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: ________________________ ________________________________________________ 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.