By submitting below I represent that I am an accredited investor by one of the three definitions above on the form herein and that to the best of my knowledge an investment in the Company is suitable and consistent with my investment objectives. I represent to the Company that I have the proper knowledge, expertise, and understanding of both my financial position and of these types of investments to make this judgment; and that I have or will review all documents that I deem necessary before making an investment and/or participate in one of the alternaive Private Equity Offering(s). PR stands for Primary Residence and NW stands for Net Worth.
Anti-Money Laundering Certification By selecting one of the options on the form and submitting the form below, I hereby represent and certify that I am not involved in any money laundering scheme and that my investment funds have not been directly or indirectly derived from activities that may contravene U.S. or international laws, rules and regulations designed to avoid money laundering, including, without limitation, the provisions of the Bank Secrecy Act of 1970, as amended. Neither I nor any person controlling, controlled by, or under common control with me, nor any person having a beneficial interest in my investments, is a country, territory, person or entity named on the U.S. Department of Treasury Office of Foreign Asset Control list, or is a person or entity that resides or has a place of business in a country or territory named in such lists. I agree to notify you promptly should I become aware of any changes to the information set forth in this statement. I acknowledge that, due to anti-money laundering requirements operating in the United States and the particular fund's own internal anti-money laundering policies, such fund may require further identification from me and the source of the investment funds before any subscriptions can be processed, monies accepted or a redemption request processed. I shall hold the fund, the investment adviser and each of its respective principals, members, directors, officers, and employees harmless and indemnified against any loss arising as a result of a failure to process this request for Private Placement Memorandum documents if any information that has been required by an indemnified party has not been satisfactorily provided by me. I further acknowledge that all subscription payments transferred to a fund must originate directly from a bank or brokerage account in my name.