Confidential Purchaser Questionnaire. INSTRUCTIONS: This Purchaser Questionnaire (this “Questionnaire”) is to be completed and executed by prospective investors interested in purchasing common shares of Vsurance, Inc., a Nevada corporation (the “Company”). The Shares being offered are sometimes hereinafter referred to as the “Securities.” Purchasers must meet, among others, certain standards imposed by Regulation D as adopted by the Securities and Exchange Commission under the Securities Act of 1933, as amended (the “Securities Act”), because neither the Securities nor the shares of Common Stock underlying the Securities have been registered under the Securities Act, and are being sold in reliance upon the exemption provided by Section 4(2) of the Securities Act and/or Rule 506 promulgated thereunder. The undersigned acknowledges and agrees that the Company is relying on the undersigned’s representations contained in this Questionnaire and the related subscription documents in determining whether to accept the subscription. The Company reserves the right to request additional information, financial or otherwise, from potential investors if necessary for verification purposes. Your answers will, at all times, be kept strictly confidential; however, everyone who agrees to purchase Securities hereby agrees that the Company may present this Questionnaire to such parties as necessary in order to assure itself that the offer and sale of Securities to you will not result in a loss of the exemption from registration under the Securities Act, which is being relied upon by the Company in connection with the sale of the Securities. Individual Investors should complete the Individual Purchaser Questionnaire beginning on page A-1. Trusts should complete the Trust Questionnaire beginning on page B-1. Partnerships should complete the Partnership Questionnaire beginning on page C-1. Corporations should complete the Corporation Questionnaire beginning on page D-1. Limited Liability Companies should complete the Limited Liability Company Questionnaire beginning on page E-1. IMPORTANT: Please Complete Investor Name: The information contained in this Questionnaire is being furnished in order to determine whether the undersigned’s subscription to purchase the Securities of Vsurance, Inc. may be accepted. All information contained in this Questionnaire will be treated confidentially. The undersigned understands, however, that the Company may present this Questionnaire to such parties as it deems appropriate if call...
Confidential Purchaser Questionnaire. Please complete the Purchaser Questionnaire. Please note that there are separate questionnaires for “individual,” “trust,” “partnership,” “corporation” and “limited liability company” purchasers. In order to participate in the offering, you must demonstrate that you are an accredited investor (as such term is defined in Section 501(c) of the Securities Act of 1933, as amended (the “Securities Act”)) and that you have such knowledge and expertise in business and financial matters and that you are capable of evaluating the merits and risks of an investment in the Company. Any capitalized term used herein and not defined shall have the respective meaning ascribed to it in that certain Securities Purchase Agreement of even date herewith.
Confidential Purchaser Questionnaire. The purpose of the following information is to assure the Company may rely on the exemptions from the registration requirements of the Securities Act, afforded by Section 4(a)(2) of the Securities Act and/or Regulation D promulgated under the Securities Act, and of any applicable state statutes or regulations. Please answer every question. Your answers will at all times be kept strictly confidential. However, by signing an Purchaser Questionnaire, you agree that the Company may present such Purchaser Questionnaire to such parties as it deems appropriate if called upon to verify the information provided or to establish the availability of an exemption from registration under Section 4(a)(2) of the Securities Act, Regulation D or any state securities statutes or regulations, or if the contents are relevant to any issue in any action, suit or proceeding to which the Company or any agent of the Company involved in offering the debentures and warrants is a party or by which it is or may be bound. Your investment will not be accepted until the Company determines that you satisfy all of the suitability standards.
(a) The Purchaser represents and warrants that he, she or it comes within one category marked below, and that for any category marked, he, she or it has truthfully set forth, where applicable, the factual basis or reason the Purchaser comes within that category. ALL INFORMATION IN RESPONSE TO THIS SECTION WILL BE KEPT STRICTLY CONFIDENTIAL. The undersigned agrees to furnish any additional information which the Company deems necessary in order to verify the answers set forth below. Category A ___ The undersigned is an individual (not a partnership, corporation, etc.) whose individual net worth, or joint net worth with his or her spouse, presently exceeds $1,000,000.
Confidential Purchaser Questionnaire. Anavex Life Sciences Corp. Annex A US PERSONS
Confidential Purchaser Questionnaire. INFORMATION TO BE PROVIDED BY ALL INVESTORS.
Confidential Purchaser Questionnaire. The undersigned Purchaser represents and warrants that he, she or it comes within one category marked below, and that for any category marked, he, she or it has truthfully set forth, where applicable, the factual basis or reason the Purchaser comes within that category. ALL INFORMATION IN RESPONSE TO THIS SECTION WILL BE KEPT STRICTLY CONFIDENTIAL. The undersigned agrees to furnish any additional information which the Company deems necessary in order to verify the answers set forth below. Category A The undersigned is an individual (not a partnership, corporation, etc.) who’s individual net worth, or joint net worth with his or her spouse, presently exceeds $1,000,000.
Confidential Purchaser Questionnaire. INVESTORS MUST ANSWER EACH QUESTION UNLESS DIRECTED TO PROCEED TO A LATER SECTION. INCOMPLETE QUESTIONNAIRES WILL BE RETURNED AND MAY CAUSE DELAYS IN THE INVESTMENT. BECAUSE THE GENERAL PARTNER WILL RELY ON YOUR ANSWERS IN ORDER TO COMPLY WITH FEDERAL AND STATE LAWS, YOU MUST CAREFULLY ANSWER EACH QUESTION. PURCHASERS CAN BE HELD LIABLE FOR ANY MISSTATEMENT OR OMISSION IN THIS QUESTIONNAIRE.
Confidential Purchaser Questionnaire. All subscribers must complete all sections and sign on the last page. The Confidential Purchaser Questionnaire is attached hereto as Exhibit A. 3.
Confidential Purchaser Questionnaire. THIS QUESTIONNAIRE MUST BE ANSWERED FULLY AND RETURNED ALONG WITH YOUR COMPLETED SUBSCRIPTION AGREEMENT IN CONNECTION WITH YOUR PROSPECTIVE PURCHASE OF UNITS FROM ICAGEN, INC. (THE “COMPANY”). THE INFORMATION SUPPLIED IN THIS QUESTIONNAIRE WILL BE HELD IN STRICT CONFIDENCE. NO INFORMATION WILL BE DISCLOSED EXCEPT TO THE EXTENT THAT SUCH DISCLOSURE IS REQUIRED BY LAW OR REGULATION, OTHERWISE DEMANDED BY PROPER LEGAL PROCESS OR IN LITIGATION INVOLVING THE COMPANY AND ITS CONTROLLING PERSONS. Capitalized terms used herein without definition shall have the respective meanings given such terms as set forth in the Subscription Agreement between Icagen, Inc. and the subscriber signatory thereto (the “Subscription Agreement”).
Confidential Purchaser Questionnaire. Purpose of this Questionnaire Up to 33 Units, each Unit consisting of 28,571 shares of Common Stock, 28,571 Common Stock A Purchase Warrants and 28,571 Common Stock B Purchase Warrants of EuroWeb International Corp., a Delaware corporation (the "Company"), are being offered pursuant to a Confidential Private Offering Memorandum of the Company dated April 2, 1999, without registration under the Securities Act of 1933, as amended (the "Act"), or the securities laws of some states, in reliance on the private offering exemptions contained in Sections 3(b), 4(2) and/or 4(6) of the Act and/or in Rule 506 of the General Rules and Regulations under the Act ("Rule 506"), and in reliance on similar exemptions under applicable state laws. The Company must determine that an organization meets certain suitability requirements before selling (or, in some states, offering) Units to such entity. This Questionnaire does not constitute an offer to sell or a solicitation of an offer to buy Units or any other security. THE COMPANY WILL NOT OFFER OR SELL UNITS TO ANY CORPORATION, TRUST, PARTNERSHIP OR SIMILAR ENTITY UNLESS A QUESTIONNAIRE HAS BEEN DULY COMPLETED ON BEHALF OF SUCH ENTITY, AND ON THE BASIS OF THE INFORMATION SET FORTH THEREIN THE COMPANY HAS CONCLUDED THAT THE ENTITY IS AN "ACCREDITED INVESTOR." INSTRUCTIONS One (1) copy of this Questionnaire should be completed, signed, dated and delivered to EuroWeb International Corp., 000 Xxxx Xxxxxx, Xxx Xxxx, XX 00000. Please contact Xxxxx X. Xxxxx, Counsel to EuroWeb International Corp., (000) 000-0000 if you have any questions with respect to the Questionnaire.
