IRREVOCABLE TRUSTS. If the trust is an irrevocable trust, please answer the following questions: Please provide the name of each trustee: Trustee Name: Trustee Name: Does the trust have assets greater than $5 million? Yes ๐ No ๐ Do you have 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? Yes ๐ No ๐ Indicate how often you invest in: Marketable Securities Often ๐ Occasionally ๐ Seldom ๐ Never ๐ Restricted Securities Often ๐ Occasionally ๐ Seldom ๐ Never ๐ Venture Capital Companies Often ๐ Occasionally ๐ Seldom ๐ Never ๐ The undersigned has been informed of the significance to the Company of the foregoing representations and answers contained in this Confidential Purchaser Questionnaire and such representations and answers have been provided with the understanding that the Company and the Selling Agent will rely on them. Date: Name of Individual (Please type or print) Signature (Joint Owner) Date: Print or Type Entity Name By: Name: Print or Type Name Title: Signature Title: Signature (other authorized signatory) 25 In addition to the covenants, representations and warranties contained in the Securities Purchase Agreement, to which this Annex B โ Certificate of Subscriber is attached, the undersigned Purchaser (or the Purchaser on behalf of one or more beneficial purchasers for whom the Purchaser is purchasing as principal) covenants, represents and warrants to the Company that the Purchaser (or one or more beneficial purchasers for whom the Purchaser is purchasing as principal) is resident in British Columbia, Alberta, Manitoba, Quebec, Newfoundland and Labrador, or Ontario and either (i) qualifies under Category 1 โ Accredited Investor as an โaccredited investorโ as defined in NI 45-106 and has checked the appropriate box below, or (ii) qualifies under Category 2 โ Minimum $150,000 Investment, and has checked the appropriate box below, or (iii) for all jurisdictions listed above, except Ontario, qualifies under Category 3 as โFamily, friends and business associatesโ as required by section 2.5 of NI 45-106 and has checked the appropriate box below; or (iv) for Ontario residents only, qualifies under Category 4 as โFounder, control person and family as required by section 2.7 of NI 45-106 and has checked the appropriate box below. Category 1 - Accredited Investor ๐ a. a Canadian financial institution, or a Schedule III bank;
Appears in 1 contract
Sources: Securities Purchase Agreement
IRREVOCABLE TRUSTS. If the trust is an irrevocable trust, please answer the following questions: Please provide the name of each trustee: Trustee Name: Trustee Name: Does the trust have assets greater than $5 million? Yes ๐o No ๏ฟฝo ๏ฟฝ Do you have 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? Yes o ๐ Noo ๐ Indicate how often you invest :
(i) in: Marketable Securities Ofteo n ๐ Occasionalo ly ๐ Selo dom ๐ No
(ii) ever ๐ Restricted Securities o Often ๐ Occasio onally ๐o Seldom o
(iii) ๐ Never ๐ Venture Capital Compano ies Often ๐ Oco casionallo y ๐ Seldom ๐ Never ๐ The undersigned hao By signing this Questionnaire, I hereby confirm the following statements:
(a) I am aware that the offering s been informed of tsecurities being offered by the Company in the Offering will involve securities that are not transferable and for which no market exists, thereby requiring my investment to be maintained for an indefinite period of time.
(b) I acknowledge that any delivery to me of the Transaction Documents relating to the securities being offered by the Company prior to the determination by the Company of my suitability as an investor, shall not constitute an offer of such securities being offered by the Company until such determination of suitability shall be made, and I agree that I shall promptly return the Transaction Documents he significance toupon request.
(c) My answers to the Company of the foregoing questions are, representations and answers contained in this Confidential Purchasewere on any date (if any) that I previously subscribed for securities being offered by the Company, true r Questionnaire and such complete to the best of my information representations and answers have been provided with thbelief and were true on any date e undI previously as of, and I will promptly notify erstanding that of any changes in the Company and the Selling Agent winformation I have providedill reDatedly___________________________ __________________________________ ______________________________________ (Print Name) (Signature) __________________________________ ______________________________________ (Print on them. Date: NamJoint Investor) e of Individual (PleaSignature of Joint Investorse type or p__________________________________ ______________________________________ rint) SignatPrint Name of Entityure (Joi(Signature) ______________________________________ (nt Owner) Date: Print or Type Entity Name By: Name: Print or Type Name Title: Signature Title: Signature (other authorized signatory) 25 In addition to the covenants, representations and warranties contained in the Securities Purchase Agreement, to which this Annex Title B โ Certificate of Subscriber is attached, the undersigned Purchaser (or the Purchaser on behalf of one or more beneficial purchasers for whom the Purchaser is purchasing as principal) covenants, represents and warrants to the Company that the Purchaser (or one or more beneficial purchasers for whom the Purchaser is purchasing as principal) is resident in British Columbia, Alberta, Manitoba, Quebec, Newfoundland and Labrador, or Ontario and either (i) qualifies under Category 1 โ Accredited Investor as an โaccredited investorโ as defined in NI 45-106 and has checked the appropriate box below, or (ii) qualifies under Category 2 โ Minimum $150,000 Investment, and has checked the appropriate box below, or (iii) for all jurisdictions listed above, except Ontario, qualifies under Category 3 as โFamily, friends and business associatesโ as required by section 2.5 of NI 45-106 and has checked the appropriate box below; or (iv) for Ontario residents only, qualifies under Category 4 as โFounder, control person and family as required by section 2.7 of NI 45-106 and has checked the appropriate box below.
Category 1 - Accredited Investor ๐ a. a Canadian financial institution, or a SPerson Signing)chedule III bank;
Appears in 1 contract
Sources: Securities Purchase Agreement (Ads in Motion, Inc.)
IRREVOCABLE TRUSTS. If the trust is an irrevocable trust, please answer the following questions: Please provide the name of each trustee: Trustee Name: Trustee Name: Does the trust have assets greater than $5 million? Yes ๐ No ๏ฟฝYES NO ๏ฟฝ Do you have 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? Yes ๐ NoYES NO ๐ Indicate how often you invest :
(i) in: Marketable Securities Ofteโ n ๐ Occasionalโ ly ๐ Selโ dom ๐ Nโ
(ii) ever ๐ Restricted Securities โ Often ๐ Occasiโ onally ๐โ Seldom โ
(iii) ๐ Never ๐ Venture Capital Companโ ies Often ๐ Ocโ casionallโ y ๐ Seldom ๐ Never ๐ The undersigned haโ By signing this Questionnaire, I hereby confirm the following statements:
(a) I am aware that the offering s been informed of tSecurities will involve securities that are not transferable and for which no market exists, thereby requiring my investment to be maintained for an indefinite period of time.
(b) I acknowledge that any delivery to me of transactions documents relating to the Securities prior to the determination by the Company of my suitability as an investor, shall not constitute an offer of such Securities until such determination of suitability shall be made, and I agree that I shall promptly return the transaction documents he significance toupon request.
(c) My answers to the Company of the foregoing questions are, representations and anwere on any date (if any) that I previously purchased securities swers contained in this Confidential Purchasethe Company, true r Questionnaire and such complete to the best of my information representatibelief and were true on any date that I previously as of, and I will promptly notify the Company of any changes in the information I ons and answers have beeprovided. Dated: _____________________________ (Print Name) (Signature) (Print Name of Joint Investor) (Signature of Joint Investor) (Print Name of Entity) (Signature) (Print Name and Title of Person Signing) I, ________________________, am n provided with th__________________________ of _________________________ (the โEntityโ). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of that certain Subscription Agreement dated as of 2020, by and between the Entity and Elite Performance Holding Corp. (the โSubscription Agreementโ), and to purchase and hold the Securities (as defined in the Subscription Agreement), and certify further e understanding tSubscription Agreement has been duly hat the Company and the Selling Agent will rely on them. Date: Name of Individual (Please type or print) Signature (Joint Owner) Date: Print or Type Entity Name By: Name: Print or Type Name Title: Signature Title: Signature (other authorized signatory) 25 In addition to the covenants, representations and warranties contained in the Securities Purchase Agreement, to which this Annex B โ Certificate of Subscriber is attached, the undersigned Purchaser (ovalidly executed r the Purchaser on behalf of one or more beneficial purchasers for whom the Purchaser is purchasing as principal) covenaEntity nts, represents constitutes a legal and binding obligation of and warrants to the Company that the Purchaser (or one or more beneficial purchasers for whom the Purchaser is purchasing as principal) is resident in British Columbia, Alberta, Manitoba, Quebec, Newfoundland and Labrador, or Ontario and either (i) qualifies under Category 1 โ Accredited Investor as an โaccredited investorโ as defined in NI 45-106 and has checked the appropriate box below, or (ii) qualifies under Category 2 โ Minimum $150,000 Investment, and has checked the appropriate box below, or (iii) for all jurisdictions listed above, except Ontario, qualifies under Category 3 as โFamily, friends and business associatesโ as required by section 2.5 of NI 45-106 and has checked the appropriate box below; or (iv) for Ontario residents only, qualifies under Category 4 as โFounder, control person and family as required by section 2.7 of NI 45-106 and has checked the approEntitypriate box below.
Category 1 - Accredited Investor ๐ a. a Canadian financial institution, or a Schedule III bank;
Appears in 1 contract
Sources: Subscription Agreement (Elite Performance Holding Corp)
IRREVOCABLE TRUSTS. If the trust is an irrevocable trust, please answer the following questions: Please provide the name of each trustee: Trustee Name: ________________________________________ Trustee Name: ________________________________________ Does the trust have assets greater than $5 million? Yes ๐ No ๏ฟฝ๏ฟฝ Do you have 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? Yes ๐ No ๐ Indicate how often you invest in: Marketable Securities Ofte[ ] n ๐ Occasional[ ] ly ๐ Sel[ ] dom ๐ N[ ] ever ๐ Restricted Securities [ ] Often ๐ Occasi[ ] onally ๐[ ] Seldom [ ] ๐ Never ๐ Venture Capital Compan[ ] ies Often ๐ Oc[ ] casionall[ ] y ๐ Seldom ๐ Never ๐ The undersigned ha[ ] TO: Anavex Life Sciences Corp. (the โIssuerโ) RE: Purchase of Units (the โUnitsโ) s been informed of the significance to the Company of the foregoing representations and anIssuer Capitalized terms used swers contained in this Confidential Purchaser Questionnaire and such representatinot specifically defined ons and answers have been provided with the undmeaning ascribed to them in erstanding tPrivate Placement Subscription Agreement between the Subscriber hat the Company and the Selling Agent will rely on them. Date: Name of Individual (Please type or print) Signature (Joint Owner) Date: Print or Type Entity Name By: Name: Print or Type Name Title: Signature Title: Signature (other authorized signatory) 25 In addition to the covenants, representations and warranties contained in the Securities PurcIssuer hase Agreement, to which this Annex B โ CertificatExhibit A e of Subscr. In connection with the purchase by the Subscriber (being the undersignedibor if er is attached, the undersigneis purchasing d Purchaser (oUnits as agent r the Purchaser on behalfa disclosed of one or more beneficial purcSubscriber, such beneficial Subscriber, shall be referred herein as hasers for whoโSubscriberโ) of the Units, the Subscriber hereby represents, warrants and certifies to the Issuer that the Subscriber:
(i) m the Purchasethe Units r is purchasing as principal) covenants, represents and warrants to the Company thaprincipal t the Purchaser (or one or more beneficial purcdeemed principal under hasers for whom the Purchaser is purchasterms of National Instrument 45-106 - Prospectus and Registration Exemptions adopted by the Canadian Securities Administrators (โNI 45-106โ));
(ii) (Aing as principal)or is subject to the laws of one of the following (check one): [ ] Alberta [ ] New Brunswick [ ] โโโโโโ โโโโโโ Island [ ] is resident in British Columbia, Alberta, MaColumbia [ ] Nova Scotia [ ] Quebec [ ] Manitoba [ ] Ontario [ ] Saskatchewan [ ] nitoba, Quebec, Newfoundland and Labrador, or OntLabrador [ ] United States: _________________________________arList State of Residenceio and either (i) qualifies under Category 1 โ Accredited Investor as an โaccredited investorโ as defined in NI 45-106 and has checked the appropriate box below, or (ii) qualifies under Category 2 โ Minimum $150,000 Investment, and has checked the appropriate box below, or (iii) for all jurisdictions listed above, except Ontario, qualifies under Category 3 as โFamily, friends and business associatesโ as required by section 2.5 of NI 45-106 and has checked the appropriate box below; or (iv) for Ontario residents only, qualifies under Category 4 as โFounder, control person and family as required by section 2.7 of NI 45-106 and has checked the appropriate box below.
Category 1 - Accredited Investor ๐ a. a Canadian financial institution, or a Sorchedule III bank;
Appears in 1 contract
Sources: Securities Purchase Agreement (Anavex Life Sciences Corp.)
IRREVOCABLE TRUSTS. If the trust is an irrevocable trust, please answer the following questions: Please provide the name of each trustee: Trustee Name: Trustee Name: Does the trust have assets greater than $5 million? Yes ๐ No ๏ฟฝYES NO ๏ฟฝ Do you have 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? Yes ๐ NoYES NO ๐ Indicate how often you invest :
(i) in: Marketable Securities Ofteโ n ๐ Occasionalโ ly ๐ Selโ dom ๐ Nโ
(ii) ever ๐ Restricted Securities โ Often ๐ Occasiโ onally ๐โ Seldom โ
(iii) ๐ Never ๐ Venture Capital Companโ ies Often ๐ Ocโ casionallโ y ๐ Seldom ๐ Never ๐ The undersigned haโ By signing this Questionnaire, I hereby confirm the following statements:
(a) I am aware that the offering s been informed of tSecurities will involve securities that are not transferable and for which no market exists, thereby requiring my investment to be maintained for an indefinite period of time.
(b) I acknowledge that any delivery to me of transactions documents relating to the Securities prior to the determination by the Company of my suitability as an investor, shall not constitute an offer of such Securities until such determination of suitability shall be made, and I agree that I shall promptly return the transaction documents he significance toupon request.
(c) My answers to the Company of the foregoing questions are, representations and anwere on any date (if any) that I previously purchased securities swers contained in this Confidential Purchasethe Company, true r Questionnaire and such complete to the best of my information representatibelief and were true on any date that I previously as of, and I will promptly notify the Company of any changes in the information I ons and answers have beeprovided. (Print Name) (Signature) (Print Name of Joint Investor) (Signature of Joint Investor) (Print Name of Entity) (Signature) (Print Name and Title of Person Signing) I, , am n provided with thof (the โEntityโ). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of that certain Subscription Agreement dated as of_____________2022, by and between the Entity and Elite Performance Holding Corp. (the โSubscription Agreementโ), and to purchase and hold the Securities (as defined in the Subscription Agreement), and certify further e understanding tSubscription Agreement has been duly hat the Company and the Selling Agent will rely on them. Date: Name of Individual (Please type or print) Signature (Joint Owner) Date: Print or Type Entity Name By: Name: Print or Type Name Title: Signature Title: Signature (other authorized signatory) 25 In addition to the covenants, representations and warranties contained in the Securities Purchase Agreement, to which this Annex B โ Certificate of Subscriber is attached, the undersigned Purchaser (ovalidly executed r the Purchaser on behalf of one or more beneficial purchasers for whom the Purchaser is purchasing as principal) covenaEntity nts, represents constitutes a legal and binding obligation of and warrants to the Company that the Purchaser (or one or more beneficial purchasers for whom the Purchaser is purchasing as principal) is resident in British Columbia, Alberta, Manitoba, Quebec, Newfoundland and Labrador, or Ontario and either (i) qualifies under Category 1 โ Accredited Investor as an โaccredited investorโ as defined in NI 45-106 and has checked the appropriate box below, or (ii) qualifies under Category 2 โ Minimum $150,000 Investment, and has checked the appropriate box below, or (iii) for all jurisdictions listed above, except Ontario, qualifies under Category 3 as โFamily, friends and business associatesโ as required by section 2.5 of NI 45-106 and has checked the appropriate box below; or (iv) for Ontario residents only, qualifies under Category 4 as โFounder, control person and family as required by section 2.7 of NI 45-106 and has checked the approEntitypriate box below.
Category 1 - Accredited Investor ๐ a. a Canadian financial institution, or a Schedule III bank;
Appears in 1 contract
Sources: Subscription Agreement (Elite Performance Holding Corp)