SUBSCRIPTION AGREEMENT RIVULET MEDIA, INC.
EXHIBIT 10.3
0000 X.
Xxxxxx Xx, Xxxxx 000-X
Xxxxxxx,
Xxxxxxx 00000
Attn:
Xxxxxxx Xxxxxxxxx
Re:
Purchase of Rivulet Media, Inc. Common Shares
Gentlemen:
The
undersigned (the “Purchaser”) hereby subscribes to
purchase the number of shares of Common Stock, $0.0001 par value
per share, of Rivulet Media, Inc., a Delaware corporation (the
“Company”), set forth on the signature page hereof at a
cash purchase price of $0.10 per share. The shares being purchased
are referred to herein as the “Shares.” This
subscription may be rejected by the Company in its sole
discretion.
Such
purchase of Shares is subject to the terms and conditions set forth
in this Subscription Agreement, the Form 10-K filed with the
Securities and Exchange Commission (the “SEC”) and attached hereto
as Exhibit A (the
“Form
10-K”), and in the Company’s other reports filed
with the SEC pursuant to the Securities Exchange Act of 1934, as
amended, including but not limited to the Risk Factors contained
therein. Such purchase of Shares is also subject to the following
paragraphs.
1.
Purchase. Subject to the terms
and conditions hereof, Purchaser hereby irrevocably agrees to
purchase the number of Shares set forth on the signature page
hereof and tenders herewith the consideration set forth on the
signature page hereof. Payment in full by cash, certified check, or
wire transfer in the amount of $0.10 per Share purchased
accompanies the delivery of this Subscription
Agreement.
2.
Representations and Warranties.
Purchaser hereby makes the following representations and warranties
to the Company and Purchaser agrees to indemnify, hold harmless,
and pay all judgments of and claims against the Company from any
liability or injury, including, but not limited to, that arising
under federal or state securities laws, incurred as a result of any
misrepresentation herein or any warranties not performed by
Purchaser.
(a)
Purchaser is the
sole and true party in interest and is not purchasing for the
benefit of any other person.
(b)
Purchaser has read,
analyzed, and is familiar with the information set forth in the
Form 10-K and the Company’s other reports filed with the SEC
pursuant to the Securities Exchange Act of 1934, as amended,
including but not limited to the Risk Factors contained therein,
this Subscription Agreement, and the Investor Suitability
Questionnaire and has retained copies of all such documents.
Purchaser has had an opportunity to discuss the business plans of
the Company with Company management and has had an opportunity to
ask questions and received satisfactory responses from management
with respect to the Company.
(c)
Purchaser has read,
analyzed, and is familiar with the section of this Subscription
Agreement entitled “Investor Suitability
Questionnaire” and Purchaser hereby warrants that
Purchaser either [CHECK ALL THAT
APPLY]:
☐
is an Accredited
Investor, as defined in Rule 501 of Regulation D promulgated under
the Securities Act of 1933, as amended (the “Act”), and all
liabilities necessary to make a verification of net worth have been
disclosed to the person completing the Accredited Investor
Verification, if any;
☐
alone or with a
purchaser representative(s) has such knowledge and experience in
financial and business matters that he or she is capable of
evaluating the merits and risks of the prospective investment;
or
☐
is not a
“U.S. person” as that term is defined under Regulation
S promulgated under the 1933 Act.
(d)
Purchaser
understands that all books, records, and documents of the Company
relating to this investment have been and remain available for
inspection by Purchaser upon reasonable notice. Purchaser confirms
that all documents requested by Purchaser have been made available,
and that Purchaser has been supplied with all of the additional
information concerning this investment that has been requested. In
making a decision to purchase the Shares, Purchaser has relied
exclusively upon information provided in the Form 10-K and the
Company’s other reports filed with the SEC pursuant to the
Securities Exchange Act of 1934, as amended, including but not
limited to the Risk Factors contained therein, this Subscription
Agreement, and its own independent investigation of the
Company’s books, records, and documents.
(e)
Purchaser is aware
that an investment in the Shares is highly speculative and subject
to substantial risks, including those risks set forth in the Risk
Factors contained in the Form 10-K. Purchaser is capable of bearing
the high degree of economic risk and burdens of this venture,
including, but not limited to, the possibility of the complete loss
of all funds invested, the loss of any anticipated tax benefits,
the lack of a public market, the unavailability of redemption for
the Shares, and limited transferability of the Shares that may make
the liquidation of this investment impossible for the indefinite
future.
(f)
The offer to sell
the Shares was directly communicated to Purchaser by the Company,
or through a person acting on its behalf, in such a manner that
Purchaser was able to ask questions of and receive answers from the
Company concerning the terms and conditions of this transaction. At
no time was Purchaser presented with or solicited by or through any
article, notice, or other communication published in any newspaper
or other leaflet, public promotional meeting, television, radio, or
other broadcast or transmittal advertisement or any other form of
general advertising.
(g)
Purchaser, if a
corporation, partnership, trust, or other entity, is authorized and
duly empowered to purchase and hold the Shares, has its principal
place of business at the address set forth on the signature page
and has not been formed for the specific purpose of purchasing the
Shares.
(h)
The Shares are
being purchased solely for Purchaser’s own account for
investment and are not being purchased with a view to the resale,
distribution, subdivision, or fractionalization
thereof.
(i)
Purchaser
understands that the Shares have not been registered under the Act
or any state securities laws in reliance upon exemptions from
registration for non-public offerings. Purchaser understands that
the Shares or any interest therein may not be, and agrees that the
Shares or any interest therein, will not be, resold or otherwise
disposed of by Purchaser unless the Shares are subsequently
registered under the Act and under appropriate state securities
laws or unless the Company receives an opinion of counsel
satisfactory to it that an exemption from registration is
available.
(j)
Purchaser has been
informed of and understands the following:
(1)
There are
substantial restrictions on the transferability of the Shares under
the Act; and
(2)
No federal or state
agency has made any finding or determination as to the fairness of
the Shares for public investment nor any recommendation or
endorsement of the Shares.
(k)
None of the
following information has ever been represented, guaranteed, or
warranted to Purchaser expressly or by implication, by any broker,
the Company, or agents or employees of the foregoing, or by any
other person:
(1)
The approximate or
exact length of time that Purchaser will be required to hold the
Shares;
(2)
The percentage of
profit and/or amount of or type of consideration, profit or loss to
be realized, if any, as a result of an investment in the Shares;
or
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(3)
That the past
performance or experience of the Company, or associates, agents,
affiliates, or employees of the Company or any other person, will
in any way indicate or predict economic results in connection with
the purchase of the Shares.
(l)
The information set
forth in the Investor Suitability Questionnaire and executed by
Purchaser is true, correct and complete.
(m)
Purchaser has not
distributed this Subscription Agreement to anyone, no other person
has used the Subscription Agreement, and Purchaser has made no
copies of the Subscription Agreement.
(n)
Purchaser hereby
agrees to indemnify the Company, its officers, its directors,
persons who participated in the preparation of this Subscription
Agreement, and any person participating in the offering and hold
them harmless from and against any and all liability, damage, cost
(including legal fees and court costs) and expense incurred on
account of or arising out of:
(1)
Any inaccuracy in
the declarations, representations, and warranties set forth
herein;
(2)
The disposition of
any of the Shares by Purchaser contrary to the foregoing
declarations, representations, and warranties; and
(3)
Any action, suit,
or proceeding based upon (i) the claim that said declarations,
representations, or warranties were inaccurate or misleading or
otherwise cause for obtaining damages or redress from the Company;
(ii) the disposition of any of the Shares; or (iii) the breach by
Purchaser of any part of this Subscription Agreement.
(o)
If Purchaser is a
corporation, partnership, limited liability company, trust, or
other entity and the Purchaser is not an employee benefit plan as
defined under ERISA (an “Employee Benefit Plan”),
“Benefit Plan Investors,” as that term is defined in
the regulations promulgated under ERISA, own less than twenty-five
percent (25%) of the value of each class of equity interests in the
Purchaser (excluding from the computation interests of any
individual or entity with discretionary authority or control over
the assets of the Purchaser). If Purchaser is such an entity and at
any time twenty-five percent (25%) or more of such value is or
comes to be held by Benefit Plan Investors (a “25% Purchaser”),
Purchaser shall immediately notify the Company in writing that
Purchaser has become a 25% Purchaser. If Purchaser is or becomes a
25% Purchaser or an Employee Benefit Plan, Purchaser understands
and agrees that (i) its subscription may be reduced by the Company
(in any manner that the Company considers appropriate) to an amount
that, when aggregated with all other Benefit Plan Investor
participation in the Company, such participation in the Company is
less than twenty-five percent (25%), and (ii) notwithstanding
anything in this Agreement or in the Company Agreement to the
contrary, the Company shall have the right to require Purchaser to
withdraw any or all of its investment at any time or from time to
time, if in the exclusive discretion of the Company, such
withdrawal is advisable to limit participation by Benefit Plan
Investors in the Company to less than twenty-five percent (25%). If
Purchaser is an Employee Benefit Plan or a 25% Purchaser, the
person signing this Agreement on behalf of Purchaser also makes the
additional representations and warranties attached
hereto.
(p)
If Purchaser is a
qualified plan (including a Xxxxx plan or an Individual Retirement
Account) or is otherwise a Benefit Plan Investor, to the best of
Purchaser’s knowledge, neither the Company nor any affiliate
(i) has investment discretion with respect to the assets being used
to purchase the Shares, (ii) regularly gives individualized
investment advice which serves as the primary basis for the
investment decisions made with respect to such assets, or (iii) is
otherwise a fiduciary with respect to such assets.
(q)
Either (i) no part
of the assets to be used to purchase the Shares constitutes assets
of any employee benefit plan (as defined in Section 3(3) of ERISA)
that is subject to Title I of ERISA or Section 4975 of the Code, or
(ii) part of the assets to be used to purchase the Shares
constitutes assets of one or more employee benefit plans subject to
Title I of ERISA or Section 4975 of the Code and such purchase is
eligible for coverage under one or more statutory or administrative
exemptions from the prohibited transaction rules of ERISA and the
Code.
3
(r)
Neither Purchaser
nor, to its knowledge after making due inquiry, any person or
entity controlled by Purchaser, or if Purchaser is other than a
natural person, any person or entity controlled by, controlling or
under common control with Purchaser nor any person having a
beneficial interest in Purchaser:
(1)
is a person or
entity listed in Executive Order No. 13224 (September 23, 2001)
issued by the President of the United States (Executive Order
Blocking Property and Prohibiting Transactions with Persons Who
Commit, Threaten to Commit, or Support Terrorism), any related
enabling legislation or any other similar Executive Orders
(collectively, the “Executive Order”), or if
Purchaser is other than a natural person, is a person or entity
listed in the Annex to Section 1(b), (c) or (d) of the Executive
Order;
(2)
is named on the
List of Specially Designated Nationals and Blocked Persons (the
“SDN
List”) maintained by the U.S. Office of Foreign Asset
Control (“OFAC”), Department of the
Treasury, and/or on any other similar list (“Other Lists”) maintained
by OFAC pursuant to any authorizing statute, Executive Order or
regulation (collectively, “OFAC Laws and
Regulations”);
(3)
is a
“Designated National” as defined in the Cuban Assets
Control Regulations, 31 C.F.R. Part 515 (“Cuban Designated
Nationals”) (the SDN List, the Other Lists and Cuban
Designated Nationals are referred to in this Agreement,
collectively, as the “Lists”);
(4)
is a foreign shell
bank or is otherwise a bank with no physical presence in any
country, e.g., no place of business at a fixed address in a country
in which it is authorized to do business with full time employees
and records and which is subject to inspection by its licensing
authority; or
(5)
is (i) a current or
former senior official in the executive, legislative,
administrative, military, or judicial branch of a foreign
government (whether elected or not), a senior official of a major
foreign political party, or a senior executive of a foreign
government-owned commercial enterprise, (ii) a corporation,
business or other entity that has been formed by, or for the
benefit of, any such individual (iii) an immediate family member of
any such individual, or (iv) a person who is widely and publicly
known (or is actually known by Purchaser) to maintain a close
personal relationship with any such individual (collectively, an
“SFPF”).
(s)
Neither Purchaser
nor, to its knowledge after making due inquiry, any holder of a
beneficial interest in it (i) is under investigation by any
governmental authority for, or has been charged with or convicted
of, money laundering (18 U.S.C. §§ 1956 and 1957), drug
trafficking, terrorist-related activities, or other money
laundering predicate crimes or a violation of the Bank Secrecy Bank
(“BSA”)
laws (31 U.S.C. § 5311 et seq.) and regulations, (ii) has been
assessed civil penalties under these or related laws, or (iii) has
had its funds seized or forfeited in an action under these or
related laws.
(t)
The funds invested
by Purchaser in the Shares are derived from legal sources. If
Purchaser is other than a natural person, Purchaser has taken, and
will continue to take, reasonable measures appropriate to the
circumstances, with respect to each of its stockholders, members,
partners or other investors (collectively, “Entity Investors”) in
Purchaser, to assure that funds invested in it by such Entity
Investors are derived from legal sources and that these measures
will be in accordance with all applicable BSA laws, regulations and
government guidance on BSA compliance and on the prevention and
detection of money laundering violations under 18 U.S.C.
§§ 1956 and 1957) (collectively, “Anti-Money Laundering
Laws”).
(u)
If Purchaser is a
financial institution or financial intermediary, Purchaser has
taken, and will continue to take, reasonable steps, consistent with
industry practice for comparable organizations and in any event as
required by law, to ensure that it is and shall be in compliance
with all current and future Anti-Money Laundering Laws, and laws,
regulations, and government guidance for the prevention of
terrorism, terrorist financing and drug trafficking.
4
(v)
Purchaser agrees to
provide the Company, promptly upon request, all information that
the Company reasonably deems necessary or appropriate to comply
with applicable U.S. anti-money laundering and anti-terrorist laws
and regulations and OFAC Laws and Regulations. Purchaser consents
to the disclosure to U.S. regulators and law enforcement
authorities by the Company and its affiliates and agents of such
information about Purchaser that the Company reasonably deems
necessary or appropriate to comply with applicable U.S. anti-money
laundering and anti-terrorist laws and regulations and OFAC Laws
and Regulations.
(w)
If Purchaser is a
financial institution or financial intermediary, Purchaser agrees
to adopt and maintain adequate policies, procedures and controls to
ensure that it is, and that each holder of any beneficial interest
in it is, in compliance with all OFAC Laws and Regulations,
Executive Orders and related government guidance (such OFAC
policies, procedures and controls are collectively referred to as
“Purchaser OFAC
Policies”). Purchaser further agrees to make its
Purchaser OFAC Policies and the respective policies, procedures and
controls for persons or entities becoming and being Entity
Investors in Purchaser (such policies, procedures and controls are
collectively referred to as “Entity Investor OFAC
Policies”), together with the information collected
thereby concerning Purchaser and such Entity Investors, available
to the Company for its review and inspection from time to time
during normal business hours and upon reasonable prior notice, and
Purchaser agrees to deliver copies of the same to the Company from
time to time upon request. The Company will keep Purchaser OFAC
Policies and the Entity Investor OFAC Policies, and the information
collected thereby, confidential subject to customary exceptions for
legal process, auditors, regulators or as otherwise reasonably
required by the Company for enforcement of its rights and/or in
connection with reasonable business use for holding and dealing
with its assets and investments.
(x)
If Purchaser is
other than a natural person and if Purchaser OFAC Policies and the
Entity Investor OFAC Policies referred to in subparagraph 5(w)
above, and the measures referred to in subparagraph 5(w) above to
assure that Purchaser’s and each Entity Investor’s
funds are derived from legal sources, shall not provide, in the
reasonable determination of the Company, adequate means to assure
that persons or entities that are listed on any of the Lists, or
that are designated persons under any of the Executive Orders, or
whose funds are not derived from legal sources, are excluded from
becoming or being Entity Investors in Purchaser, the Company shall
notify Purchaser of its determination. If such policies, procedures
and controls, as applicable, and such measures are not modified to
the satisfaction of the Company within 30 days following notice to
Purchaser of the Company’s determination, Purchaser
acknowledges that the Company, in addition to all of their other
rights and remedies, may declare that a breach of this Agreement
exists with respect to Purchaser.
(y)
Purchaser
acknowledges and agrees that if, following its investment in the
Company, the Company reasonably believes that Purchaser has
breached its representations and warranties or its agreements set
forth in this Agreement, or a breach of this Agreement otherwise
has been declared to exist with respect to Purchaser, the Company
has the right or may be obligated to freeze the investment to
prohibit additional investments, to segregate the assets
constituting the investment in accordance with applicable OFAC Laws
and Regulations, to decline any redemption requests, or to redeem
Purchaser’s investment. Purchaser further acknowledges that
it will have no claim against the Company, or any of its respective
affiliates, officers, directors, stockholders, employees and agents
for any form of damages as a result of any of the foregoing
actions.
(z)
If Purchaser is
other than a natural person, Purchaser shall require each person
that proposes to acquire any interest in Purchaser to sign an
agreement with such representations, warranties, and covenants
substantially in the form of paragraph 2 of this Agreement and to
deliver the same to Purchaser.
5
Purchaser agrees to
notify the Company promptly if there is any change with respect to
the representations provided in this paragraph 2. The foregoing
representations and warranties of Purchaser are complete, true, and
accurate as of the date of this Agreement and shall survive
delivery of this Agreement to the Company for all purposes. If any
of such representations and warranties shall not be true and
accurate in any respect following the execution and delivery of
this Agreement, Purchaser shall give prompt written notice of such
fact to the Company, specifying which representations and
warranties are not true and accurate and the reasons
therefor.
3.
Setoff. Notwithstanding the
provisions of the last preceding section or the enforceability
thereof, the undersigned hereby grants to the Company
the right to setoff
against any amounts payable by the Company to the undersigned, for
whatever reason, of any and all damages, costs, and expenses
(including, but not limited to, reasonable attorneys’ fees)
which are incurred on account of or arising out of any of the items
referred to in clauses (1) through (3) of
Section 2(n).
4.
Restrictions on Transferability of
Shares and Compliance with the Securities Act.
(a)
Restrictions on
Transferability. Purchaser acknowledges that the Shares have
not been registered under the Act or any state blue sky laws, and
that the transferability of an interest in the Shares is restricted
by applicable federal and state securities laws.
(b)
Restrictive Legend. The
certificate representing the Shares, if any, and any other
securities issued in respect thereto upon any distribution,
recapitalization, merger, consolidation or similar event, are
expected (unless otherwise permitted by the provisions of this
Section or by applicable law) to be stamped or otherwise imprinted
with a legend in substantially the following form (in addition to
any legend required under applicable state securities
laws):
THE
SECURITIES REPRESENTED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED
UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE
“ACT”).
THE SECURITIES MAY BE SOLD OR TRANSFERRED ONLY IF THE SECURITIES
ARE REGISTERED UNDER THE ACT OR THE COMPANY RECEIVES AN OPINION OF
COUNSEL SATISFACTORY TO IT THAT AN EXEMPTION FROM REGISTRATION IS
AVAILABLE.
5.
Transferability of Subscription
Agreement. Purchaser agrees not to transfer or assign the
obligations or duties contained in this Subscription Agreement or
any of Purchaser’s interest herein.
6.
Regulation D and Regulation S.
Notwithstanding anything herein to the contrary, every person or
entity who, in addition to or in lieu of Purchaser, is deemed to be
a purchaser pursuant to Regulation D or Regulation S promulgated
under the Act or otherwise, does hereby make and join in the making
of all the covenants, representations, and warranties made by
Purchaser.
7.
Acceptance. Execution and
delivery of this Subscription Agreement and tender of the payment
referenced in Section 1 above shall constitute Purchaser’s
irrevocable offer to purchase the Shares indicated, which offer may
be accepted or rejected by the Company in its discretion for any
cause or for no cause. Acceptance of this offer by the Company
shall be indicated by the execution hereof by the
Company.
8.
Binding Agreement. Purchaser
agrees that Purchaser may not cancel, terminate, or revoke this
Subscription Agreement or any agreement Purchaser makes hereunder,
and that this Subscription Agreement shall survive upon the death
or disability of Purchaser and shall be binding upon and inure to
the benefit of the heirs, successors, assigns, executors,
administrators, guardians, conservators, or personal
representatives of Purchaser.
9.
Incorporation by Reference. The
statement of the number of Shares subscribed and related
information set forth on the signature page are incorporated as
integral terms of this Subscription Agreement.
10.
Notices. Notices and other
communications under this Subscription Agreement shall be in
writing and shall be deemed delivered when received or, if by U.S.
mail, when deposited in a regularly maintained receptacle, by
Certified First Class Mail, postage prepaid,
addressed:
6
(a)
if to Purchaser, at
the address shown on the signature page hereof unless the Purchaser
has advised the Company, in writing, of a different address as to
which notices shall be sent under this Subscription Agreement;
and
(b)
if to the Company,
at the address first above stated, to the attention of the CEO or
to such other address or to the attention of other such officer, as
the Company shall have furnished to Purchaser.
11.
Legal Counsel. Purchaser has
had the opportunity to consider the terms of this Subscription
Agreement with Purchaser’s legal counsel and has either
obtained the advice of legal counsel in connection with
Purchaser’s execution hereof or does hereby expressly waive
its right to seek such legal counsel in connection with this
transaction and furthermore has relied on its legal advisor to
provide advice as to the tax consequences to Purchaser upon making
the purchase.
12.
Miscellaneous. This
Subscription Agreement and the documents and agreements referenced
herein embody the entire agreement and understanding between the
Company and the other parties hereto and supersede all prior
agreements and understandings relating to the subject matter
hereof. It is the intent of the parties hereto that all questions
with respect to the construction and interpretation of this
Subscription Agreement and the rights and liabilities of the
parties hereto shall be determined in accordance with the laws of
the State of Arizona, without regard to principles of conflicts of
laws thereof that would call for the application of the substantive
law of any jurisdiction other than the State of Delaware. Each of
the parties hereto irrevocably and unconditionally agrees
(i) to be subject to the jurisdiction of the courts of the
State of Arizona, (ii) that service of process may be made on
such party by prepaid certified mail with a validated proof of
mailing receipt constituting evidence of valid service, and
(iii) that service made pursuant to clause (ii) above shall
have the same legal force and effect as if serviced upon such party
personally within the State of Arizona. The headings in this
Subscription Agreement are for purposes of reference only and shall
not limit or otherwise affect the meaning hereof. This Subscription
Agreement may be executed in any number of counterparts, each of
which shall be an original, but all of which together shall
constitute one instrument.
13.
Subscription Payments. All
subscription payments should be made payable to “Rivulet Media, Inc.” There
will be no independent escrow agent and no interest paid on funds
collected. As there is no minimum, the Company shall begin using
funds on behalf of the Company as needed, immediately upon
acceptance.
(Remainder
of Page Intentionally Left Blank)
7
IN
WITNESS WHEREOF, Purchaser has executed this Subscription Agreement
on the date set forth on the signature page.
Purchaser
desires to take title in the Shares as follows (check
one):
______
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(a)
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Individual (one signature required on page 10);
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______
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(b)
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Husband and Wife as community property (one signature is required
on page 10 if interest is held in one name, i.e., managing spouse;
two signatures are required on page 10 if interest is held in both
names);
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______
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(c)
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Joint Tenants with rights of survivorship (both parties must sign
on page 10);
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______
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(d)
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Tenants in Common (both parties must sign on page 10);
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______
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(e)
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Trust (trustee(s) must sign on page 11);
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______
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(f)
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Partnership or Limited Liability Company (general partners(s),
manager(s), or authorized member(s) must sign on page
12);
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______
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(g)
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Corporation (authorized officer must sign on page 14);
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______
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(h)
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Employee Benefit Plan (authorized officer must sign on page
15);
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______
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(i)
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Individual Retirement Account (authorized party must sign on page
15);
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______
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(j)
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Xxxxx Plan (authorized party must sign on page 15);
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______
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(k)
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Other Tax‑Exempt Entities (authorized parties must sign on
page 15).
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The
exact name(s) under which title to the Shares is to be taken is as
follows:
(Please
print)
8
SUBSCRIPTION AGREEMENT
SIGNATURE PAGE
FOR INDIVIDUAL PURCHASERS,
JOINT TENANTS, AND TENANTS IN COMMON
Total
Shares Subscribed:
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Total
Dollar Amount:
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Investor #1
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Investor #2
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Signature
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Signature
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Social Security Number
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Social Security Number
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Print or Type Name
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Print or Type Name
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Residence Address
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Residence Address
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INDIVIDUAL ACKNOWLEDGMENT
State of
_______________
)
)
ss:
County of
_____________
)
On this
___ day of ______________, 20__, ________________________ and
___________________________ personally appeared before me and swore
to be the person(s) whose name is subscribed to the within
instrument and acknowledged to me that he/she/they executed the
same, and that the same is true to the best of his/her/their
knowledge, information, and belief.
SEAL
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Notary
Public in and for Said County and State
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My
Commission expires: ___________________
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Subscription accepted:
By:
_______________________________________________
Xxxxxxx
Xxxxxxxxx, President
9
SUBSCRIPTION AGREEMENT
SIGNATURE PAGE
FOR TRUST PURCHASERS
Total Shares Subscribed:
___________________________________________________
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Total Dollar Amount:
___________________________________________________
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Executed
at ___________________________,
____________________________________________________
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this
______________ day of
____________________________________________,
_____________________ .
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__________________________________________________________________________________________
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Name
of Trust (Please print or type)
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__________________________________________________________________________________________
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Name
of Trustee (Please print or type)
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Date
Trust was formed:
______________________________________________________________________
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By:
______________________________________________________________________________________
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Trustee’s
signature
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Taxpayer
Identification Number: _______________________________________________________________
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Trustee’s
Address: __________________________________________________________________________
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__________________________________________________________________________________________ |
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__________________________________________________________________________________________
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Attention:
_________________________________________________________________________________
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ACKNOWLEDGMENT IF SUBSCRIBER IS A TRUST
STATE
OF ____________
)
)
ss:
COUNTY
OF __________
)
On the
____ day of ___________________________, 20__ personally appeared
before me, ___________________________, who being duly sworn did
say that he/she is the trustee of the ___________________________,
a trust, and that said instrument was signed in behalf of said
trust by authority of the applicable trust instrument and he/she
acknowledged to me that said trust executed the same.
SEAL
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Notary
Public in and for Said County and State
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My
Commission expires: ___________________
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Subscription accepted:
By:
_______________________________________________
Xxxxxxx
Xxxxxxxxx, President
10
SUBSCRIPTION AGREEMENT
SIGNATURE PAGE
FOR PARTNERSHIP AND LIMITED LIABILITY COMPANY
PURCHASERS
Total Shares Subscribed:
__________________________________________________
Total
Dollar Amount:
__________________________________________________
this
______________ day of ____________________________________________,
_______________________ .
____________________________________________________________________________________________
Name of
Partnership or Limited Liability Company (Please print or
type)
By:
_________________________________________________________________________________________
Signature of
General Partner, Manager, or authorized Member
By:
_________________________________________________________________________________________
Signature of
additional General Partner, Manager, or authorized Member (if
required by Partnership
Agreement or
Limited Liability Company Agreement)
By:
_________________________________________________________________________________________
Signature of
additional General Partner, Manager, or authorized Member (if
required by Partnership
Agreement or
Limited Liability Company Agreement)
Taxpayer
Identification Number:
__________________________________________________________________
Business
Mailing Address:
_______________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Attention:
____________________________________________________________________________________
11
ACKNOWLEDGMENT IF SUBSCRIBER IS A PARTNERSHIP
OR LIMITED LIABILITY COMPANY
STATE OF
_____________
)
)
ss:
COUNTY OF
__________
)
On
the___ day of ___________________________, 20__, personally
appeared before me, ___________________________ and
___________________________ who being duly sworn (or affirmed) did
say that he/she/they are the ___________________________ of the
partnership/limited liability company that executed the within
instrument and such instrument was signed by him/her/them on behalf
of said partnership/limited liability company and acknowledged to
me that said partnership/limited liability company executed the
same.
SEAL
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Notary
Public in and for Said County and State
|
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My
Commission expires: ___________________
|
|
|
Subscription accepted:
By:
_______________________________________________
Xxxxxxx
Xxxxxxxxx, President
12
SUBSCRIPTION AGREEMENT
SIGNATURE PAGE
FOR CORPORATE PURCHASERS
Total Shares
Subscribed:
_________________________________________________
Total Dollar
Amount:
_________________________________________________
Executed
at _____________________________,
_____________________________________________________
this ______________
day of ____________________________________________,
_________________________ .
______________________________________________________________________________________________
Name of Corporation
(Please print or type)
By:
___________________________________________________________________________________________
Signature of
authorized agent
Title:
_________________________________________________________________________________________
Taxpayer
Identification Number:
___________________________________________________________________
Address of
Principal Corporate Offices:
______________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Mailing Address:
_______________________________________________________________________________
(if different)
___________________________________________________________________________________
Attention:
_____________________________________________________________________________________
ACKNOWLEDGMENT IF PURCHASER IS A CORPORATION
STATE OF
_____________
)
)
ss:
COUNTY OF
___________
)
On the
_____ day of ___________________________, 20__, personally appeared
before me, ___________________________ who being duly sworn (or
affirmed) did say that he/she is the ___________________________ of
___________________________, and that said instrument was signed by
him on behalf of said Corporation by authority of its bylaws (or of
a resolution of its board of directors, as the case may be), and
he/she acknowledged to me that said corporation executed the
same.
SEAL
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Notary
Public in and for Said County and State
|
|
My
Commission expires: ___________________
|
|
|
Subscription accepted:
By:
_______________________________________________
Xxxxxxx
Xxxxxxxxx, President
13
SUBSCRIPTION AGREEMENT
SIGNATURE PAGE IF PURCHASER IS AN
EMPLOYEE BENEFIT PLAN, INDIVIDUAL RETIREMENT ACCOUNT,
XXXXX
PLAN, OR OTHER ENTITY
Total Shares
Subscribed:
_________________________________________________
Total Dollar
Amount:
_________________________________________________
Executed at
______________________________,
____________________________________________________
this ______________
day of ____________________________________________,
________________________ .
_____________________________________________________________________________________________
Name of Entity
(Please print or type)
By:
__________________________________________________________________________________________
Signature of
authorized agent
____________________________________________________________________________________________
Title
Taxpayer
Identification Number:
___________________________________________________________________
Address of
Principal Offices:
______________________________________________________________________
_____________________________________________________________________________________________
Mailing Business
Address:
________________________________________________________________________
______________________________________________________________________________________________
Attention:
_____________________________________________________________________________________
ACKNOWLEDGMENT IF PURCHASER IS AN
EMPLOYEE BENEFIT PLAN, INDIVIDUAL RETIREMENT ACCOUNT,
XXXXX
PLAN OR OTHER ENTITY
STATE OF
_____________
)
)
ss:
COUNTY OF
__________
)
On the
_____ day of ___________________________, 20__, personally appeared
before me, ___________________________ of
___________________________, and that said instrument was signed by
him/her on behalf of said entity, and he/she acknowledged to me
that said entity executed the same.
SEAL
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Notary
Public in and for Said County and State
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|
My
Commission expires: ___________________
|
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|
Subscription accepted:
By:
_______________________________________________
Xxxxxxx
Xxxxxxxxx, President
14
RIVULET MEDIA, INC.
INVESTOR SUITABILITY QUESTIONNAIRE
______________________
ALL
INFORMATION FURNISHED IN THIS
QUESTIONNAIRE
WILL BE TREATED CONFIDENTIALLY
Rivulet
Media, Inc. (the “Company”) will use the
responses to this questionnaire to qualify prospective investors
for purposes of federal and state securities laws. Please
complete,
sign, date and return (facsimile or scan
acceptable) one copy of this questionnaire as soon as possible to
the Company.
Your
answers will be kept confidential at all times. However, by signing
this questionnaire, you agree that the Company may present this
questionnaire to such parties as it deems appropriate to establish
the availability of exemptions from registration under state and
federal security laws.
NOTE:
Individual investors should complete the questionnaire beginning
with Part I on this page while non-individual investors such as
corporations, partnerships, trusts and other entities should
complete the questionnaire beginning with Part II on page
4.
I. INDIVIDUAL
INVESTORS:
(Investors
other than natural persons (for example, corporations, limited
liability companies,
partnerships
and trusts) should turn to Part II on page 4)
1.
Amount of Investment
Please indicate the
amount of your proposed investment:
__________________________________________________
2.
Personal
Name:
__________________________________________________________________________________________
(EXACT NAME AS IT SHOULD APPEAR
ON SHARE CERTIFICATE)
Residence Address:
________________________________________________________________________________
City, State
Zip:
____________________________________________________________________________________
Home
Telephone:
__________________________________________________________________________________
Home
Facsimile:
___________________________________________________________________________________
Email
Address:
____________________________________________________________________________________
Date of Birth:
_____________________________________________________________________________________
3.
Business
Occupation:
_______________________________________________________________________________________
Number of Years:
___________________________________________________________________________________
Present Employer:
__________________________________________________________________________________
Position/Title:
______________________________________________________________________________________
Business Address:
___________________________________________________________________________________
City, State
Zip:
_____________________________________________________________________________________
Business Telephone:
__________________________________________________________________________________
Business
Facsimile:
__________________________________________________________________________________
15
4.
Residence
Information
(a)
Set forth in the
space provided below the state(s) in which you have maintained your
principal residence during the past three years and the dates
during which you resided in each state.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
(b)
Are you registered
to vote in, or do you have a driver’s license issued by, or
do you maintain a residence in any other state? If yes, in which
state(s)?
__________________________________________________________________________________________________
5.
Income
(a)
Do you reasonably
expect either your
own income from all sources during the current year to exceed
$200,000 or the
joint income of you and your spouse (if married) from all sources
during the current year to exceed $300,000?
☐
Yes
☐
No
If no,
please specify amount: _______________
(b)
What percentage of
your income as shown above is anticipated to be derived from
sources other than salary?
_________________________________________________________________________________________________
(c)
Was either your yearly income from
all sources during each of the last two years in excess of $200,000
or was the joint
income of you and your spouse (if married) from all sources during
each of such years in excess of $300,000?
☐
Yes
☐
No
If no,
please specify amount for:
Last
Year: ________________
Year
Before Last: ________________
6.
Net Worth
Will
your net worth as of the date you purchase the securities offered,
together with the net worth of your spouse, be in excess of
$1,000,000? (Note that “net worth” includes all of the
assets owned by you and your spouse in excess of total liabilities,
excluding the fair market value of your principal residence from
assets but including as a liability any debt on your principal
residence that is in excess of the fair market value.)
☐
Yes
☐
No
If not,
please specify amount: __________________
7.
Education
Please
describe your educational background and degrees obtained, if
any.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
16
8.
Affiliation
If you
have any pre-existing personal or business relationship with the
Company or any of its officers, directors or controlling persons,
please describe the nature and duration of such
relationship.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
9.
Business and Financial Experience
(a)
Please describe in
reasonable detail the nature and extent of your business, financial
and investment experience which you believe gives you the capacity
to evaluate the merits and risks of the proposed investment and the
capacity to protect your interests.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
(b)
Are you purchasing
the securities offered for your own account and for investment
purposes only?
☐
Yes
☐
No
If no,
please state for whom you are investing and/or the reason for
investing.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
10.
Financial Advisors
In
evaluating this investment, will you use the services of any of the
following advisors? (If so, please identify, providing address and
telephone number.)
Accountant:
______________________
________________________________
________________________________
Attorney:
________________________
________________________________
________________________________
Other:
__________________________
________________________________
________________________________
PLEASE
TURN TO PART III ON PAGE 6 AND SIGN AND DATE THIS
QUESTIONNAIRE
17
II. NON-INDIVIDUAL
INVESTORS:*
(Please
answer Part II only if the purchase is proposed to
be
undertaken
by a corporation, partnership, trust or other entity)
*
If the investment will be made by more than one affiliated entity,
please complete a copy of
this questionnaire for EACH entity.
1.
Identification
Name:
________________________________________________________________________________________
(EXACT NAME AS IT SHOULD APPEAR ON SHARE CERTIFICATE)
Address of
Principal Place of Business: ______________________________________________________________
City, State
Zip: __________________________________________________________________________________
Jurisdiction of
Formation or Incorporation: ____________________________________________________________
Type of Entity
(corporation, partnership, trust, etc.): _____________________________________________________
Contact
Person: __________________________________________________________________________________
Telephone
Number: _______________________________________________________________________________
Facsimile
Number: ________________________________________________________________________________
Internet
Address: __________________________________________________________________________________
Was
entity formed for the purpose of this investment?
☐
Yes
☐
No
If the answer is YES, then ALL stockholders, partners or
other equity owners must answer Part I of this Questionnaire.
If the above answer is no, please continue completing this
form.
2.
Amount Of Investment
Please indicate the
amount of your proposed investment: $
________________________________________________
State
the investing entity’s net worth at the time the securities
will be purchased: $ ______________________________
3.
Business
Please
check the appropriate box to indicate which of the following
accurately describes the nature of the business conducted by the
investing entity:
☐
a corporation, organization described in Section 501(c)(3) of
the Internal Revenue Code, a Massachusetts or similar business
trust or a partnership, in each case, not formed for the purpose of
this investment, with total assets in excess of
$5,000,000;
☐
private business development company as defined in Section
202(a)(22) of the Investment Advisers Act of 1940 (a U.S. venture
capital fund which invests primarily through private placements in
non-publicly traded securities and makes available (either directly
or through co-investors) to the portfolio companies significant
guidance concerning management, operations or business
objectives);
☐
a Small Business Investment Company licensed by the U.S. Small
Business Administration under Section 301(c) or (d) of the Small
Business Investment Act of 1958;
☐
an investment company registered under the Investment Company Act
of 1940 or a business development company as defined in Section
2(a)(48) of that Act;
18
☐
a bank as defined in Section 3(a)(2) or a savings and loan
association or other institution defined in Section 3(a)(5)(A)
of the Securities Act of 1933 acting in either an individual or
fiduciary capacity;
☐
an insurance company as defined in Section 2(13) of the
Securities Act of 1933;
☐
an employee benefit plan within the meaning of Title I of the
Employee Retirement Income Security Act of 1974 whose investment
decision is made by a fiduciary which is either a bank, savings and
loan association, insurance company, or registered investment
advisor, or whose total assets exceed $5,000,000, or, if a
self-directed plan, a plan whose investment decisions are made
solely by persons who are accredited investors;
☐
an entity not located in the U.S. and whose equity owners are
neither U.S. citizens nor U.S. residents;
☐
a trust with total assets in excess of $5,000,000 whose purchase is
directed by a sophisticated person as described in
Rule 506(b)(2)(ii) of the Securities Act of 1933.
☐
Other. Describe (and ALL stockholders, partners or other equity
owners must answer Part I of this Questionnaire):
________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
4.
Investment Experience
Please
provide information detailing the business, financial and
investment experience of the entity and investment manager of such
entity.
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
(Signature Page Follows)
19
III. SIGNATURE
The
above information is true and correct in all material respects and
the undersigned recognizes that the Company and its counsel are
relying on the truth and accuracy of such information in reliance
on the exemption contained in Subsection 4(2) of the
Securities Act of 1933, as amended, and Regulation D
promulgated thereunder. The undersigned agrees to notify the
Company promptly of any changes in the foregoing information which
may occur prior to the investment.
Executed at ___________________, on
_________________, 20__.
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(Signature)
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(Name)
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(Title if signing on behalf of an entity)
|
20
ADDITIONAL REPRESENTATIONS AND WARRANTIES OF
25% PERSONS AND EMPLOYEE BENEFIT PLANS
1.
If Purchaser is an Employee Benefit Plan, such person is either a
named fiduciary of the Employee Benefit Plan (as defined in Section
402(a)(2) of ERISA) or an investment manager of the Employee
Benefit Plan (as defined in Section 3(38) of ERISA) with full
authority under the terms of the Employee Benefit Plan and full
authority from all Employee Benefit Plan beneficiaries, if
required, to cause the Employee Benefit Plan to invest in the
Company. Such investment has been duly approved by all other named
fiduciaries whose approval is required, if any, and is not
prohibited or restricted by any provisions of the Employee Benefit
Plan or of any related instrument.
2.
Such person has independently determined that the investment by the
Employee Benefit Plan or 25% Purchaser in the Company satisfies all
requirements of Section 404(a)(1) of ERISA, specifically including
the “prudent man” standards of Section 404(a)(1)(B) and
the “diversification” standard of Section 404(a)(1)(C),
and will not be prohibited under any of the provisions of Section
406 of ERISA or Section 4975(c)(1) of the Code. Such person has
requested and received all information from the Company that such
person, after due inquiry, considered relevant to such
determinations. In determining that the requirements of Section
404(a)(1) are satisfied, such person has taken into account the
risk of a loss of the Employee Benefit Plan’s or 25%
Purchaser’s investment and that an investment in the Company
will be relatively illiquid, and funds so invested will not be
readily available for the payment of employee benefits. Taking into
account these factors, and all other factors relating to the
Company, the undersigned has concluded that investment in the
Company constitutes an appropriate part of the Employee Benefit
Plan’s or 25% Purchaser’s overall investment
program.
3.
Such person will notify the Company, in writing, of (A) any
termination, merger or consolidation of the Employee Benefit Plan
or the 25% Purchaser, (B) any amendment to any such Employee
Benefit Plan or any related instrument that materially affects the
authority of any named fiduciary or investment manager to authorize
plan investments, and (C) any alteration in the identity of any
named fiduciary or investment manager, including such person, who
has the authority to approve plan investments.
4.
The Company and its affiliates do not render any investment advice
on a regular basis pursuant to a mutual understanding, arrangement
or agreement, written or otherwise, between the Employee Benefit
Plan or any Employee Benefit Plan investing in the 25% Purchaser
and any of such parties who will act in regard to the Company and
none of such parties renders any investment advice to any such
Employee Benefit Plan that furnishes a primary basis for investment
decisions with respect to assets of any such Employee Benefit
Plan.
5.
Purchaser agrees to notify the Company within thirty (30) days if
any of the foregoing representations are no longer true. If the
Company or any officer, director, employee or agent of the Company
is ever held to be a fiduciary, it is agreed that, in accordance
with Sections 405(b)(1), 405(c)(2), and 405(d) of ERISA, the
fiduciary responsibilities of that person shall be limited to such
person’s duties in administering the business of the Company,
and such person shall not be responsible for any other duties with
respect to any Employee Benefit Plan or any Employee Benefit Plan
investing in the 25% Purchaser (specifically including evaluating
the initial or continued appropriateness of any such Employee
Benefit Plan’s investment in the Company under Section
404(a)(1) of ERISA).
21
EXHIBIT A
Form 10-K
Text of
exhibit omitted.
22