Pennsylvania Residents. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person criminal and civil penalties.
Pennsylvania Residents. If you have accepted an offer to purchase these Certificates and have received a written notice explaining your right to withdraw your acceptance pursuant to section 207(m)(2) of the Pennsylvania Securities Act of 1972, you may elect, within two business days from the date of receipt by the issuer of your binding contract of purchase or, in the case of a transaction in which there is no binding contract of purchase, within two business days after you make the initial payment for the Certificates being offered, to withdraw you acceptance and receive a full refund of all moneys paid by you. Your withdrawal of acceptance will be without any further liability to any person. To accomplish this withdrawal, you need only send a written notice (including a notice by facsimile or electronic mail) to United Pentecostal Church Development Fund, Inc. indicating your intention to withdraw. Georgia Residents: See the Offering Circular for right of rescission.
Pennsylvania Residents. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties Oregon Residents : Any person who, knowingly and with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement that is relied upon by the insurer and is material to the content of the policy and to the risk assumed by the insurer, may be prosecuted for insurance fraud. There is no time limit on contestability in the event of fraud on the part of the insured.
Pennsylvania Residents. You have the right to withdraw from this purchase agreement and receive a full refund of all monies paid by you. The right must be exercised within two business days. The procedure to be followed in exercising the right is explained in the Offering Circular.
Pennsylvania Residents. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.
Pennsylvania Residents. Residents of the Commonwealth of Pennsylvania can only transfer the Securities offered hereby in accordance with the provisions of section 203(d) of the Pennsylvania Securities Act of 1972 and are subject to the following conditions:
Pennsylvania Residents. By purchasing an Investment Certificate pursuant to the exemption provided in Section 203(d) of the Pennsylvania Securities Act of 1972, Pennsylvania residents agree not to sell the securities purchased under the exemption within 12 months after the date of purchase, except in accordance with 64 Pennsylvania Code § 204.011 Security Number: Interest Rate: Representative: If you have additional questions about this application, please call (000) 000-0000. Please print clearly using a ballpoint pen. The offer and sale of Investment Certificates (“Certificates”) are subject to the terms of the United Pentecostal Church Development Fund, Inc. d/b/a United Pentecostal Church Loan Fund Offering Circular dated April 1, 2020, as may be supplemented, amended and restated (“Offering Circular”), which is incorporated herein by reference. The United Pentecostal Church Development Fund, Inc. d/b/a United Pentecostal Church Loan Fund reserves the right to refuse your application and not offer or sell any Certificate to you for any reason. □ NEW APPLICATION □ CHANGE OF INFORMATION Name Social Security or Tax I.D. Number Date of Birth: mo/day/year Email Address (optional) Address City State Zip ( ) ( ) ( ) Home Phone Work Phone Mobile Phone This application is to be used by individual applicants. You may select only one of the following additional ownership categories. If you do not select any of the following options, we will issue the Certificate solely in the name of the primary applicant. □ Joint Tenants. If you select this option, we will issue the Certificate to the primary applicant and joint applicant as joint tenants with right of survivorship, unless you elect below to hold this Certificate as tenants-in-common. We will honor the request of either co-owner to redeem a Certificate, effect a transfer or take any other action requiring the consent of the holder of the Certificate. Name Social Security or Tax I.D. Number Date of Birth: mo/day/year Email Address (optional) Address City State Zip ( ) ( ) ( ) Home Phone Work Phone Mobile Phone □ Tenants-in-Common. We elect to hold this Certificate as tenants-in-common, not as joint tenants with right of survivorship. For joint applications, please indicate the number of signatures required to process a redemption request: □ (1) □ (2) □ Trust. If you check this box, the Certificate will be issued in the name of the primary applicant, as trustee of the trust. If there is more than one trustee, each trustee must be identif...
Pennsylvania Residents. The undersigned hereby acknowledges that the Company is relying upon the exemption from registration of securities set forth in Section 203(d) of the Pennsylvania Securities Act of 1972, as amended (the "Pennsylvania Act") in connection with the sale of the Units to the undersigned. In accordance with the requirements of Section 203(d) of the Pennsylvania Act, the undersigned hereby agrees not to sell his Units within twelve (12) months from the date of purchase except pursuant to Section 204.01 of the Blue Sky Regulations of the Pennsylvania Securities Act of 1972. Additionally, the undersigned is aware of the right of withdrawal under Section 207(m) of the Act described in the introductory pages of the Memorandum.
Pennsylvania Residents. The undersigned, if a resident of the Commonwealth of Pennsylvania and if purchasing the Preferred Securities other than as an Institutional Investor or a Principal, as such terms are defined by Section 102(k) of the Pennsylvania Securities Act of 1972, as amended, (the "Pennsylvania Act") or Regulation 102.111 of Chapter 102 of Title 64 of the Pennsylvania Code, as amended, and Regulation 203.184 of Chapter 203 of Title 64 of the Pennsylvania Code, respectively, acknowledges that the certificates for the Preferred Securities will bear a restrictive legend and represents that the undersigned has completed and delivered the Agreement Not to Sell (in the form attached as Appendix A).
Pennsylvania Residents. By signing this Subscription Agreement, I acknowledge and understand (i) that I am prohibited from selling the Class BD Units for a period of 12 months after the date of purchase, except in accordance with waivers established by rule or order of the Pennsylvania Securities Commission, (ii) that the Class BD Units have not been registered under the Pennsylvania Securities Act of 1972 in reliance upon an exemption therefrom, and (iii) that no subsequent resale or other disposition of the Class BD Units may be made within 12 months following their initial sale in the absence of an effective registration, except in accordance with waivers established by rule or order of the Pennsylvania Securities Commission, and thereafter only pursuant to an effective registration or exemption.
