Common use of Background Information Clause in Contracts

Background Information. Name of Beneficial Owner of the Securities:_____________________________________________ Business Address:________________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)__________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:___________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ No ¨ If an individual: Residence Address:_______________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) __________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the Corporation? Yes ¨ No ¨ Social Security or Taxpayer Identification No. ___________________________________________________

Background Information. Name of Beneficial Owner of the Securities:Shares: _____________________________________________ Business Address:________________________________________________________________ (Number and Street) Business Address: _________________________________________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)__________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:___________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ No ¨ If an individual: Residence Address:_______________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) __________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: __________________________ Set forth in the space provided below the state(s)If a corporation, if anypartnership, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each statelimited liability company, trust or other entity: Are you a director or executive officer Type of the Corporation? Yes ¨ No ¨ Social Security or Taxpayer Identification No. entity: ____________________________________________________________________________________________________________ Were you formed for the purpose of investing in the securities being offered? Yes _____ No _____ If an individual: Residence Address: ___________________________________________________________________________________________________ (Number and Street) ____________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) _________________________________________________________________________________________ Age:______ Citizenship: ____________________________ Where registered to vote: __________________________________________ If an individual, set forth in the space provided below the state in the United States in which you maintain your residence: If an entity, set forth in the space provided below the state in the United States in which you made your investment decision: Are you a director or executive officer of the Company? Yes _____ No _____ Social Security or Taxpayer Identification No.: _____________________________________________________

Background Information. Name of Beneficial Owner of the Securities:Shares: _________________________________________________________ Business Address:: ___________________________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)__________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:___________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ No ¨ If an individual: Residence Address:_______________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) _____________________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity: ______________________________________________________________________________ Were you formed for the purpose of investing in the securities being offered? Yes ____ No ____ If an individual: Residence Address: __________________________________________________________________________ (Number and Street) __________________________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) _____________________________________________________________________ Age: :__________ Citizenship: ____________ Where registered to vote: _______________ Set If an individual, set forth in the space provided below the state(s), if any, state in the United States in which you maintained maintain your residence during residence: If an entity, set forth in the past two years and space provided below the dates during state in the United States in which you resided in each statemade your investment decision: Are you a director or executive officer of the CorporationCompany? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. _____________________________________________________

Background Information. Name of Beneficial Owner of the Securities:ADSs: _____________________________________________ Business Address:________________________________________________________________ (Number and Street) Business Address: ___________________________________________________________________________________________ (Number and Street) (City) (State) (Zip Code) Telephone Number: (___)) ______________________________________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:: ___________________________________________________________________________________________ State of formation:______________________ Approximate Date date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ ____ No ¨ ____ If an individual: Residence Address:: _______________________________________________________________ (Number and Street) ______________________________________________________________________________ (Number and Street) (City) (State) (Zip Code) Telephone Number: (___) ______________________________________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the CorporationCompany? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. ______________________________________________________________________

Background Information. Name of Beneficial Owner of the Securities:: _________________________________________________ Business Address:: __________________________________________________________________________________ (Number and Street) __________________________________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)_________) _________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:__________________: _________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ ____ No ¨ ____ If an individual: Residence Address:: __________________________________________________________________________________ (Number and Street) __________________________________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) __________________________________________________________ Age: Age:­­­­­­­­ ­__________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the Corporation? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. ___________________________________________________

Background Information. Name of Beneficial Owner of the Securities:_____________________________________________ Business Address:___________________________________________________________________ (Number and Street) Business Address: ________________________________________________________________________________________ (Number and Street) (City) (State) (Zip Code) Telephone Number: (( ) ___)_______________________________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:_____________________________________________________________________________________________ State of formation:__: ____________________ Approximate Date of formation: :_______________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ ____ No ¨ ____ If an individual: Residence Address:_______________________________________________________________ (Number and Street) ______________________________________________________________________________ (Number and Street) (City) (State) (Zip Code) Telephone Number: (( ) ___) ___________________________________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the Corporation? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. ._______________________________________________________________________

Background Information. Name of Beneficial Owner of the Securities:_____________________________________________ Business Address:________________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)__________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:___________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ ____ No ¨ ____ If an individual: Residence Address:_______________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) __________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the Corporation? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. ___________________________________________________

Background Information. Name of Beneficial Owner of the Securities:: _____________________________________________________________________________ Business Address:__________________________________________________________________________________________________ (Number and Street) _______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)) ____________________________________________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:__________________: _________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ ____ No ¨ ____ If an individual: Residence Address:: ________________________________________________________________________________________________ (Number and Street) ________________________________________________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) ____________________________________________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the Corporation? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. ___________________________________________________

Background Information. Name of Beneficial Owner of the Securities:________________________________________________ Business Address:_____________________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)__________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:___________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ No ¨ If an individual: Residence Address:_______________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) _______________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:_________________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Set forth in the space provided below the (i) state(s), if any, in the United States in which you maintained your principal office during the past two years and the dates during which you maintained your office in each state, and (ii) state(s), if any, in which you pay income taxes: ____________________________ ____________________________ ____________________________ Were you formed for the purpose of investing in the securities being offered? Yes ____ No ____ If an individual: Residence Address:____________________________________________________________________ (Number and Street) ____________________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) _______________________________________________________________ Age: ___________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the Corporation? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. .___________________________________________________

Background Information. Name of Beneficial Owner of the Securities:_____: ________________________________________ Business Address:___: _____________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)_____) _____________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:___: ________________________________________________________________ State of formation:: _____________________________________________________________ Approximate Date of formation: __________________________________________________ Were you formed for the purpose of investing in the securities Securities being offered? Yes ¨ ____ No ¨ ____ If an individual: Residence Address:___: ____________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (_____) __________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the Corporation? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. ___________________________________________________

Background Information. Name of Beneficial Owner of the SecuritiesShares:_____________________________________________ Business Address:____________________________________________________________ (Number and Street) ___________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) ______________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:_______________________________________________________________ Were you formed for the purpose of investing in the securities being offered? Yes ____ No ____ If an individual: Residence Address:___________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)______________________________________________________ Age: _____________ Citizenship: ____________ Where registered to vote:________ If an individual, set forth in the space provided below the state in the United States in which you maintain your residence: If an entity, set forth in the space provided below the state in the United States in which you made your investment decision: Are you a corporation, partnership, limited liability company, trust director or other entity: Type executive officer of entity:the Company? Yes ____ No ____ Social Security or Taxpayer Identification No.___________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ No ¨ If an individual: Residence Address:_______________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) __________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the Corporation? Yes ¨ No ¨ Social Security or Taxpayer Identification No. ___________________________________________________

Background Information. Name of Beneficial Owner of the Securities:ADSs: ________________________________________________________________________ Business Address:: __________________________________________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)__________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:___________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ No ¨ If an individual: Residence Address:_______________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) ____________________________________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity: _____________________________________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ____ No ____ If an individual: Residence Address: _________________________________________________________________________________________ (Number and Street) ___________________________________________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) ____________________________________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the CorporationCompany? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. _____________________________________________________________________

Background Information. Name of Beneficial Owner of the SecuritiesShares:____________________________________________________________ Business Address:_______________________________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)__________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:___________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ No ¨ If an individual: Residence Address:_______________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) __________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s)If a corporation, if anypartnership, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each statelimited liability company, trust or other entity: Are you a director or executive officer Type of the Corporation? Yes ¨ No ¨ Social Security or Taxpayer Identification No. entity:__________________________________________________________________________________ Were you formed for the purpose of investing in the securities being offered? Yes ____ No ____ If an individual: Residence Address:______________________________________________________________________________ (Number and Street) ______________________________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) _________________________________________________________________________ Age:­­­­­­­­ ­__________ Citizenship: ____________ Where registered to vote: _______________ If an individual, set forth in the space provided below the state in the United States in which you maintain your residence: If an entity, set forth in the space provided below the state in the United States in which you made your investment decision: Are you a director or executive officer of the Company? Yes ____ No ____ Social Security or Taxpayer Identification No._________________________________________________________

Background Information. Name of Beneficial Owner of the Securities:: _______________________________________________________________ Business Address:: ___________________________________________________________________________________ (Number and Street) __________________________________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)_____________________________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:: _____________________________________________________________________________________ State of formation:______________________ Approximate Date of formation: __________________________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ ____ No ¨ ____ If an individual: Residence Address:: __________________________________________________________________________________ (Number and Street) __________________________________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) )______________________________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the Corporation? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. ______________________________________________________________

Background Information. Name of Beneficial Owner of the Securities:_____________________________________________ Business Address:________________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)__________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:___________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ No ¨ If an individual: Residence Address:_______________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) _________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:__________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ____ No ____ If an individual: Residence Address:______________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) _________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the Corporation? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. ___________________________________________________.

Background Information. Name of Beneficial Owner of the Securities:_____________________________________________ : Business Address:________________________________________________________________ (Number and Street) City: _________________ State: ___________ Zip Code: ______________________________ Telephone Number: _______________________ (City) (State) (Zip Code) Telephone Number: (___)__________________________________________________________ US_ACTIVE\122682223\V-9 If a corporation, partnership, limited liability company, trust or other entity: Type of entity:__________________________________________: _________________________ State of formation:_: _____________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities Securities being offered? Yes ¨  No ¨  If an individual: Residence Address:__________: _____________________________________________________ (Number and Street) City: _________________ State: _________ Zip Code: ___________ Telephone Number: _______________________ Age: __________ Citizenship: _________ Where registered to vote: _______ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: __________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) __________________________________________________________ Age: __________ Citizenship: ____________ Where registered to voteAre you a director or executive officer of the Corporation? Yes  No  Social Security or Taxpayer Identification No.: ________________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the Corporation? Yes ¨ No ¨ Social Security or Taxpayer Identification No. ___________________________________________________US_ACTIVE\122682223\V-9

Background Information. Name of Beneficial Owner of the Securities:_____________________________________________ Business Address:________________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)) __________________________________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:___________________________________________________________________ State of formation:______________________ Approximate Date of formation: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ ____ No ¨ ____ If an individual: Residence Address:_______________________________________________________________ (Number and Street) ______________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) __________________________________________________________ Age: __________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the Corporation? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. .___________________________________________________

Background Information. Name of Beneficial Owner of the Securities:Preferred Shares: ______________________________________________ Business Address:: ________________________________________________________________________ (Number and Street) ________________________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___)____________________) ______________________________________ If a corporation, partnership, limited liability company, trust or other entity: Type of entity:_____________________: ______________________________________________ State Were you formed for the purpose of formation:investing in the securities being offered? Yes ____ No ____ Social Security or Taxpayer Identification No. _____________________ Approximate Date of formationIf an individual: Residence Address: ____________________ Were you formed for the purpose of investing in the securities being offered? Yes ¨ No ¨ If an individual: Residence Address:_______________________________________________________________ (Number and Street) __________________________________________________________________________________________ (City) (State) (Zip Code) Telephone Number: (___) __________________________________________________________ Age: :__________ Citizenship: ____________ Where registered to vote: _______________ Set forth in the space provided below the state(s), if any, in the United States in which you maintained your residence during the past two years and the dates during which you resided in each state: Are you a director or executive officer of the CorporationCompany? Yes ¨ ____ No ¨ ____ Social Security or Taxpayer Identification No. ________________________________________________________