Individuals. Please complete the following information if you are investing as an individual or jointly with another individual: Name: ________________________. Spouse's full name, if jointly held: ________________________. Date of birth: ________________________. Citizenship: ________________________. Permanent home address: ________________________ ________________________________________________ Marital status: ________________________. Address for notices: ________________________ ________________________________________________ Home telephone number: ________________________. Business telephone number: ________________________. Social security or tax identification number: ________________________. Occupation or profession: ________________________. Are you purchasing Shares for your own account? Yes No If you are not purchasing Shares for your own account, please complete the following:
Individuals. If the undersigned is a natural person (ignoring any revocable grantor trust), then the undersigned hereby represents and warrants as follows (check whichever applies): ☐ The undersigned is a director, executive officer, or general partner of the Issuer, or a director, executive officer, or general partner of a general partner of the Issuer. ☐ The undersigned has a net worth (either individually or jointly with the undersigned’s spouse) in excess of $1,000,000 (see calculation guidance below). ☐ The undersigned (i) either (A) had an individual annual income (exclusive of spousal income) in excess of $200,000 or (B) had a joint income with the undersigned’s spouse in excess of $300,000 in each of the two preceding tax years, and (ii) reasonably expects to have the same income level (individually or jointly, as applicable) in the current tax year (see calculation guidance below).
Individuals. (i) The Investor is an individual with a net worth, or a joint net worth together with his or her spouse, in excess of $1,000,000. (In calculating net worth, you may include equity in personal property and real estate, including your principal residence, cash, short-term investments, stock and securities. Equity in personal property and real estate should be based on the fair market value of such property less any debt secured by such property.)
Individuals. 1. A certified copy of a valid identification document including a specimen signature of the holder (identity card, passport, driving license with photo, or any other appropriate document) for the subscriber and, if applicable, for all third-party beneficiaries.
Individuals. Unless otherwise agreed to in writing by ERCOT, Contractor warrants that all individuals performing Services on behalf of Contractor under this Agreement (“Individuals” or, singularly, an “Individual”) are employees of Contractor who may legally work in the United States, and for whom Contractor is solely responsible and pays wages, required federal, state, and local tax withholdings (including social security, unemployment, and Medicare), workers’ compensation insurance, and employment benefits (“Contractor Employees”). Under no circumstances will any Individuals, whether Contractor Employees or a Subcontractor, as defined below in Section 3.3, be considered employees of ERCOT.
Individuals. ☐ The Investor has an individual net worth, or joint net worth with his or her spouse, in excess of $1,000,000.1 ☐ The Investor had individual income (exclusive of any income attributable to his or her spouse) of more than $200,0002 in each of the past two years, or joint income with his or her spouse of more than $300,0003 in each of those years, and reasonably expects to reach the same income level in the current year.
Individuals. The Company has determined that those persons listed on Exhibit B attached hereto are the persons currently subject to the reporting and liability provisions of Section 16 of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), and the rules and regulations promulgated thereunder ("Section 16 Individuals"). Exhibit B will be amended and -updated from time to time as appropriate to include an updated list of directors and officers and shareholders who beneficially own more than 10% of the Company's common stock.
Individuals. For multiple choice sections, please tick the appropriate box Subscriber acting on its own behalf Subscriber acting on behalf of third parties Last, First name Profession Economic sector If your activity falls within one of the following sectors, please tick the appropriate box : Casino, games Religious financial institution Charity Diamond merchant, lapidary Real estate agency Art dealership Date of birth Place of birth Source of invested capital Savings Property income Inheritance Game winnings Other details : Political mandate or public office No Yes details : TIN - Tax Id Number* Identification ID card Passport N° Country of issue Second subscriber (If applicable) - For multiple choice sections, please tick the appropriate box Subscriber acting on its own behalf Subscriber acting on behalf of third parties Last, First name Profession Economic sector If your activity falls within one of the following sectors, please tick the appropriate box : Casino, games Religious financial institution Charity Diamond merchant, lapidary Real estate agency Art dealership Date of birth Place of birth Source of invested capital Savings Property income Inheritance Game winnings Other details : Political mandate or public office No Yes details : TIN - Tax Id Number* Identification ID card Passport N° Country of issue * TIN – Tax / National / Personal Identification Number
Individuals. 1. I am a natural person whose individual net worth, or joint net worth with my spouse, exceeds $1,000,000.1 Yes ☐ No ☐ (Please check either yes or no)
Individuals. Unless otherwise specified, all Natural Persons residing in the United States who, at any time between April 20, 2010 and April 16, 2012, lived in, worked in, were offered and accepted work in, owned or leased real or personal property located within, or owned or leased or worked on a vessel harbored or HOME PORTED in the States of Louisiana, Mississippi, or Alabama, the counties of Chambers, Galveston, Jefferson and Orange in the State of Texas, or the counties of Bay, Calhoun, Charlotte, Citrus, Collier, Dixie, Escambia, Franklin, Gadsden, Gulf, Hernando, Hillsborough, Holmes, Jackson, Jefferson, Lee, Leon, Levy, Liberty, Manatee, Monroe, Okaloosa, Pasco, Pinellas, Santa Rosa, Sarasota, Taylor, Wakulla, Walton and Washington in the State of Florida, including all adjacent Gulf waters, bays, estuaries, straits, and other tidal or brackish waters within the States of Louisiana, Mississippi, Alabama, or those described counties of Texas or Florida (the “GULF COAST AREAS”) (Exhibit 22), or the U.S. waters of the Gulf of Mexico and all adjacent bays, estuaries, straits, and other tidal or brackish waters within the Gulf Coast Areas, as specifically shown and described in Exhibit 23 (“SPECIFIED GULF WATERS”), or worked on a vessel in Specified Gulf Waters after April 20, 2009. With respect to SEAFOOD CREW2 Claims, persons must have worked on a vessel that landed SEAFOOD in the Gulf Coast Areas after April 20, 2009. and