Common use of Individuals Clause in Contracts

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: (a) capacity in which you are purchasing Shares (e.g.,: agent, representative, administrator, trustee, etc.) (b) name, address and home and business telephone numbers of person(s) you represent: (c) Please attach evidence of authority authorizing you to represent each person.

Individuals. Please complete the following information if you are investing as an individual or jointly with another individual: Name: ________________________. Spouse's ’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: (a) capacity in which you are purchasing Shares (e.g.,: agent, representative, administrator, trustee, etc.)) __________________________________________________________. (b) name, address and home and business telephone numbers of person(s) you represent:: __________________________________________________________ __________________________________________________________. (c) Please attach evidence of authority authorizing you to represent each person.

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: _______________________________________________ ________________________________________________ Marital status. Home telephone number: ________________________. Address for notices: ________________________ ________________________________________________ Home . Business telephone number: ________________________. Business telephone number: ________________________. Social security or tax identification number: ____________________________. Occupation or profession: __________________________________________. Are you purchasing Shares Units for your own account? Yes No If you are not purchasing Shares Units for your own account, please complete the following: (a) capacity in which you are purchasing Shares Units (e.g.,: agent, representative, administrator, trustee, etc.)) ________________________________________________________. (b) name, address and home and business telephone numbers of person(s) you represent:: ________________________________________________________. ________________________________________________________. (c) Please attach evidence of authority authorizing you to represent each person.

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: (a) capacity in which you are purchasing Shares (e.g.,: agent, representative, administrator, trustee, etc.)) __________________________________________________________. (b) name, address and home and business telephone numbers of person(s) you represent:: __________________________________________________________ __________________________________________________________. (c) Please attach evidence of authority authorizing you to represent each person.

Individuals. Please complete the following information if you are investing as an individual or jointly with another individual: Name: ___________________________________________________________________. Spouse's ’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 Units for your own account? Yes _________ No _________ If you are not purchasing Shares Units for your own account, please complete the following: (a) capacity in which you are purchasing acquiring Shares (e.g.,: , agent, representative, administrator, trustee, etc.) (b) name, address and home and business telephone numbers of person(s) you represent: (c) Please attach evidence of authority authorizing you to represent each person.

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 Units for your own account? Yes No If you are not purchasing Shares Units for your own account, please complete the following: (a) capacity in which you are purchasing Shares Units (e.g.,: agent, representative, administrator, trustee, etc.)) ________________________________________________________. (b) name, address and home and business telephone numbers of person(s) you represent:: ________________________________________________________. ________________________________________________________. (c) Please attach evidence of authority authorizing you to represent each person.

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 Units for your own account? Yes No If you are not purchasing Shares Units for your own account, please complete the following: (a) capacity in which you are purchasing Shares Units (e.g.,: agent, representative, administrator, trustee, etc.)) _________________________________________________________________. (b) name, address and home and business telephone numbers of person(s) you represent: (c) Please attach evidence of authority authorizing you to represent each person.

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: (a) capacity in which you are purchasing Shares (e.g.,: agent, representative, administrator, trustee, etc.)) __________________________________________. (b) name, address and home and business telephone numbers of person(s) you represent:: _________________________________________________________. _________________________________________________________. (c) Please attach evidence of authority authorizing you to represent each person.

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: _______________________________________________ ________________________________________________ Marital status. Home telephone number: ________________________. Address for notices: ________________________ ________________________________________________ Home . Business 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: (a) capacity in which you are purchasing Shares (e.g.,: agent, representative, administrator, trustee, etc.)) ________________________________________________________. (b) name, address and home and business telephone numbers of person(s) you represent:: ________________________________________________________. ________________________________________________________. (c) Please attach evidence of authority authorizing you to represent each person.

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 Units for your own account, please complete the following: (a) capacity in which you are purchasing Shares Units (e.g.,: agent, representative, administrator, trustee, etc.)) __________________________________________________________. (b) name, address and home and business telephone numbers of person(s) you represent:: __________________________________________________________ __________________________________________________________. (c) Please attach evidence of authority authorizing you to represent each person.

Individuals. Please complete the following information if you are investing as an individual or jointly with another individual: Name: ________________________. Spouse's ’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: (a) capacity in which you are purchasing Shares (e.g.,: agent, representative, administrator, trustee, etc.)) __________________________________________________________. (b) name, address and home and business telephone numbers of person(s) you represent: (c) Please attach evidence of authority authorizing you to represent each person: __________________________________________________________.