RANGER GOLD CORP. REGULATION S SUBSCRIPTION AGREEMENT AND INVESTMENT REPRESENTATION
REGULATION
S SUBSCRIPTION AGREEMENT AND INVESTMENT REPRESENTATION
SECTION
1
1.1 Subscription.
(a) The
undersigned, intending to be legally bound, hereby irrevocably subscribes for
and agrees to purchase ____________ Units (hereafter defined) to be issued by
Ranger Gold Corp., a Nevada corporation (the "Company"), in an offshore
transaction negotiated outside the U.S. and to be consummated and closed outside
the U.S. The Company is directly offering for sale ______ Units for
an aggregate gross proceeds of $___. A “Unit” shall consist of the
following:
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(1)
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one
share of Common Stock (a “Purchased
Share”);
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(2)
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one
Class A Warrant, as further described in the Class A Warrant Agreement
attached hereto as Exhibit A, entitling the undersigned to purchase one
share of Common Stock at an exercise price of $___ per share, expiring on
____ (a “Class A Warrant”); and
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[(3)
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one
Class B Warrant, as further described in the Class B Warrant Agreement
attached hereto as Exhibit B, entitling the undersigned to purchase one
share of Common Stock at an exercise price of $___ per share, expiring on
____ (a “Class B Warrant, and together with the Class A Warrant, the
“Warrants”). ]
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(b) For
purposes of this Subscription Agreement:
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(1)
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“Common
Stock” means the common stock of the
Company.
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(2)
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“Securities”
means the Purchased Shares, the Warrant[s] and the Warrant
Shares.
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(3)
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“Warrant
Shares” means the shares of Common Stock issuable upon due exercise of the
Warrant[s].
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1
1.2 Purchase of
Units.
The undersigned understands and
acknowledges that the purchase price to be remitted to the Company in exchange
for the Units shall be ____________ dollars ($______) or $___ per
Unit. Simultaneous with the execution and delivery of this Agreement,
including the Investor Questionnaire annexed hereto, the undersigned shall
deliver to the Company the aforementioned purchase price by wire transfer of
immediately available funds. Wire instructions are attached hereto as Appendix
A.
1.3 Acceptance or
Rejection.
(a) The
undersigned understands and agrees that the Company reserves the right to reject
this subscription for the Units if, in its reasonable judgment, it deems such
action in the best interest of the Company, at any time prior to the Closing,
notwithstanding prior receipt by the undersigned of notice of acceptance of the
undersigned's subscription.
(b) The
undersigned understands and agrees that its subscription for the Units is
irrevocable.
(c) In
the event the sale of the Units subscribed for by the undersigned 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 the undersigned 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 undersigned the purchase price
remitted to the Company by the undersigned, without interest thereon or
deduction therefrom, in exchange for the Units.
SECTION
2
2.1 Closing. The
closing (the "Closing") of the purchase and sale of the Units, shall occur
simultaneously with the acceptance by the Company of the undersigned's
subscription, as evidenced by the Company's execution of this Subscription
Agreement.
SECTION
3
3.1 Investor Representations and
Warranties.
The
undersigned hereby acknowledges, represents and warrants to, and agrees with,
the Company and its affiliates as follows:
2
(a) The
undersigned is acquiring the Securities for his own account as principal, not as
a nominee or agent, for investment purposes only, and not with a view to, or
for, resale, distribution or fractionalization thereof in whole or in part and
no other person has a direct or indirect beneficial interest in such Securities
or any portion thereof. Further, the undersigned does not have any
contract, undertaking, agreement or arrangement with any person to sell,
transfer or grant participations to such person or to any third person, with
respect to the Securities for which the undersigned is subscribing or any part
of the Securities.
(b) The
undersigned has full power and authority to enter into this Agreement, the
execution and delivery of this Agreement has been duly authorized, if
applicable, and this Agreement constitutes a valid and legally binding
obligation of the undersigned.
(c) The
undersigned is not subscribing for the Securities as a result of or subsequent
to any advertisement, article, notice or other communication published in any
newspaper, magazine or similar media or broadcast over television or radio, or
presented at any seminar or meeting, or any solicitation of a subscription by
person previously not known to the undersigned in connection with investment
securities generally.
(d) The
undersigned understands that the Company is under no obligation to register the
Securities under the Securities Act of 1933, as amended (the “Securities Act”),
or to assist the undersigned in complying with the Securities Act or the
securities laws of any state of the United States or of any foreign
jurisdiction.
(e) The
undersigned is (i) experienced in making investments of the kind described in
this Agreement and the related documents, (ii) able, by reason of the business
and financial experience of its officers (if an entity) and professional
advisors (who are not affiliated with or compensated in any way by the Company
or any of its affiliates or selling agents), to protect its own interests in
connection with the transactions described in this Agreement, and the related
documents, and (iii) able to afford the entire loss of its investment in the
Securities. The undersigned further understands that the Company currently has
no business or operations and although it is contemplating entering the field of
clean energy technologies, the Company currently has no agreements or
arrangements with any persons in connection therewith.
(f) The
undersigned acknowledges his understanding that the offering and sale of the
Purchased Shares, Warrants and the issuance of the Warrant Shares upon due
exercise of the Warrants is intended to be exempt from registration under the
Securities Act. In furtherance thereof, in addition to the other
representations and warranties of the undersigned made herein, the undersigned
further represents and warrants to and agrees with the Company and its
affiliates as follows:
3
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(i)
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The
undersigned realizes that the basis for the exemption may not be present
if, notwithstanding such representations, the undersigned has in mind
merely acquiring the Securities for a fixed or determinable period in the
future, or for a market rise, or for sale if the market does not
rise. The undersigned does not have any such
intention;
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(ii)
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The
undersigned has the financial ability to bear the economic risk of his
investment, has adequate means for providing for his current needs and
personal contingencies and has no need for liquidity with respect to his
investment in the Company;
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(iii)
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The
undersigned has such knowledge and experience in financial and business
matters as to be capable of evaluating the merits and risks of the
prospective investment in the Securities. The undersigned also
represents it has not been organized for the purpose of acquiring the
Securities;
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(iv)
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The
undersigned 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 Securities, the Company and all other information to
the extent the Company possesses such information or can acquire it
without unreasonable effort or
expense; and
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(v)
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The
undersigned has carefully reviewed all of the Company’s filings under the
Securities Exchange Act of 1934, as amended (the “Exchange
Act”).
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(g) The
undersigned is not relying on the Company, or its affiliates or agents with
respect to economic considerations involved in this investment. The
undersigned has relied solely on its own advisors.
(h) No
representations or warranties have been made to the undersigned 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
Units the undersigned is not relying upon any representations other than those
contained herein.
(i) Any
resale of the Securities 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 Securities 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 Securities in any jurisdiction
unless the Investor obtains all required consents, if any.
4
(j) The
undersigned understands that the Securities are being offered and sold 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 in order to determine the applicability of such
exemptions and the suitability of the Investor to acquire the
Securities. In this regard, the undersigned represents, warrants and
agrees that:
1.
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The
undersigned is not an 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 Securities for the account or benefit of
a U.S. Person. A U.S. Person means any one of the
following:
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·
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any
natural person resident in the United States of
America;
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·
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any
partnership or corporation organized or incorporated under the laws of the
United States of America;
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·
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any
estate of which any executor or administrator is a U.S.
person;
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·
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any
trust of which any trustee is a U.S.
person;
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·
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any
agency or branch of a foreign entity located in the United States of
America;
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·
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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;
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·
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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
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·
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any
partnership or corporation if:
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(A)
organized or incorporated under the laws of any foreign jurisdiction;
and
(B)
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.
5
2.
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At
the time of the origination of contact concerning this Agreement and the
date of the execution and delivery of this Agreement, the undersigned was
outside of the United States.
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3.
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The
undersigned will not, during the period commencing on the date of issuance
of the Purchased Shares or Warrants 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 Purchased Shares or the Warrants in the
United States, or to a U.S. Person for the account or for the benefit of a
U.S. Person, or otherwise in a manner that is not in compliance with
Regulation S.
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4.
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The
undersigned will, after expiration of the Restricted Period, offer, sell,
pledge or otherwise transfer the Purchased Shares or Warrants 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.
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The
undersigned 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 Securities, including
without limitation, any put, call or other option transaction, option
writing or equity swap.
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6.
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Neither
the undersigned nor or any person acting on his behalf has engaged, nor
will engage, in any directed selling efforts to a U.S. Person with respect
to the Securities and the Investor and any person acting on his behalf
have complied and will comply with the “offering restrictions”
requirements of Regulation S under the Securities
Act.
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7.
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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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6
8.
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Neither
the undersigned nor any person acting on his 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
Securities. The undersigned agrees not to cause any
advertisement of the Securities to be published in any newspaper or
periodical or posted in any public place and not to issue any circular
relating to the Securities, 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.
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Each
certificate representing the Securities 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:
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“THE
SECURITIESARE 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 UNITED STATES SECURITIES AND EXCHANGE
COMMISSION UNDER THE SECURITIES ACT IN RELIANCE UPON REGULATION S PROMULGATED
UNDER THE SECURITIES ACT.”
“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.
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The
undersigned 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 Securities set forth in this
Section 2.
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7
Cross
out if inapplicable
(k) The
undersigned is an “accredited investor” as that term is defined in Rule 501 of
the General Rules and Regulations under the Securities Act by reason of Rule
501(a)(3).
(l) The
undersigned understands that an investment in the Securities is a speculative
investment which involves a high degree of risk and the potential loss of his
entire investment.
(m) The
undersigned's overall commitment to investments which are not readily marketable
is not disproportionate to the undersigned's net worth, and an investment in the
Securities will not cause such overall commitment to become
excessive.
(n) The
undersigned has received all documents, records, books and other information
pertaining to the undersigned’s investment in the Company that has been
requested by the undersigned. The undersigned has reviewed all
reports and other documents filed by the Company with the Securities and
Exchange Commission (the “SEC Documents”).
(o) The
undersigned represents and warrants to the Company that all information that the
undersigned 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 correct and complete as of the
date hereof.
(p) Other
than as set forth herein, the undersigned is not relying upon any other
information, representation or warranty by the Company or any officer, director,
stockholder, agent or representative of the Company in determining to invest in
the Securities. The undersigned has consulted, to the extent deemed
appropriate by the undersigned, with the undersigned’s own advisers as to the
financial, tax, legal and related matters concerning an investment in the
Securities and on that basis believes that his or its investment in the
Securities is suitable and appropriate for the undersigned.
(q) The
undersigned is aware that no federal or state agency has (i) made any finding or
determination as to the fairness of this investment, (ii) made any
recommendation or endorsement of the Securities or the Company, or (iii)
guaranteed or insured any investment in the Securities or any investment made by
the Company.
(p) The
undersigned understands that the price of the Securities offered hereby bear no
relation to the assets, book value or net worth of the Company and were
determined arbitrarily by the Company. The undersigned further
understands that there is a substantial risk of further dilution on his or its
investment in the Company.
8
SECTION
4
The
Company represents and warrants to the undersigned as follows:
4.1
Organization of the
Company. The Company is a corporation duly organized and
validly existing and in good standing under the laws of the State of Nevada, and
has all requisite power and authority to own, lease and operate its properties
and to carry on its business as now being conducted.
4.2 Authority. (a) The
Company has the requisite corporate power and authority to enter into and
perform its obligations under this Agreement and to issue the Securities; (b)
the execution and delivery of this Agreement by the Company and the consummation
by it of the transactions contemplated hereby and thereby have been duly
authorized by all necessary corporate action and no further consent or
authorization of the Company or its Board of Directors is required; and (c) this
Agreement has been duly executed and delivered by the Company and constitutes a
valid and binding obligation of the Company enforceable against the Company in
accordance with its terms, except as
such enforceability may be limited by applicable
bankruptcy, insolvency, or similar laws relating to, or affecting generally the
enforcement of, creditors' rights and remedies or by other equitable principles
of general application.
4.3 SEC
Documents. To the best of Company's knowledge, the Company has
not provided to the undersigned any information that, according to applicable
law, rule or regulation, should have been disclosed publicly prior to the date
hereof by the Company, but which has not been so disclosed. As of their
respective dates, the SEC Documents complied in all material respects with the
requirements of the Securities Act or the Exchange Act, as the case may be, and
other federal, state and local laws, rules and regulations applicable to such
SEC Documents, and none of the SEC Documents contained any untrue statement of a
material fact or omitted to state a material fact required to be stated therein
or necessary in order to make the statements therein, in light of the
circumstances under which they were made, not misleading. The financial
statements of the Company included in the SEC Documents comply as to form and
substance in all material respects with applicable accounting requirements and
the published rules and regulations of the Securities and Exchange Commission
(the “SEC”) or other applicable rules and regulations with respect thereto. Such
financial statements have been prepared in accordance with generally accepted
accounting principles applied on a consistent basis during the periods involved
(except (a) as may be otherwise indicated in such financial statements or the
notes thereto or (b) in the case of unaudited interim statements, to the extent
they may not include footnotes or may be condensed or summary statements) and
fairly present in all material respects the financial position of the Company as
of the dates thereof and the results of operations and cash flows for the
periods then ended (subject, in the case of unaudited statements, to normal
year-end audit adjustments).
9
4.5 Exemption from Registration;
Valid Issuances. The sale and issuance of the Securities, in
accordance with the terms and on the bases of the representations and warranties
of the undersigned set forth herein, may and shall be properly issued by the
Company to the undersigned pursuant to Section 4(2), Regulation S and/or any
applicable U.S state law. When issued and paid for as herein provided, the
Securities shall be duly and validly issued, fully paid, and nonassessable.
Neither the sales of the Securities pursuant to, nor the Company's performance
of its obligations under, this Agreement shall (a) result in the creation or
imposition of any liens, charges, claims or other encumbrances upon the
Securities or any of the assets of the Company, or (b) entitle the other holders
of the Common Stock of the Company to preemptive or other rights to subscribe to
or acquire the Common Stock or other securities of the Company. The Securities
shall not subject the undersigned to personal liability by reason of the
ownership thereof.
4.6 No General Solicitation or
Advertising in Regard to this Transaction. Neither the Company nor any of
its affiliates nor any person acting on its or their behalf (a) 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 Securities, or
(b) 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.
4.7 No
Conflicts. The
execution, delivery and performance of this Agreement by the Company and the
consummation by the Company of the transactions contemplated hereby, including
without limitation the issuance of the Securities, do not and will not (a)
result in a violation of the Certificate or By-Laws of the Company or (b)
conflict with, or constitute a material default (or an event that with notice or
lapse of time or both would become a material default) under, or give to others
any rights of termination, amendment, acceleration or cancellation of, any
material agreement, indenture, instrument or any "lock-up" or similar provision
of any underwriting or similar agreement to which the Company is a party, or (c)
result in a violation of any federal, state, local or foreign law, rule,
regulation, order, judgment or decree (including federal and state securities
laws and regulations)applicable to the Company or by which any property or asset
of the Company is bound or affected (except for such conflicts, defaults,
terminations, amendments, accelerations, cancellations and violations as would
not, individually or in the aggregate, have a material adverse effect on the
business, operations, properties, prospects or condition (financial or
otherwise) of the Company) nor is the Company otherwise in violation of,
conflict with or in default under any of the foregoing. The Company is not
required under U.S. federal, state or local law, rule or regulation to obtain
any consent, authorization or order of, or make any filing or registration with,
any court or governmental agency in order for it to execute, deliver or perform
any of its obligations under this Agreement or issue and sell the Common Stock
in accordance with the terms hereof (other than any SEC, NASD or
state securities filings that may be required to be made by the Company
subsequent to the Closing); provided that, for purposes of the representation
made in this sentence, the Company is assuming and relying upon the accuracy of
the relevant representations and agreements of the undersigned
herein.
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SECTION
5
5.1 Indemnity. The
undersigned 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 undersigned to comply
with any covenant or agreement made by the undersigned herein or in any other
document furnished by the undersigned to any of the foregoing in connection with
this transaction.
5.2 Modification. Neither
this Agreement nor any provisions hereof shall be modified, discharged or
terminated except by an instrument in writing signed by the party against whom
any waiver, change, discharge or termination is sought.
5.3 Notices. Any
notice, demand or other communication which any party hereto may be
required, or may elect, to give to anyone interested hereunder shall be
sufficiently given if (a) deposited, postage prepaid, in a United States mail
letter box, registered or certified mail, return receipt requested, addressed to
such address as may be given herein, or (b) delivered personally at such
address.
5.4 Counterparts. This
Agreement may be executed through the use of separate signature pages or in any
number of counterparts and by facsimile, and each of such counterparts shall,
for all purposes, constitute one agreement binding on all parties,
notwithstanding that all parties are not signatories to the same counterpart.
Signatures may be facsimiles.
5.5 Binding
Effect. Except as otherwise provided herein, this Agreement
shall be binding upon and inure to the benefit of the parties and their heirs,
executors, administrators, successors, legal representatives and
assigns. If the undersigned is more than one person, the obligation
of the undersigned shall be joint and several and the agreements,
representations, warranties and acknowledgments herein contained shall be deemed
to be made by and be binding upon each such person and his heirs, executors,
administrators and successors.
5.6 Entire
Agreement. This Agreement and the documents referenced herein
contain the entire agreement of the parties and there are no representations,
covenants or other agreements except as stated or referred to herein and
therein.
5.7 Assignability. This
Agreement is not transferable or assignable by the undersigned.
11
5.8 Applicable
Law. This Agreement shall be governed by and construed in
accordance with the laws of the State of Nevada, without giving effect to
conflicts of law principles.
5.9 Pronouns. The
use herein of the masculine pronouns "him" or "his" or similar terms shall be
deemed to include the feminine and neuter genders as well and the use herein of
the singular pronoun shall be deemed to include the plural as well.
IN
WITNESS WHEREOF, the undersigned has executed this Agreement on the day of ______,
2010.
Amount of
Investment:
$_____________________
INDIVIDUAL
INVESTOR:
______________________
Name:
PARTNERSHIP,
CORPORATION, TRUST,
CUSTODIAL
ACCOUNT, OTHER INVESTOR
___________________________
(Print
Name of Entity)
By: __________________
Name:
Title:
Address:
Taxpayer
Identification Number:_____________
12
ACCEPTANCE
OF SUBSCRIPTION
(to be
filed out only
by the Company)
The
Company hereby accepts the above application for subscription for Units on
behalf of the Company.
RANGER
GOLD
CORP. Dated:
January 25, 2010
By:__/s/
Xxxxxxxxx Xxxxx Basrai_
Name:
Xxxxxxxxx Xxxxx Basrai
Title:
Chief Executive Office, President, Secretary, and Treasurer
13
Appendix
A
Wiring
Instructions
For
Payment of Purchase Price
The
following are the wire instructions for the account into which the payment of
the purchase price for the Units subscribed for should be wired.
The bank
account of Ranger Gold Corp. at _________ is as follows:
__________
__________
__________
__________
In case
the entity on behalf of which the transfer is taking place is different from the
transferor, please make sure that the wire includes in the comments the name of
the entity.
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INVESTOR
QUESTIONNAIRE
A.
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eGeneral 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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____________________________________
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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.
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Permanent
Address:
(if
different from Address for Notices above)
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____________________________________
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8.
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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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9.
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U.S.
Investors Only:
U.S.
Taxpayer Identification or Social
Security
Number:
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____________________________________
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B. Accredited Investor
Status
The
Investor represents and warrants that the Investor is an “accredited investor”
within the meaning of Rule 501 of Regulation D under the Securities Act of 1933,
as amended (the “Securities Act”), and has checked the box or boxes below which
are next to the categories under which the Investor qualifies as an accredited
investor:
FOR
INDIVIDUALS:
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o
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A
natural person with individual net worth (or joint net worth with spouse)
in excess of $1 million. For purposes of this item, “net worth” means the
excess of total assets at fair market value, including home, home
furnishings and automobiles (and including property owned by a spouse),
over total liabilities.
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o
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A
natural person with individual income (without including any income of the
Investor’s spouse) in excess of $200,000, or joint income with spouse of
$300,000, in each of the two most recent years and who reasonably expects
to reach the same income level in the current year.
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FOR
ENTITIES:
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o
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A
bank as defined in Section 3(a)(2) of the Securities Act or any savings
and loan association or other institution as defined in Section 3(a)(5)(A)
of the Securities Act, whether acting in its individual or fiduciary
capacity.
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o
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An
insurance company as defined in Section 2(13) of the Securities
Act.
|
||
o
|
A
broker-dealer registered pursuant to Section 15 of the Securities Exchange
Act of 1934.
|
||
o
|
An
investment company registered under the Investment Company Act of 1940, as
amended (the “Investment Company Act”). If an Investor has checked this
box, please contact _______ for additional information that will be
required.
|
||
o
|
A
business development company as defined in Section 2(a)(48) of the
Investment Company Act.
|
||
16
o
|
A
small business investment company licensed by the Small Business
Administration under Section 301(c) or (d) of the Small Business
Investment Act of 1958.
|
o
|
A
private business development company as defined in Section 202(a)(22) of
the Investment Advisers Act of 1940. If an Investor has checked this box,
please contact ______ for additional information that will be
required.
|
o
|
An
organization described in Section 501(c)(3) of the Internal Revenue Code,
a corporation, Massachusetts or similar business trust, or partnership,
not formed for the specific purpose of acquiring the Units, with total
assets in excess of $5 million.
|
o
|
A
trust with total assets in excess of $5 million not formed for the
specific purpose of acquiring the Units, whose purchase is directed by a
person with such knowledge and experience in financial and business
matters as to be capable of evaluating the merits and risks of an
investment in the Company and the purchase of the
Units.
|
o
|
An
employee benefit plan within the meaning of ERISA if the decision to
invest in the Units is made by a plan fiduciary, as defined in Section
3(21) of ERISA, which is either a bank, savings and loan association,
insurance company, or registered investment adviser, or if the employee
benefit plan has total assets in excess of $5 million or, if a
self-directed plan, with investment decisions made solely by persons that
are accredited investors.
|
o
|
A
plan established and maintained by a state, its political subdivisions, or
any agency or instrumentality of a state or its political subdivisions,
for the benefit of its employees, if the plan has total assets in excess
of $5 million.
|
o
|
An
entity, including a grantor trust, in which all of the equity owners are
accredited investors as determined under any of the foregoing paragraphs
(for this purpose, a beneficiary of a trust is not an equity owner, but
the grantor of a grantor trust is an equity
owner).
|
C. Supplemental
Data for Entities
1. If
the Investor is not a natural person, furnish the following supplemental data
(natural persons may skip this Section C of the Investor
Questionnaire):
Legal
form of entity (trust, corporation, partnership, etc.):
_________________________
Jurisdiction
of organization: ________________________________________________
2. Was
the Investor organized for the specific purpose of acquiring the
Units?
o Yes
|
o No
|
If the
answer to the above question is “Yes,” please contact _______, ________, at
_______ or ________ for additional information that will be
required.
17
3. Are
shareholders, partners or other holders of equity or beneficial interest in the
Investor able to decide individually whether to participate, or the extent of
their participation, in the Investor’s investment in the Company (i.e., can
shareholders, partners or other holders of equity or beneficial interest in the
Investor determine whether their capital will form part of the capital invested
by the Investor in the Company)?
o Yes
|
o No
|
If the
answer to the above question is “Yes,” please contact Xxxxx Xxxxx &
Associates, PLLC (xxxxx@xxxxxxxxxxxxxxxx.xxx
or 516-284-1740) for additional information that will be required.
4(a). Please
indicate whether or not the Investor is, or is acting on behalf of, (i) an
employee benefit plan within the meaning of Section 3(3) of ERISA, whether or not such plan is
subject to ERISA, or (ii) an entity which is deemed to hold the assets of
any such employee benefit plan pursuant to 29 C.F.R. § 2510.3-101. For example,
a plan which is maintained by a foreign corporation, governmental entity or
church, a Xxxxx plan covering no common-law employees and an individual
retirement account are employee benefit plans within the meaning of Section 3(3)
of ERISA but generally are not subject to ERISA (collectively, “Non-ERISA Plans”). In
general, a foreign or US entity which is not an operating company and which is
not publicly traded or registered as an investment company under the Investment
Company Act of 1940, as amended, and in which 25% or more of the value of any
class of equity interest is held by employee pension or welfare plans (including
an entity which is deemed to hold the assets of any such plan), would be deemed
to hold the assets of one or more employee benefit plans pursuant to 29 C.F.R. §
2510.3-101. However, if only Non-ERISA Plans were invested in such an entity,
the entity generally would not be subject to ERISA. For purposes of determining
whether 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 Units is subject to ERISA.
___________%.
5. Does
the amount of the Investor’s subscription for the Units 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 Xxxxx Xxxxx & Associates
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
|
18
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 Xxxxx Xxxxx & Associates 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
|
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 Xxxxx Xxxxx & Associates
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)
|
D.
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 Units 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 Xxxxx Xxxxx & Associates for additional information
that will be required.
19
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
Units;
|
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.
20
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.
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.
21
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.
22
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.
|
23