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: 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) (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: (___) 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 SecuritiesPreferred 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: (___) 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: :__________ 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: 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 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 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: 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 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 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 SecuritiesPreferred 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 Resident 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, ) 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: 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 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.