Applicable Categories. The Subscriber hereby certifies to the Company that the categories initialed below apply to the Subscriber. (The Subscriber must initial each applicable category.) ____ The Subscriber is a Shareholder that is a Benefit Plan Investor (as defined in Schedule 2). ____ The Subscriber is an Other Plan Investor (as defined in Schedule 2 – e.g., a “governmental” plan). ____ The Subscriber is a Tax-Exempt Subscriber (i.e., exempt from U.S. federal income taxation under Section 501 of the Code). ____ The Subscriber is a BHC Subscriber1 (i.e., a bank holding company registered under the BHC Act or a non-bank subsidiary thereof). ____ The Subscriber is a Foundation (as defined in Section 509 of the Code). ____ The Subscriber is a “United States person” for U.S. federal income tax purposes. ____ The Subscriber is a “charitable remainder trust” within the meaning of Section 664 of the Code. ____ The Subscriber is or may become a person (including an entity) that has discretionary authority or control with respect to the assets of the Company or a person who provides investment advice with respect to the assets of the Company or an “affiliate” of such a person. (For purposes of the foregoing, an “affiliate” is any person controlling, controlled by or under common control with any such person, including by reason of having the power to exercise a controlling influence over the management or policies of such person.) ____ The Subscriber is “Centerbridge Related” (i.e., an affiliate of the Company or the Advisor, or a director, officer, employee or agent of the Company or the Advisor or any of their respective affiliates). ____ The Subscriber is subject to the Freedom of Information Act, 5 U.S.C § 552 (“FOIA”), any state public records access laws, any state or other jurisdiction’s laws similar in intent or effect to FOIA, or any similar statutory or legal right that might result in the disclosure of confidential information relating to the Company (together with FOIA, “Public Disclosure Laws”). Please indicate the relevant Public Disclosure Laws to which the Subscriber is subject.
Applicable Categories. The Subscriber hereby certifies to the Company that the categories initialed below apply to the Subscriber. (The Subscriber must initial each applicable category.) ____ The Subscriber is a Stockholder that is a Benefit Plan Investor (as defined in Schedule 2). ____ The Subscriber is an Other Plan Investor (as defined in Schedule 2 – e.g., a “governmental” plan). ____ The Subscriber is a Tax-Exempt Partner (i.e., exempt from income taxation under §501 of the Internal Revenue Code). ____ The Subscriber is a BHC Subscriber1 (i.e., a bank holding company registered under the BHC Act or a non-bank subsidiary thereof). ____ The Subscriber is a Foundation Partner (as defined in §509 of the Internal Revenue Code). ____ The Subscriber is a “United States person” for U.S. federal income tax purposes. ____ The Subscriber is a “charitable remainder trust” within the meaning of Section 664 of the Code. ____ The Subscriber is or may become a person (including an entity) that has discretionary authority or control with respect to the assets of the Company or a person who provides investment advice with respect to the assets of the Company or an “affiliate” of such a person. (For purposes of the foregoing, an “affiliate” is any person controlling, controlled by or under common control with any such person, including by reason of having the power to exercise a controlling influence over the management or policies of such person.) ____ The Subscriber is “Stone Point Related” (i.e., an affiliate of the Company or the Adviser, or a director, officer, employee or agent of the Company or the Adviser or any of their respective affiliates).
Applicable Categories. To the extent permitted under applicable law, 1Life or One Medical Group will complete the background checks required below prior to Personnel performing Services.
Applicable Categories. The Subscriber hereby certifies to the Company that the categories initialed below apply to the Subscriber. (The Subscriber must initial each applicable category.) The Subscriber is a Shareholder that is a Benefit Plan Investor (as defined in Schedule 2). The Subscriber is an Other Plan Investor (as defined in Schedule 2 – e.g., a “governmental” plan). The Subscriber is a Tax-Exempt Partner (i.e., exempt from income taxation under §501 of the Internal Revenue Code). The Subscriber is a BHC Subscriber1 (i.e., a bank holding company registered under the BHC Act or a non-bank subsidiary thereof). The Subscriber is a Foundation Partner (as defined in §509 of the Internal Revenue Code). The Subscriber is a “United States person” for U.S. federal income tax purposes. The Subscriber is a “charitable remainder trust” within the meaning of Section 664 of the Code. The Subscriber is or may become a person (including an entity) that has discretionary authority or control with respect to the assets of the Company or a person who provides investment advice with respect to the assets of the Company or an “affiliate” of such a person. (For purposes of the foregoing, an “affiliate” is any person controlling, controlled by or under common control with any such person, including by reason of having the power to exercise a controlling influence over the management or policies of such person.)
Applicable Categories. The Subscriber hereby certifies to the Fund that the categories initialed below apply to the Subscriber. (The Subscriber must initial each applicable category.) ____ The Subscriber is a Shareholder that is a Benefit Plan Investor (as defined in Schedule 2). ____ The Subscriber is an Other Plan Investor (as defined in Schedule 2 – e.g., a “governmental” plan). ____ The Subscriber is a Tax-Exempt Partner (i.e., exempt from income taxation under §501 of the Internal Revenue Code). ____ The Subscriber is a BHC Subscriber1 (i.e., a bank holding company registered under the BHC Act or a non-bank subsidiary thereof). ____ The Subscriber is a Foundation Partner (as defined in §509 of the Internal Revenue Code). ____ The Subscriber is a “United States person” for U.S. federal income tax purposes. ____ The Subscriber is a “charitable remainder trust” within the meaning of Section 664 of the Code.
Applicable Categories. The Subscriber hereby certifies to the Company that the categories initialed below apply to the Subscriber. (The Subscriber must initial each applicable category.) ____ The Subscriber is a Shareholder that is a Benefit Plan Investor (as defined in Schedule 2). ____ The Subscriber is an Other Plan Investor (as defined in Schedule 2 – e.g., a “governmental” plan). ____ The Subscriber is a Tax-Exempt Subscriber (i.e., exempt from U.S. federal income taxation under Section 501 of the Code). ____ The Subscriber is a BHC Subscriber1 (i.e., a bank holding company registered under the BHC Act or a non-bank subsidiary thereof). ____ The Subscriber is a Foundation (as defined in Section 509 of the Code). ____ The Subscriber is a “United States person” for U.S. federal income tax purposes. ____ The Subscriber is a “charitable remainder trust” within the meaning of Section 664 of the Code. ____ The Subscriber is or may become a person (including an entity) that has discretionary authority or control with respect to the assets of the Company or a person who provides investment advice with respect to the assets of the Company or an “affiliate”
