Subscriber as an Individual Investor. The Subscriber’s investment in the Company is being made (please check one and any corresponding box underneath the appropriate category): ☐ as an individual. ☐ with the Subscriber’s spouse (please check one):1 ☐ as joint tenants with rights of survivorship. ☐ as tenants in common. ☐ as community property. ☐ through a revocable trust established to facilitate distribution of the Subscriber’s estate and there are ___ living grantor(s) and ___ beneficiary(ies) other than the grantors (determined by treating any person indirectly owning an interest in the trust through one or more pass-through entities (i.e., limited liability companies treated as a partnership for income tax purposes, partnerships, S corporations and trusts) as if such person were a beneficiary). If the Subscriber is investing through a revocable trust, the Subscriber further represents that: (Please indicate whether the following representations are applicable by checking the appropriate box.)
Subscriber as an Individual Investor. The Subscriber’s investment in the Company is being made (please check one and any corresponding box underneath the appropriate category): ☐ as an individual. ☐ with the Subscriber’s spouse (please check one)1: ☐ as joint tenants with rights of survivorship. ☐ as tenants in common. ☐ as community property. ☐ through a revocable trust established to facilitate distribution of the Subscriber’s estate and there are living grantor(s) and beneficiary (ies) other than the grantors (determined by treating any person indirectly owning an interest in the trust through one or more pass-through entities (i.e., limited liability companies treated as a partnership for income tax purposes, partnerships, S corporations and trusts) as if such person were a beneficiary). If the Subscriber is investing through a revocable trust, the Subscriber further represents that: (Please indicate whether the following representations are applicable by checking the appropriate box.)
Subscriber as an Individual Investor. The Subscriber’s investment in the Company is being made (please check one and any corresponding box underneath the appropriate category): ◻ as an individual. ◻ with the Subscriber’s spouse (please check one)1: ◻ as joint tenants with rights of survivorship. ◻ as tenants in common. ◻ as community property. ◻ through a revocable trust established to facilitate distribution of the Subscriber’s estate and there are ___ living grantor(s) and ___ beneficiary (ies) other than the grantors (determined by treating any person indirectly owning an interest in the trust through one or more pass-through entities (i.e., limited liability companies treated as a partnership for income tax purposes, partnerships, S corporations and trusts) as if such person were a beneficiary). If the Subscriber is investing through a revocable trust, the Subscriber further represents that: (Please indicate whether the following representations are applicable by checking the appropriate box.) substantially all of the value of each beneficial owner’s interest (direct or indirect) in the trust is not attributable to such trust’s interest (direct or indirect) in the Company. (Please check one.) ◻ Yes ◻ No ◻ through an Individual Retirement Account (For U.S. domestic Subscribers only. Does not apply to foreign Subscribers.) ◻ through the Subscriber’s self-directed Xxxxx Plan Account. ◻ through another self-directed employee benefit plan as defined in Title I of ERISA. 1 Any Co-Owner other than a spouse must submit a separate subscription agreement. ANNEX A – FOR INDIVIDUAL SUBSCRIBERS ONLY
