SUBSCRIPTION AGREEMENT
Made
and
signed as of the ___ day of __________ (month) 2007.
BETWEEN: |
_____________________
|
(the
“Investor”)
AND: |
(the
“Company”)
WHEREAS: |
the
Board of Directors of the Company determined that it is in the
Company’s
best interests to raise capital by means of the issuance of shares
of
Common Stock in the Company (the “Shares”) all on the terms and conditions
more fully set forth in this Agreement;
and
|
WHEREAS: the
Investor wishes to invest in the Company pursuant to the terms and conditions
more fully set forth in this Agreement; and
NOW
THEREFORE THE PARTIES AGREE AS FOLLOWS:
Preamble
and Exhibits; Investment
1. |
a)
The
Preamble to this Agreement and the Exhibits hereto constitute an
integral
part hereof.
|
b) |
Subject
to the terms and conditions hereof, the Investor is acquiring from
the
Company, in consideration of US$_______ paid by the Investor to
the
Company, _____________ Shares at a price of US$ 0.025 per Share.
Subject
to the Company’s acceptance of the Investor’s subscription and the
Investor’s payment in full of the purchase price, the Shares will be duly
authorized, validly issued, fully paid-up, non-assessable and free
of all
mortgages, charges, pledges, claims, liens and encumbrances and
any third
party rights created by the Company and will be entitled to all
rights to
which the Company’s Shares are
entitled.
|
Declarations
of the Company
2. |
The
Company covenants, represents and warrants the following to be
true and
correct:
|
a) |
The
Company is a Delaware corporation, formed by filing its Certificate
of
Incorporation with the Secretary of State of the State of Delaware
on
March 30, 2007 under the Delaware General Corporation
Law.
|
b) |
The
Company has the necessary power and authority to execute and deliver
this
Agreement, to allot the Shares hereunder and to carry out and perform
its
obligations hereunder. This Agreement is valid and binding upon
the
Company and enforceable in accordance with its terms, subject to
applicable liquidation, wind-up, insolvency,
reorganization,
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1
moratorium
and similar laws affecting creditors’ rights and remedies generally and subject,
as to enforceability, to general principles of equity. This Agreement does
not
require the consent or approval of any third party in order for it to be
fully
binding on and enforceable against the Company. The execution and delivery
of
this Agreement by the Company does not, and the consummation of the transactions
contemplated hereby and the performance by the Company of the provisions
of this
Agreement will not, violate any provisions of the Company’s Certificate of
Incorporation.
c) |
Neither
the Company nor any of its affiliates nor any person acting on
its or
their behalf (i) has conducted or will conduct any general solicitation
(as that term is used in Rule 502(c) of Regulation D) or general
advertising with respect to any of the Shares, or (ii) made any
offers or
sales of any security or solicited any offers to buy any security
under
any circumstances that would require registration of the Common
Stock
under the Securities Act of 1933.
|
Declarations
of Investor
3. |
The
Investor covenants, represents and warrants the following to be
true and
correct:
|
a) |
The
Investor understands that the Shares are being sold in connection
with an
offering by the Company of an aggregate of up to 2,000,000 (two
million)
shares of Common Stock for total proceeds of up to $50,000 (fifty
thousand
dollars).
|
b) |
The
Investor understands and acknowledges that the Shares are being
offered
and sold under one or more of the exemptions from registration
under the
Securities Act of 1933, as amended (the “Act”), that the Investor is
purchasing said Shares without being offered or furnished any offering
literature, prospectus or other material, financial or otherwise,
except
as noted herein, that this transaction has not been scrutinized
by the
United States Securities and Exchange Commission or by any regulatory
authority charged with the administration of the securities laws
of any
state. The Investor hereby further represents and warrants as
follows:
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i) |
The
Investor confirms that the Investor understands and has fully considered,
for purposes of this investment, the risks of any investment in
the Shares
and that the Investor understands that: (i) this investment is
suitable
only for an investor who is able to bear the economic consequences
or
losing the Investor’s entire investment, (ii) the purchase of Shares is a
speculative investment which involves a high degree of risk of
loss by the
Investor of the Investor’s entire investment, and (iii) that there is no
public market for the Shares and accordingly, it may not be possible
for
the Investor to liquidate the Investor’s investment in the Shares in case
of an emergency. The Investor
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2
understands
that the following factors, among others, could cause the loss of any or
all of
the Investor’s investment.
(1) |
The
Company currently does not have enough working capital to satisfy
its
capital needs. The Company is dependent upon its management team
to fund
its ongoing operations, and cannot be certain that future financing
will
be available to it on acceptable terms when it needs it. The Company
can
give no assurances that it will be able to sell any portion of
this
offering or that management will continue to fund its ongoing operations.
This, along with the possibility of other factors and circumstances
the
Company cannot predict, may require it to seek additional financing
faster
than anticipated. If the Company is unable to obtain financing
to meet its
needs, the Investor may lose all of the Investor’s investment.
|
(2) |
The
Company’s officers and directors will only devote a limited amount of time
to the Company. Their divided interests may hinder the Company's
ability
to generate revenue. This could result in missed business opportunities
and worse-than-expected operating results. The Investor may lose
the
Investor’s entire investment.
|
(3) |
Management
has never operated in the industry in which it intends to operate.
This
lack of experience may result in the Company’s needing to employ outside
experts that have such experience. The additional cost could result
in a
net operating loss and, ultimately, could result in the Company's
failure.
Management's inexperience may limit the Company’s ability to generate
revenues. The Company may never achieve successful operations,
and the
Investor may lose the Investor’s entire
investment.
|
ii) |
The
Investor acknowledges that all documents received from the Company
contain
the management’s view of the Company, and that the analysis of the market
and of the Company’s strategy and competitive position contained therein
represent subjective assessments about which reasonable persons
could
disagree and there can be no assurance that the actual results
of
operations of the Company will be as contemplated. The Investor
has been
provided an opportunity for a reasonable period of time prior to
the date
hereof to obtain additional information concerning the offering
of the
Shares, the Company and all other information to the extent the
Company
possesses such information or can acquire it without unreasonable
effort
or expense;
|
iii) |
The
Investor confirms that the Investor is: (i) able to bear the economic
risk
of this investment, (ii) able to hold the Shares for the period
of time
set forth herein, and (iii) presently able to afford a complete
loss of
the Investor’s investment; and represents that the Investor has sufficient
liquid assets so that the illiquidity associated
with
|
3
this
investment will not cause any undue financial difficulties or affect the
Investor’s ability to provide for the Investor’s current needs and possible
financial contingencies, and that the Investor’s commitment to all speculative
investments (including this one if the Investor’s subscription is accepted by
the Company) is reasonable in relation to the Investor’s net worth and annual
income;
iv) |
The
Investor has such knowledge and experience in financial and business
matters that the Investor is capable of evaluating the merits and
risks of
an investment in the Shares and of making an informed investment
decision.
The Investor also represents that it has not been organized for
the
purpose of acquiring the Shares;
|
v) |
The
Shares are being acquired by the Investor solely for the Investor’s own
personal account, for investment purposes only, and not with a
view to, or
in connection with, any resale or distribution thereof; the Investor
has
and had no contract, undertaking, understanding, agreement or arrangement,
formal or informal, with any person to sell, transfer or pledge
to any
person the Shares for which the Investor is subscribing, any part
thereof,
any interest therein or any rights thereto; the Investor has no
present
plans to enter into any such contract, undertaking, agreement or
arrangement; and the Investor understands the legal consequences
of the
foregoing representations and warranties to mean that the Investor
must
bear the economic risk of the investment for an indefinite period
of time
because the Shares have not been registered under the Act and,
therefore,
cannot be sold unless they are subsequently registered under the
Act
(which the Company is not obligated to do) or unless an exemption
from
such registration is available; the Shares will be considered “Restricted
Securities” for purposes of Rule 144 promulgated under the
Act;
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vi) |
The
Investor understands that no Federal or state agency has passed
on or made
any recommendation or endorsement of the Shares and that the Company
is
relying on the truth and accuracy of the representations, declarations
and
warranties herein made by the Investor in offering the Shares for
sale to
the Investor without having first registered the Shares under the
Act;
|
vii) |
The
Investor realizes that the basis for the exemption may not be present
if,
notwithstanding such representations, the Investor has in mind
merely
acquiring the Shares for a fixed or determinable period in the
future, or
for a market rise, or for sale if the market does not rise. The
Investor
does not have any such intention;
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viii) |
The
Investor represents and warrants to the Company that all information
that
the Investor has provided to the Company, including, without limitation,
the information in the Investor Questionnaire attached hereto or
previously provided to the Company (the “Investor Questionnaire”), is
true, correct and complete as of the date hereof. In the event
that any
information in the Investor Questionnaire changes
on
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4
or
before
the Closing, the Investor will update the Investor Questionnaire to reflect
such
changes.
b) |
The
Investor has relied solely upon the advice of its own tax and legal
advisors with respect to the tax and other legal aspects of this
transaction. No representations or warranties have been made to
the
Investor by the Company, or any officer, employee, agent, affiliate
or
subsidiary of the Company, other than the representations of the
Company
contained herein, and in subscribing for Shares the Investor is
not
relying upon any representations other than those contained
herein.
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c) |
The
Investor has the necessary power and authority to execute and deliver
this
Agreement, to receive and hold the Shares and to carry out and
perform its
obligations hereunder. This Agreement is valid and binding upon
the
Investor and enforceable in accordance with its terms, subject
to
applicable liquidation, wind-up, insolvency, reorganization, moratorium
and similar laws affecting creditors’ rights and remedies generally and
subject, as to enforceability, to general principles of equity.
The
execution and delivery of this Agreement by the Investor does not,
and the
consummation of the transaction contemplated hereby and the performance
by
the Investor of the provisions of this Agreement will not violate
any
provisions of the Investor’s Certificate of Incorporation and By-laws, or
any provisions of, or result in the acceleration of any obligation
under,
or constitute an event of default, or an event which, with the
giving of
notice or the passage of time, or both, would constitute an event
of
default under any mortgage, lien, lease, agreement, instrument,
order,
arbitration award, judgment or decree to which the Investor is
bound,
which, either individually or in the aggregate would result in
a material
adverse change in the business, properties, results of operations,
condition (financial or otherwise) of the
Investor.
|
d) |
Any
resale of the Shares during the ‘distribution compliance period’ as
defined in Rule 902(f) to Regulation S shall only be made in compliance
with exemptions from registration afforded by Regulation S. Further,
any
such sale of the Shares in any jurisdiction outside of the United
States
will be made in compliance with the securities laws of such jurisdiction.
The Investor will not offer to sell or sell the Shares in any jurisdiction
unless the Investor obtains all required consents, if
any.
|
e) |
The
Investor understands that the Shares are being offered and sold
to the
Investor in reliance on an exemption from the registration requirements
of
United States federal and state securities laws under Regulation
S
promulgated under the Securities Act and that the Company is relying
upon
the truth and accuracy of the representations, warranties, agreements,
acknowledgments and understandings of the Investor set forth herein
and in
the Investor Questionnaire attached hereto in order to determine
the
applicability of such exemptions and the suitability of the Investor
to
acquire the Shares. In this regard, the Investor represents, warrants
and
agrees that:
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5
(1) |
The
Investor is not a U.S. Person (as defined below) and is not an
affiliate
(as defined in Rule 501(b) under the Securities Act) of the Company
and is
not acquiring the Shares for the account or benefit of a U.S. Person.
A
U.S. Person means any one of the
following:
|
(A) |
any
natural person resident in the United States of
America;
|
(B) |
any
partnership or corporation organized or incorporated under the
laws of the
United States of America;
|
(C) |
any
estate of which any executor or administrator is a U.S.
person;
|
(D) |
any
trust of which any trustee is a U.S.
person;
|
(E) |
any
agency or branch of a foreign entity located in the United States
of
America;
|
(F) |
any
non-discretionary account or similar account (other than an estate
or
trust) held by a dealer or other fiduciary for the benefit or account
of a
U.S. person;
|
(G) |
any
discretionary account or similar account (other than an estate
or trust)
held by a dealer or other fiduciary organized, incorporated or
(if an
individual) resident in the United States of America;
and
|
(H) |
any
partnership or corporation if:
|
(i) |
organized
or incorporated under the laws of any foreign jurisdiction;
and
|
(ii) |
formed
by a U.S. person principally for the purpose of investing in securities
not registered under the Securities Act, unless it is organized
or
incorporated, and owned, by accredited investors (as defined in Rule
501(a) under the Securities Act) who are not natural persons, estates
or
trusts.
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(2) |
At
the time of the origination of contact concerning this Agreement
and the
date of the execution and delivery of this Agreement, the Investor
was
outside of the United States.
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(3) |
The
Investor will not, during the period commencing on the date of
issuance of
the Shares and ending on the first anniversary of such date, or
such
shorter period as may be permitted by Regulation S or other applicable
securities law (the “Restricted Period”), offer, sell, pledge or otherwise
transfer the Shares in the United States, or to a U.S. Person for
the
account or for the
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6
benefit
of a U.S. Person, or otherwise in a manner that is not in compliance with
Regulation S.
(4) |
The
Investor will, after expiration of the Restricted Period, offer,
sell,
pledge or otherwise transfer the Shares only pursuant to registration
under the Securities Act or an available exemption therefrom and,
in
accordance with all applicable state and foreign securities
laws.
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(5) |
The
Investor was not in the United States, engaged in, and prior to
the
expiration of the Restricted Period will not engage in, any short
selling
of or any hedging transaction with respect to the Shares, including
without limitation, any put, call or other option transaction,
option
writing or equity swap.
|
(6) |
Neither
the Investor nor or any person acting on the Investor’s behalf has
engaged, nor will engage, in any directed selling efforts to a
U.S. Person
with respect to the Shares and the Investor and any person acting
on the
Investor’s behalf have complied and will comply with the “offering
restrictions” requirements of Regulation S under the Securities
Act.
|
(7) |
The
transactions contemplated by this Agreement have not been pre-arranged
with a buyer located in the United States or with a U.S. Person,
and are
not part of a plan or scheme to evade the registration requirements
of the
Securities Act.
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(8) |
Neither
the Investor nor any person acting on the Investor’s behalf has undertaken
or carried out any activity for the purpose of, or that could reasonably
be expected to have the effect of, conditioning the market in the
United
States, its territories or possessions, for any of the Shares.
The
Investor agrees not to cause any advertisement of the Shares to
be
published in any newspaper or periodical or posted in any public
place and
not to issue any circular relating to the Shares, except such
advertisements that include the statements required by Regulation
S under
the Securities Act, and only offshore and not in the U.S. or its
territories, and only in compliance with any local applicable securities
laws.
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(9) |
Each
certificate representing the Shares shall be endorsed with the
following
legends, in addition to any other legend required to be placed
thereon by
applicable federal or state securities
laws:
|
(A)“THE
SECURITIES ARE BEING OFFERED TO INVESTORS WHO ARE NOT U.S. PERSONS (AS DEFINED
IN REGULATION S UNDER THE SECURITIES ACT OF 1933, AS AMENDED (“THE SECURITIES
ACT”)) AND WITHOUT REGISTRATION WITH THE
7
UNITED
STATES SECURITIES AND EXCHANGE COMMISSION UNDER THE SECURITIES ACT IN RELIANCE
UPON REGULATION S PROMULGATED UNDER THE SECURITIES ACT.”
(B)“TRANSFER
OF THESE SECURITIES IS PROHIBITED, EXCEPT IN ACCORDANCE WITH THE PROVISIONS
OF
REGULATION S, PURSUANT TO REGISTRATION UNDER THE SECURITIES ACT, OR PURSUANT
TO
AVAILABLE EXEMPTION FROM REGISTRATION. HEDGING TRANSACTIONS MAY NOT BE CONDUCTED
UNLESS IN COMPLIANCE WITH THE SECURITIES ACT.”
(10) |
The
Investor consents to the Company making a notation on its records
or
giving instructions to any transfer agent of the Company in order
to
implement the restrictions on transfer of the Shares set forth
in this
Section 3.
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f) |
The
Investor agrees to indemnify and hold harmless the Company, its
officers
and directors, employees and its affiliates and their respective
successors and assigns and each other person, if any, who controls
any
thereof, against any loss, liability, claim, damage and expense
whatsoever
(including, but not limited to, any and all expenses whatsoever
reasonably
incurred in investigating, preparing or defending against any litigation
commenced or threatened or any claim whatsoever) arising out of
or based
upon any false representation or warranty or breach or failure
by the
Investor to comply with any covenant or agreement made by the Investor
herein or in any other document furnished by the Investor to any
of the
foregoing in connection with this transaction.
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The
Investor’s Investment
4. | a) |
The
Investor understands and agrees that the Company reserves the right
to
reject this subscription for the Shares if, in its reasonable judgment,
it
deems such action in the best interest of the Company, at any time
prior
to the Closing (as hereinafter defined), notwithstanding prior
receipt by
the Investor of notice of acceptance of the Investor's
subscription.
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b) |
The
Investor understands and agrees that its subscription for the Shares
is
irrevocable.
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c) |
In
the event the sale of the Shares subscribed for by the Investor
is not
consummated by the Company for any reason (in which event this
Subscription Agreement shall be deemed to be rejected), this Subscription
Agreement and any other agreement entered into
between
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8
the
Investor and the Company relating to this subscription shall thereafter have
no
force or effect and the Company shall promptly return or cause to be returned
to
the Investor the purchase price remitted to the Company by the Investor,
without
interest thereon or deduction therefrom, in exchange for the
Shares.
d) |
The
closing (the “Closing”) of the purchase and sale of the Shares, shall
occur simultaneously with the acceptance by the Company of the
Investor’s
subscription, as evidenced by the Company’s execution of this Subscription
Agreement.
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e) |
The
Investor understands that the price of the Shares offered hereby
bears no
relation to the assets, book value or net worth of the Company
and were
determined arbitrarily by the Company. The Investor further understands
that there is a substantial risk of further dilution on the Investor
or
its investment in the Company.
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Disputes,
Jurisdiction and Governing Law
5. |
In
the event of a dispute between the parties or any of them with
regard to
the interpretation, application or enforcement of this Agreement,
or
otherwise with regard to their relationships in the context of
this
Agreement, that dispute shall be submitted to such arbitrator as
is
designated by the Company.
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6.
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This
Agreement shall be governed by, and construed and interpreted in
accordance with, the laws of the State of New York, without regard
to
conflicts of law principles. Without derogating from the arbitration
provisions of Clause 5 above, the courts located in the United
States
District Court for the Southern District of New York, will have
exclusive
jurisdiction to decide any dispute between the parties arising
out of or
related to this Agreement.
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General
provisions
7. |
This
Agreement may not be amended, altered or modified except by a written
instrument signed by the parties.
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8. |
The
parties agree that they will impose - mutatis
mutandis -
upon any person who may acquire their Shares or part of them their
undertakings under this Agreement. This Clause will not continue
to bind
the parties after the conclusion of a public offering of the Company’s
shares.
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9.
|
Except
as specifically provided in this Agreement, nothing contained herein
shall
be construed to constitute any party hereto as the agent or partner
of any
other party hereto.
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10. |
This
Agreement supersedes and supplants any previous agreements, declarations
or undertakings of the parties and is the sole and exclusive instrument
by
which the parties desire to be bound. Specifically, the parties
agree that
any Company business plan that may have been presented to the Investor
shall have no binding effect as between
them.
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9
11. |
None
of the provisions of this Agreement shall be for the benefit or,
or
enforceable by, any third party.
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12.
|
This
Agreement shall be binding upon and inure to the benefit of the
parties,
their respective successors and permitted
assigns.
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13.
|
With
regard to any power, remedy or right provided herein or otherwise
available to any party hereunder, no waiver or extension of time
shall be
effective unless expressly contained in a writing signed by the
waiving
party and no alteration, modification or impairment shall be implied
by
reason of any previous waiver, extension of time, delay or omission
in
exercise, or other indulgence.
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14. |
The
validity, legality or enforceability of the remainder of this Agreement
shall not be affected even if one or more of the provisions of
this
Agreement shall be held to be invalid, illegal or unenforceable in any
respect. However, it is expressly stated that any party that terminates
this Agreement must terminate it in its
entirety.
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15. |
Upon
request of the Company, the Investor will enter into a customary
form of
Shareholders’ Agreement.
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16. |
All
parties to this Agreement were represented by counsel. Therefore,
there
shall be no presumption that this Agreement should be interpreted
against
the party that drafted it. Each party to this Agreement shall bear
its own
costs of counsel and other advisors incurred with regard to the
negotiation (including the due diligence process) of this
Agreement.
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17.
|
The
Article headings in this Agreement are inserted only as a matter
of
convenience, and in no way define, limit, or extend or interpret
the scope
of the Agreement or of any particular
Article.
|
18.
|
This
Agreement may be executed simultaneously in two or more counterparts,
each
of which shall be deemed to be an original, but all of which together
shall constitute one and the same
instrument.
|
IN
WITNESS WHEREOF THE INVESTOR HAS HEREUNTO SET ITS HAND AS OF THE DATE AND
YEAR
FIRST WRITTEN
[Investor
Name]
10
ACCEPTANCE
OF SUBSCRIPTION
(to
be
filed out only
by the
Company)
The
Company hereby accepts the above application for subscription for
Shares.
Dated:
August ___, 2007
By:
President
11
INVESTOR
QUESTIONNAIRE
A.
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General
Information
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1.
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Print
Full Name of Investor:
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Individual:
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______________________________
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First,
Middle, Last
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Partnership,
Corporation, Trust, Custodial Account, Other:
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____________________________________________________________
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Name
of Entity
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2.
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Address
for Notices:
|
____________________________________________________________
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______________________________
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____________________________________________________________
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3.
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Name
of Primary Contact Person:
Title:
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____________________________________________________________
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4.
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Telephone
Number:
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______________________________
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5.
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E-Mail
Address:
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____________________________________________________________
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6.
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Facsimile
Number:
Permanent
Address:
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____________________________________
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7.
|
Permanent
Address:
(if
different from Address for Notices above)
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____________________________________________________________
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8.
|
Authorized
Signatory:
Title:
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____________________________________
____________________________________
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Telephone
Number:
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____________________________________
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Facsimile
Number:
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____________________________________
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B.
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 Xxxx X. Xxxxxx, Esq. at
(000) 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 Xxxx X. Xxxxxx, Esq. at
(000) 000-0000 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
2
to
ERISA.
For purposes of determining whether this 25% threshold has been met or exceeded,
the value of any equity interest 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.
o
Yes
|
o
No
|
4(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.
o
Yes
|
o
No
|
4(c.) If
the
Investor answered “Yes” to question 4.(b) and the Investor is investing the
assets of an insurance company general account, please indicate what percentage
of the Investor’s assets the purchase of the Shares is subject to ERISA.
___________%.
5.
Does
the
amount of the Investor’s subscription for the Shares in the Company exceed 40%
of the total assets (on a consolidated basis with its subsidiaries) of the
Investor?
o
Yes
|
o
No
|
If
the
question above was answered “Yes,” please contact Xxxx X. Xxxxxx, Esq. at (000)
000-0000 for additional information that will be required.
6(a). Is
the
Investor a private investment company which is not registered under the
Investment Company Act, in reliance on Section 3(c)(1) or Section 3(c)(7)
thereof?
o
Yes
|
o
No
|
6(b).
If
the
question above was answered “Yes,” was the Investor formed prior to April 30,
1996?
o
Yes
|
o
No
|
If
the
questions set forth in (a) and (b) above were both answered “Yes,” please
contact Xxxx X. Xxxxxx, Esq. at (000) 000-0000 for additional information
that
will be required.
7(a).
Is
the
Investor a grantor trust, a partnership or an S-Corporation for US federal
income tax purposes?
o
Yes
|
o
No
|
3
7(b).
If
the
question above was answered “Yes,” please indicate whether or not:
(i)
more
than 50 percent of the value of the ownership interest of any beneficial
owner
in the Investor is (or may at any time during the term of the Company be)
attributable to the Investor’s (direct or indirect) interest in the Company;
or
o
Yes
|
o
No
|
(ii)
it
is a principal purpose of the Investor’s participation in the Company to permit
the Partnership to satisfy the 100 partner limitation contained in US Treasury
Regulation Section 1.7704-1(h)(3).
o
Yes
|
o
No
|
If
either
question above was answered “Yes,” please contact Xxxx X. Xxxxxx, Esq. at (000)
000-0000 for additional information that will be required.
8. If
the
Investor’s tax year ends on a date other than December 31, please indicate such
date below:
|
____________________________________
|
|
(Date)
|
C. Related
Parties
1. To
the
best of the Investor’s knowledge, does the Investor control, or is the Investor
controlled by or under common control with, any other investor in the
Company?
o
Yes
|
o
No
|
If
the
answer above was answered “Yes”, please identify such related investor(s)
below.
Name(s)
of related investor(s):
______________________________________________
______________________________________________________________________________________________________________________________
2. Will
any
other person or persons have a beneficial interest in the Shares to be acquired
hereunder (other than as a shareholder, partner, or other beneficial owner
of
equity interest in the Investor)?
o
Yes
|
o
No
|
If
either
question above was answered “Yes”, please contact Xxxx X. Xxxxxx, Esq. at (000)
000-0000 for additional information that will be required.
[THE
REST
OF THIS PAGE HAS INTENTIONALLY BEEN LEFT BLANK]
4
The
Investor understands that the foregoing information will be relied upon by
the
Company for the purpose of determining the eligibility of the Investor to
purchase the Shares. The Investor agrees to notify the Company immediately
if
any representation or warranty contained in this Subscription Agreement,
including this Investor Questionnaire, becomes untrue at any time. The Investor
agrees to provide, if requested, any additional information that may reasonably
be required to substantiate the Investor’s status as an accredited investor or
to otherwise determine the eligibility of the Investor to purchase the Shares.
The Investor agrees to indemnify and hold harmless the Company and each officer,
director, shareholder, agent and representative of the Company and their
respective affiliates and successors and assigns from and against any loss,
damage or liability due to or arising out of a breach of any representation,
warranty or agreement of the Investor contained herein.
|
INDIVIDUAL:
|
|
|
|
____________________________________
|
|
(Signature)
|
|
|
|
____________________________________
|
|
(Print
Name)
|
|
|
|
PARTNERSHIP,
CORPORATION, TRUST, CUSTODIAL ACCOUNT, OTHER:
|
|
|
|
___________________________________
|
|
(Name
of Entity)
|
|
|
|
By:
________________________________
|
|
(Signature)
|
|
|
|
________________________________
|
|
(Print
Name and Title)
|
5
Annex
1
DEFINITION
OF “INVESTMENTS”
The
term
“investments” means:
(1)
|
Securities,
other than securities of an issuer that controls, is controlled
by, or is
under common control with, the Investor that owns such securities,
unless
the issuer of such securities is:
|
(i)
|
An
investment company or a company that would be an investment company
but
for the exclusions or exemptions provided by the Investment Company
Act,
or a commodity pool; or
|
(ii)
|
A
Public Company (as defined below);
|
(iii)
|
A
company with shareholders’ equity of not less than $50 million (determined
in accordance with generally accepted accounting principles) as
reflected
on the company’s most recent financial statements, provided that such
financial statements present the information as of a date within
16 months
preceding the date on which the Investor acquires
Shares;
|
(2)
|
Real
estate held for investment
purposes;
|
(3)
|
Commodity
Shares (as defined below) held for investment
purposes;
|
(4)
|
Physical
Commodities (as defined below) held for investment
purposes;
|
(5)
|
To
the extent not securities, Financial Contracts (as defined below)
entered
into for investment purposes;
|
(6)
|
In
the case of an Investor that is a company that would be an investment
company but for the exclusions provided by Section 3(c)(1) or 3(c)(7)
of
the Investment Company Act, or a commodity pool, any amounts payable
to
such Investor pursuant to a firm agreement or similar binding commitment
pursuant to which a person has agreed to acquire an interest in,
or make
capital contributions to, the Investor upon the demand of the Investor;
and
|
(7)
|
Cash
and cash equivalents held for investment
purposes.
|
Real
Estate that is used by the owner or a Related Person (as defined below) of
the
owner for personal purposes, or as a place of business, or in connection
with
the conduct of the trade or business of such owner or a Related Person of
the
owner, will NOT be considered Real Estate held for investment purposes, provided
that real estate owned by an Investor who is engaged primarily in the business
of investing, trading or developing real estate in connection with such business
may be deemed to be held for investment purposes. However, residential real
estate will not be deemed to be used for personal purposes if deductions
with
respect to such real estate are not disallowed by section 280A of the Internal
Revenue Code of 1986, as amended.
6
A
Commodity Interest or Physical Commodity owned, or a Financial Contract entered
into, by the Investor who is engaged primarily in the business of investing,
reinvesting, or trading in Commodity Shares, Physical Commodities or Financial
Contracts in connection with such business may be deemed to be held for
investment purposes.
“Commodity
Shares” means commodity futures contracts, options on commodity futures
contracts, and options on physical commodities traded on or subject to the
rules
of:
(i)
|
Any
contract market designated for trading such transactions under
the
Commodity Exchange Act and the rules thereunder;
or
|
(ii)
|
Any
board of trade or exchange outside the United States, as contemplated
in
Part 30 of the rules under the Commodity Exchange
Act.
|
“Public
Company” means a company that:
(i)
|
files
reports pursuant to Section 13 or 15(d) of the Securities Exchange
Act of
1934, as amended; or
|
(ii)
|
has
a class of securities that are listed on a Designated Offshore
Securities
Market, as defined by Regulation S of the Securities
Act.
|
“Financial
Contract” means any arrangement that:
(i)
|
takes
the form of an individually negotiated contract, agreement, or
option to
buy, sell, lend, swap, or repurchase, or other similar individually
negotiated transaction commonly entered into by participants in
the
financial markets;
|
(ii)
|
is
in respect of securities, commodities, currencies, interest or
other
rates, other measures of value, or any other financial or economic
interest similar in purpose or function to any of the foregoing;
and
|
(iii)
|
is
entered into in response to a request from a counter party for
a
quotation, or is otherwise entered into and structured to accommodate
the
objectives of the counterparty to such
arrangement.
|
“Physical
Commodities” means any physical commodity with respect to which a Commodity
Interest is traded on a market specified in the definition of Commodity Shares
above.
“Related
Person” means a person who is related to the Investor as a sibling, spouse or
former spouse, or is a direct lineal descendant or ancestor by birth or adoption
of the Investor, or is a spouse of such descendant or ancestor, provided
that,
in the case of a Family Company, a Related Person includes any owner of the
Family Company and any person who is a Related Person of such an owner. “Family
Company” means a company that is owned directly or indirectly by or for two or
more natural persons who are related as siblings or spouse (including former
spouses), or direct lineal descendants by birth or adoption, spouses of such
persons, the estates of such persons, or foundations, charitable organizations
or trusts established for the benefit of such persons.
7
For
purposes of determining the amount of investments owned by a company, there
may
be included investments owned by majority-owned subsidiaries of the company
and
investments owned by a company (“Parent Company”) of which the company is a
majority-owned subsidiary, or by a majority-owned subsidiary of the company
and
other majority-owned subsidiaries of the Parent Company.
In
determining whether a natural person is a qualified purchaser, there may
be
included in the amount of such person’s investments any investment held jointly
with such person’s spouse, or investments in which such person shares with such
person’s spouse a community property or similar shared ownership interest. In
determining whether spouses who are making a joint investment in the Partnership
are qualified purchasers, there may be included in the amount of each spouse’s
investments any investments owned by the other spouse (whether or not such
investments are held jointly). There shall be deducted from the amount of
any
such investments any amounts specified by paragraph 2(a) of Annex 2 incurred
by
such spouse.
In
determining whether a natural person is a qualified purchaser, there may
be
included in the amount of such person’s investments any investments held in an
individual retirement account or similar account the investments of which
are
directed by and held for the benefit of such person.
8
Annex
2
VALUATIONS
OF INVESTMENTS
The
general rule for determining the value of investments in order to ascertain
whether a person is a qualified purchaser is that the value of the aggregate
amount of investments owned and invested on a discretionary basis by such
person
shall be their fair market value on the most recent practicable date or their
cost. This general rule is subject to the following provisos:
(1) In
the
case of Commodity Shares, the amount of investments shall be the value of
the
initial margin or option premium deposited in connection with such Commodity
Shares; and
(2) In
each
case, there shall be deducted from the amount of investments owned by such
person the following amounts:
(i) The
amount of any outstanding indebtedness incurred to acquire the investments
owned
by such person.
(ii) A
Family
Company, in addition to the amounts specified in paragraph (a) above, shall
have
deducted from the value of such Family Company’s investments any outstanding
indebtedness incurred by an owner of the Family Company to acquire such
investments.
9