IN WHICH TITLE IS TO BE HELD. (circle one)
(a) Individual Ownership (b) Community Property (c) Joint Tenant with Right of Survivorship (both parties must sign) (d) Partnership* (e) Tenants in Common (f) Company* (g) Trust* (h) Other *If Units are being subscribed for by an entity, the attached Certificate of Signatory must also be completed.
IN WHICH TITLE IS TO BE HELD. ☐ Community Property* ☐ Individual Property ☐ Joint Tenancy With Right of s_ Separate Property Survivorship* ☐ Separate Property ☐ Corporate or Fund Owners ** ☐ Tenants-in-Common* ☐ Pension or Profit Sharing Plan ☐ Tenants-in-Entirety* ☐ Trust or Fiduciary Capacity (trust documents must accompany this form) ☐ Kxxxx Plan ☐ Fiduciary for a Minor ☐ Individual Retirement Account * Signature of all parties required ** In the case of a Fund, state names of all partners. ☐ Other (Please indicate) Mxxx X. Xxx DATE Mxxx X. Xxx Zerify, Inc.
IN WHICH TITLE IS TO BE HELD. (circle one)
(a) Individual Ownership (b) CommSharey Property (c) Joint Tenant with Right of Survivorship (both parties must sign) (d) Partnership* (e) Tenants in Common
IN WHICH TITLE IS TO BE HELD. (circle one)
IN WHICH TITLE IS TO BE HELD. ☐ Community Property* ☐ Individual Property
IN WHICH TITLE IS TO BE HELD. ¨ Individual o Joint Tenancy With Right of Survivorship*
IN WHICH TITLE IS TO BE HELD. ☐ Community Property* ☐ Individual Property ☐ Joint Tenancy With Right of s_ Separate Property Survivorship* ☐ Separate Property ☐ Corporate or Fund Owners ** ☐ Tenants-in-Common* ☐ Pension or Profit Sharing Plan ☐ Tenants-in-Entirety* Trust or Fiduciary Capacity (trust documents must accompany this form) ☐ Xxxxx Plan Fiduciary for a Minor ☐ Individual Retirement Account * Signature of all parties required** In the case of a Fund, state names of all partners. ☐ Other (Please indicate) Xxxx X. Xxx DATE Xxxx X. Xxx StrikeForce Technologies, Inc. The following information is furnished to you in order for you to determine whether the undersigned is qualified to purchase shares of Common Stock (the “Shares”) in the above referenced Company pursuant to Section 3(b) of the Securities Act of 1933, as amended (the “Act”), Regulation A promulgated thereunder, and appropriate provisions of applicable state securities laws. I understand that you will rely upon the following information for purposes of such determination, and that the Shares will not be registered under the Act in reliance upon the exemption from registration provided by Section 3(b) of the Act, Regulation A, and appropriate provisions of applicable state securities laws. ALL INFORMATION CONTAINED IN THIS QUESTIONNAIRE WILL BE TREATED CONFIDENTIALLY. However, I agree that you may present this questionnaire to such parties as you deem appropriate if called upon to establish that the proposed offer and sale of the Shares is exempt from registration under the Act or meets the requirements of applicable state securities laws.
IN WHICH TITLE IS TO BE HELD. ☐ Direct
IN WHICH TITLE IS TO BE HELD. (check one)
(a) Individual Ownership (b) _____ Community Property (c) _____ Joint Tenant with Right of Survivorship (both parties must sign) (d) _____ Partnership (e) _____ Tenants in Common (f) _____ Corporation
IN WHICH TITLE IS TO BE HELD. Community Property* /_/ Individual Property /_/ Joint Tenancy With Right of Survivorship* /_/ Separate Property /_/ Corporate or Fund Owners** /_/ Tenants-in-Common* /_/ Pension or Profit Sharing Plan /_/ Tenants-in-Entirety* /_/ Trust or Fiduciary Capacity (trust documents must accompany this form) /_/ Kxxxx Plan /_/ Fiduciary for a Minor /_/ Individual Retirement Account /_/ Other (Please indicate) * Signature of all parties required ** In the case of a Fund, state names of all partners.
