Common use of Supplemental Data for Entities Clause in Contracts

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 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 SharesUnits? |_| 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 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 _______David Xxxxx, ________, Xxx. at _______ or ________ for additional (516) 000-0000 xxx xdditional 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 David Xxxxx, Xxx. at (516) 000-0000 xxx xdditional information that will be required.

Supplemental Data for Entities. 1. If the Investor Subscriber is not a natural person, furnish the following supplemental data (natural persons may skip this Section C D of the Investor Questionnaire): Legal form of entity (trust, corporation, partnership, etc.): _________________________ Jurisdiction of organization: __________________________________________________ 2. Was the Investor Subscriber organized for the specific purpose of acquiring the SharesSecurities? |_| Yes |_| No If the answer to the above question is "“Yes," ” please contact _______Mxxxxxx Xxxxxxxxxx, ________, Esq. at _______ or ________ 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 ’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 _____ Mxxxxxx Xxxxxxxxxx for additional information that will be required.

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 SharesUnits? |_| [ ] 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.