additional Subscriber Information. Subscriber agrees to provide any additional documentation the Company may reasonably request, including (without limitation) “know your customer” documentation and/or as may be required by the Company (or its agent) to form a reasonable basis that the Subscriber qualifies as an “accredited investor,” or otherwise as a “qualified purchaser” as defined in Regulation A, or as may be required by the securities administrators or regulators of any state, to confirm that the Subscriber meets any applicable minimum financial suitability standards and has satisfied any applicable maximum investment limits. Subscriber acknowledges that Subscriber’s responses to questions on the Portal are true, complete and accurate in all respects. Payment information provided by Subscriber through the Portal is true, accurate and correct and such payment information shall be deemed to be a part of this Subscription Agreement as if and to the same extent that such information was set forth herein. Notwithstanding anything to contrary, if any portion of any payment by Subscriber of any portion of the Purchase Price is returned, charged-back or otherwise not valid, Company shall have the exclusive right to offset and void each Share allocable to such amount upon notice and demand.
Additional Subscriber Information. The Subscriber certifies the following under penalties of perjury:
Additional Subscriber Information. Iroquois Valley requires information for all natural persons associated with the investment. Please complete the following information for all natural persons associated with, or benefitting from, the investment.
Additional Subscriber Information. MUST BE COMPLETED
Additional Subscriber Information. 1. Number and kind of securities of the Issuer held, directly or indirectly, if any: 2. State whether Subscriber is an Insider of the Issuer: Yes No Subscriber Information: (Name of Subscriber) Account Reference (if applicable): By: Authorized Signature (Official Capacity or Title – if the Subscriber is not an individual) (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Subscriber’s Address, including Municipality and Province) (Telephone Number) (Email Address) If the Subscriber is signing as agent for a principal and is not deemed to be purchasing as principal pursuant to NI 45-106 (as defined herein) by virtue of being either: (i) a trust company or trust corporation acting on behalf of a fully managed account managed by the trust company or trust corporation, as the case may be; or (ii) a person acting on behalf of a fully managed account managed by it, and in each case satisfying the criteria set forth in NI 45-106, complete the following and ensure that Schedule B, if applicable, is completed in respect of such principal: Name of Principal Principal's Address City/Town Province Postal Code Principal's Telephone Number -OR- E-mail Address ACCEPTANCE: The Corporation hereby accepts the subscription as set forth above on the terms and conditions contained in this Subscription this day of , 202[●]. Per:
Additional Subscriber Information. Account Reference (if applicable): 1. Number and kind of securities of the Issuer held, directly or indirectly, if any: By: Authorized Signature 2. State whether Subscriber is an Insider of the Issuer: Yes ☐ No ☐ (Official Capacity or Title – if the Subscriber is not an individual) (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) Name of Principal (Subscriber’s Address, including Municipality and Province) Principal's Address City/Town Province Postal Code (Telephone Number) (Email Address) Principal's Telephone Number -OR- E-mail Address
Additional Subscriber Information. Account Reference (if applicable):____________________ 1. Number and kind of securities of the Issuer held, directly or indirectly, if any: Authorized Signature
Additional Subscriber Information. DECLARATIONS
Additional Subscriber Information. The Subscriber further represents and warrants that the following information is true and complete: Name of Subscriber: Date of Birth: Name of Joint Subscriber, if any: Date of Birth: Amount of Initial Capital Contribution: $ Subscriber’s Social Security or Taxpayer ID No.: (A Subscriber who does not have a Social Security or Taxpayer ID number will not be admitted to the Partnership, unless the General Partner expressly waives such requirement.) Type of owner or form of ownership: Individual Joint Tenants With Right of Survivorship IRA Partnership Tenants in Common Xxxxx Plan Corporation Employee Benefit Plan Other Trust Limited Liability Company Specify: Address (Principal State of Residence): Mailing Address, if different: Telephone number: Fax number: Email: Name of Remitting Bank: Address: SWIFT/ABA/CHIPS/UID: Account name: Account number: Under Reference: Value Date for Capital Contribution: Unless notified otherwise, the Partnership will use the foregoing bank account details in the case of withdrawals. If the Subscriber is a corporation, limited liability company, partnership or a trust, please provide the names and addresses of the officers, directors, partners, managers, members and principal beneficiaries, as the case may be. To the extent the context permits, all of the information in this questionnaire is furnished on behalf of and is applicable to each of the persons listed below. The General Partner may require any one of these individuals to complete a separate Investor Questionnaire.
