Supplemental Data for Entities. 1. If the Investor is not a natural person, furnish the following supplemental data (natural persons may skip this Section C of the Investor Questionnaire): Legal form of entity (trust, corporation, partnership, etc.): _________________________ Jurisdiction of organization: ________________________________________________
2. Was the Investor organized for the specific purpose of acquiring the Shares? o Yes o No If the answer to the above question is “Yes,” please contact _______, ________, at _______ or ________ for additional information that will be required.
3. Are shareholders, partners or other holders of equity or beneficial interest in the Investor able to decide individually whether to participate, or the extent of their participation, in the Investor’s investment in the Company (i.e., can shareholders, partners or other holders of equity or beneficial interest in the Investor determine whether their capital will form part of the capital invested by the Investor in the Company)? o Yes o No If the answer to the above question is “Yes,” please contact Xxxxx Xxxxx & Associates, PLLC (xxxxx@xxxxxxxxxxxxxxxx.xxx or 516-284-1740) for additional information that will be required. 4(a). Please indicate whether or not the Investor is, or is acting on behalf of, (i) an employee benefit plan within the meaning of Section 3(3) of ERISA, whether or not such plan is subject to ERISA, or (ii) an entity which is deemed to hold the assets of any such employee benefit plan pursuant to 29 C.F.R. § 2510.3-101. For example, a plan which is maintained by a foreign corporation, governmental entity or church, a Xxxxx plan covering no common-law employees and an individual retirement account are employee benefit plans within the meaning of Section 3(3) of ERISA but generally are not subject to ERISA (collectively, “Non-ERISA Plans”). In general, a foreign or US entity which is not an operating company and which is not publicly traded or registered as an investment company under the Investment Company Act of 1940, as amended, and in which 25% or more of the value of any class of equity interest is held by employee pension or welfare plans (including an entity which is deemed to hold the assets of any such plan), would be deemed to hold the assets of one or more employee benefit plans pursuant to 29 C.F.R. § 2510.3-101. However, if only Non-ERISA Plans were invested in such an entity, the entity generally would not be subject to ERISA. For purposes of determining whether thi...
Supplemental Data for Entities. 1. If the Investor is not a natural person, furnish the following supplemental data (natural persons may skip this Section C of the Investor Questionnaire): Legal form of entity (trust, corporation, partnership, etc.): __________________ Jurisdiction of organization: __________________________________________________
2. Was the Investor organized for the specific purpose of acquiring the Shares? |_| Yes |_| No If the answer to the above question is "Yes," please contact _______, ________, at _______ or ________ for additional information that will be required.
3. Are shareholders, partners or other holders of equity or beneficial interest in the Investor able to decide individually whether to participate, or the extent of their participation, in the Investor's investment in the Company (i.e., can shareholders, partners or other holders of equity or beneficial interest in the Investor determine whether their capital will form part of the capital invested by the Investor in the Company)? |_| Yes |_| No If the answer to the above question is "Yes," please contact _____ for additional information that will be required.
Supplemental Data for Entities. 1. If the Subscriber is not a natural person, the Subscriber must furnish the following supplemental data (Natural persons may skip this Section V of the Investor Questionnaire): Jurisdiction of organization and location of domicile: Subscriber Control Person*: *For all entity accounts a Control Person is required. The Control person must be a person with significant responsibility for managing the Subscriber, including an executive officer or senior manager. Is the Subscriber (a) a trust any portion of which is treated (under subpart E of part I of subchapter J of chapter 1 of subtitle A of the Code) as owned by a natural person (e.g., a grantor trust), (b) an entity disregarded for U.S. federal income tax purposes and owned (or treated as owned) by a natural person or a trust described in clause (a) of this sentence (e.g., a limited liability company with a single member), (c) an organization described in Sections 401(a) or 501 of the Code or (d) a trust permanently set aside or to be used for a charitable purpose? ¨ Yes ¨ No Is the Subscriber acting on behalf of an unrelated third party (e.g., nominee arrangement)? ¨ Yes ¨ No If “Yes,” please describe the arrangement: Does the Subscriber have one or more ultimate beneficiaries who (a) are entitled to 10% or more of the proceeds from this investment or (b) hold 10% or more of the control rights of the Subscriber? ¨ Yes ¨ No Is the Subscriber or any of the ultimate beneficiaries publicly traded? ¨ Yes ¨ No Is the Subscriber or any of the ultimate beneficiaries a regulated entity? ¨ Yes ¨ No If the response to any of the above questions is “yes,” please complete the below chart. If there is insufficient space in the chart, please include additional sheets of paper with the relevant information. Name of Subscriber and Each 10% Beneficial Owner If the Subscriber or Any of the 10% Beneficial Owners Is Publicly Traded, Please Identify the Exchange for the Public Trading. If the Subscriber or Any of the 10% Beneficial Owners Is a Regulated Entity, Please Identify Regulator and Jurisdiction. For each 10% Beneficial Owner of the Subscriber and the Control Person listed above, please provide the below information. Name Date of Birth Address (Residential of Business Street Address) For U.S. Persons: Social Security Number For Non-U.S. Persons: Social Security Number, Passport Number and Country of Issuance, or other similar identification number* *In lieu of a passport number, Non-U.S. Persons may also provide a So...
Supplemental Data for Entities. 1. If the Subscriber is not a natural person, furnish the following supplemental data (natural persons may skip this Section D of the Investor Questionnaire): Legal form of entity (trust, corporation, partnership, etc.): _________________________ Jurisdiction of organization: ________________________________________________
2. Was the Subscriber organized for the specific purpose of acquiring the Securities? o Yes o No If the answer to the above question is “Yes,” please contact Mxxxxxx Xxxxxxxxxx, Esq. at 200-000-0000 for additional information that will be required.
3. Are shareholders, partners or other holders of equity or beneficial interest in the Investor able to decide individually whether to participate, or the extent of their participation, in the Investor’s investment in the Company (i.e., can shareholders, partners or other holders of equity or beneficial interest in the Investor determine whether their capital will form part of the capital invested by the Investor in the Company)? o Yes o No If the answer to the above question is “Yes,” please contact Mxxxxxx Xxxxxxxxxx for additional information that will be required. 4(a). Please indicate whether or not the Subscriber is, or is acting on behalf of, (i) an employee benefit plan within the meaning of Section 3(3) of ERISA, whether or not such plan is subject to ERISA, or (ii) an entity which is deemed to hold the assets of any such employee benefit plan pursuant to 29 C.F.R. § 2510.3-101. For example, a plan which is maintained by a foreign corporation, governmental entity or church, a Kxxxx plan covering no common-law employees and an individual retirement account are employee benefit plans within the meaning of Section 3(3) of ERISA but generally are not subject to ERISA (collectively, “Non-ERISA Plans”). In general, a foreign or US entity which is not an operating company and which is not publicly traded or registered as an investment company under the Investment Company Act of 1940, as amended, and in which 25% or more of the value of any class of equity interest is held by employee pension or welfare plans (including an entity which is deemed to hold the assets of any such plan), would be deemed to hold the assets of one or more employee benefit plans pursuant to 29 C.F.R. § 2510.3-101. However, if only Non-ERISA Plans were invested in such an entity, the entity generally would not be subject to ERISA. For purposes of determining whether this 25% threshold has been met or exceeded, the va...
Supplemental Data for Entities. 1. If the Investor is not a natural person, furnish the following supplemental data (natural persons may skip this Section of the Investor Questionnaire): Jurisdiction of organization:
2. Are holders of beneficial interests in the Investor able to decide individually whether to participate, or the extent of their participation, in the Investor’s investment in the Company (i.e., can shareholders, partners or other holders of equity or beneficial interests in the Investor determine whether their capital will form part of the capital invested by the Investor in the Company)? [ ] Yes [ ] No
(a) Please indicate whether or not the Investor is, or is acting on behalf of, (i) an employee benefit plan within the meaning of Section 3(3) of ERISA, whether or not such plan is subject to ERISA, or (ii) an entity which is deemed to hold the assets of any such employee benefit plan pursuant to 00 X.X .X. § 0000.0-000. For example, a plan which is maintained by a foreign corporation, governmental entity or church, a Xxxxx plan covering no common-law employees and an individual retirement account are employee benefit plans within the meaning of Section 3(3) of ERISA but generally are not subject to ERISA (collectively, “Non-ERISA Plans”). In general, a foreign or U.S. entity which is not an operating company and which is not publicly traded or registered as an investment company under the Investment Company Act, and in which 25% or more of the value of any class of equity interests is held by employee pension or welfare plans (including an entity which is deemed to hold the assets of any such plan), would be deemed to hold the assets of one or more employee benefit plans pursuant to 29 C.F.R. § 2510.3-101. However, if only Non-ERISA Plans were invested in such an entity, the entity generally would not be subject to ERISA. For purposes of determining whether this 25% threshold has been met or exceeded, the value of any equity interests held by a person (other than such a plan or entity) who has discretionary authority or control with respect to the assets of the entity, or any person who provides investment advice for a fee (direct or indirect) with respect to such assets, or any affiliate of such a person, is disregarded. [ ] Yes [ ] No
(b) If the Investor is, or is acting on behalf of, such an employee benefit plan, or is an entity deemed to hold the assets of any such plan or plans, please indicate whether or not the Investor is subject to ERISA. [ ] Yes [ ] No If the qu...
Supplemental Data for Entities. 1. If the Investor is not a natural person, furnish the following supplemental data (natural persons may skip this Section C of the Investor Questionnaire): Legal form of entity (trust, corporation, partnership, etc.): _________________________ Jurisdiction of organization: ________________________________________________
2. Was the Investor organized for the specific purpose of acquiring the Units? o Yes o No If the answer to the above question is “Yes,” please contact Xxxxx Xxxxx, Esq., counsel for the Company, (000) 000-0000 or xxxxx@xxxxxxxxxxxxxxxx.xxx, for additional information that will be required.
3. Are shareholders, partners or other holders of equity or beneficial interest in the Investor able to decide individually whether to participate, or the extent of their participation, in the Investor’s investment in the Company (i.e., can shareholders, partners or other holders of equity or beneficial interest in the Investor determine whether their capital will form part of the capital invested by the Investor in the Company)? o Yes o No If the answer to the above question is “Yes,” please contact Xxxxx Xxxxx, Esq., counsel for the Company, (000) 000-0000 or xxxxx@xxxxxxxxxxxxxxxx.xxx, for additional information that will be required. 4(a). Please indicate whether or not the Investor is, or is acting on behalf of, (i) an employee benefit plan within the meaning of Section 3(3) of ERISA, whether or not such plan is subject to ERISA, or (ii) an entity which is deemed to hold the assets of any such employee benefit plan pursuant to 29 C.F.R. § 2510.3-101. For example, a plan which is maintained by a foreign corporation, governmental entity or church, a Xxxxx plan covering no common-law employees and an individual retirement account are employee benefit plans within the meaning of Section 3(3) of ERISA but generally are not subject to ERISA (collectively, “Non-ERISA Plans”). In general, a foreign or US entity which is not an operating company and which is not publicly traded or registered as an investment company under the Investment Company Act of 1940, as amended, and in which 25% or more of the value of any class of equity interest is held by employee pension or welfare plans (including an entity which is deemed to hold the assets of any such plan), would be deemed to hold the assets of one or more employee benefit plans pursuant to 29 C.F.R. § 2510.3-101. However, if only Non-ERISA Plans were invested in such an entity, the entity generally would not...
Supplemental Data for Entities. If the Subscriber is not a natural person, please furnish the following supplemental data:
(a) Legal form of entity: ____________________
(b) State in which organized: ____________________
(c) State in which primary place of business or head office is maintained: ____________________
(d) Year of organization: ____________________
(e) Briefly identify the Subscriber’s primary business: ________________________________________________________________
(f) Was the Subscriber organized for the specific or primary purpose of acquiring the Units? o Yes o No
Supplemental Data for Entities. If the subscriber is not a natural person, please furnish the following supplemental data:
(A) Jurisdiction of organization:
(B) Location of principal place of business: 18 See xxxx://xxx.xxxx-xxxx.xxx for a current list of FATF member countries.
19 A “Section 892 Investor” is a subscriber that has indicated that it is exempt from § 892 of the Code in VII(D)(1).
(C) Briefly describe the subscriber’s primary business:
(D) Is the subscriber a wholly-owned or majority-owned subsidiary of another entity? o YES o NO
(E) Is the direct parent of the subscriber a wholly-owned or majority-owned subsidiary of another entity? o YES o NO
(F) In what countries is the subscriber generally resident for tax purposes? __________________
Supplemental Data for Entities. (a) Are you a Grantor Retained Annuity Trust, a Charitable Remainder Trust, or a private foundation?
(b) Are you a grantor trust, partnership or S-corporation for U.S. fedetaJ. income tax purposes? If"Yes," please answer Question l(b)(i) and (ii).
(i) Can (or, at any time dUringth;:t~rm of the Fund, may) interest of any beneficial own~r in' you be attributable to your the ownership in the Fund?
(ii) Is a principal purpose of your participation in the Fund to permit the to satisfy the 100 partner limitation contained in U.S. Treasury Regulation Section 1.7704-1(h)(3), or does any beneficial owner in you have such a principal purpose? Ifeither question (i) or (ii) above was answeret:\"Yes," please contact Ropes & Xxxx for additional information that will berequired.
(c) Are you an entity xxxx.xx disregarded as separate from its owner for U.S. federal income tax purposes? If this question was answered "Yes," please contact Ropes & Xxxx for additional information that will be required.
Supplemental Data for Entities. If the purchaser is not a natural person, please furnish the following supplemental data:
(A) Jurisdiction of organization:
(B) Location of principal place of business:
(C) Briefly describe the purchaser’s primary business:
(D) Is the purchaser a wholly-owned or majority-owned subsidiary of another entity?
(E) Is the direct parent of the purchaser a wholly-owned or majority-owned subsidiary of another entity?
(F) In what countries is the purchaser generally resident for tax purposes?
