Other Certification. (a) If by a Corporation: (i) That the corporation’s purchase of the Securities will be solely for the corporation’s own account and not for the account of any other person or entity; and (ii) That the corporation’s name, address of principal office, place of incorporation and Federal taxpayer identification number, as set forth in this Questionnaire, are true, correct and complete. (b) If by a Partnership: (i) That the subscribing partnership’s purchase of the Securities will be solely for the subscribing partnership’s own account and not for the account of any other person or entity; and (ii) That the subscribing partnership’s name, address of principal office, place of formation and Federal taxpayer identification number as set forth in this Questionnaire are true, correct and complete. (c) If by a Trust (Other than a Retirement-Related Trust) or Estate: (i) That the trust’s or estate’s purchase of the Securities will be solely for the trust’s or estate’s own account and not for the account of any other person or entity; (ii) That the trust’s or estate’s purchase of the Securities is within the investment powers and authority of the trust or estate (as set forth in the declaration of trust or other governing instrument) and that all necessary consents, approvals and authorizations for such purchase have been obtained and that each person who signs the Signature Page has all requisite power and authority as trustee or executor or administrator to execute this Questionnaire and the Subscription Agreement on behalf of the trust or estate; (iii) That the trust has not been established in connection with either (aa) an employee benefit plan (as defined in Section 3(3) of ERISA), whether or not subject to the provisions of Title I of ERISA, or (bb) a plan described in Section 4975(e)(1) of the Internal Revenue Code; (iv) That the trust’s name, address of principal office, place of formation and Federal taxpayer identification number as set forth in this Questionnaire are true, correct and complete. (d) If by a Retirement Plan: (i) That the retirement plan’s purchase of the Securities will be solely for the retirement plan’s own account and not for the account of any other person or entity; and (ii) That the retirement plan’s governing documents duly authorize the type of investment contemplated herein and the undersigned is authorized and empowered to make such investment on behalf of the retirement plan. (e) If by a Limited Liability Company: (i) That the limited liability company’s purchase of the Securities will be solely for its own account and not for the account of any other person or entity; and (ii) That the limited liability company’s name, address of principal office, place of organization and Federal taxpayer identification number, as set forth in this Questionnaire, are true, correct and complete.
Appears in 1 contract
Sources: Subscription Agreement (Community Bank Shares of Indiana Inc)
Other Certification. (a) If by a Corporation:
(i) That the corporation’s purchase of the Securities Common Stock will be solely for the corporation’s own account and not for the account of any other person or entity; and
(ii) That the corporation’s name, address of principal office, place of incorporation and Federal taxpayer identification number, as set forth in this Questionnaire, are true, correct and complete.
(b) If by a Partnership: By signing the Signature Page to this Questionnaire, the undersigned certifies on behalf of the subscribing partnership the following:
(i) That the subscribing partnership’s purchase of the Securities Common Stock will be solely for the subscribing partnership’s own account and not for the account of any other person or entity; and
(ii) That the subscribing partnership’s name, address of principal office, place of formation and Federal taxpayer identification number as set forth in this Questionnaire are true, correct and complete.
(c) If by a Trust (Other than a Retirement-Related Trust) or Estate: By signing the Signature Page to this Questionnaire, the undersigned certifies the following:
(i) That the trust’s or estate’s purchase of the Securities Common Stock will be solely for the trust’s or estate’s own account and not for the account of any other person or entity;
(ii) That the trust’s or estate’s purchase of the Securities Common Stock is within the investment powers and authority of the trust or estate (as set forth in the declaration of trust or other governing instrument) and that all necessary consents, approvals and authorizations for such purchase have been obtained and that each person who signs the Signature Page has all requisite power and authority as trustee or executor or administrator to execute this Questionnaire and the Subscription Agreement on behalf of the trust or estate;
(iii) That the trust has not been established in connection with either (aa) an employee benefit plan (as defined in Section 3(3) of ERISA), whether or not subject to the provisions of Title I of ERISA, or (bb) a plan described in Section 4975(e)(1) of the Internal Revenue Code;
(iv) That the trust’s name, address of principal office, place of formation and Federal taxpayer identification number as set forth in this Questionnaire are true, correct and complete.
(d) If by a Retirement Plan:
(i) That the retirement plan’s purchase of the Securities Common Stock will be solely for the retirement plan’s own account and not for the account of any other person or entity; and
(ii) That the retirement plan’s governing documents duly authorize the type of investment contemplated herein and the undersigned is authorized and empowered to make such investment on behalf of the retirement plan.
(e) If by a Limited Liability Company:
(i) That the limited liability company’s purchase of the Securities Common Stock will be solely for its own account and not for the account of any other person or entity; and
(ii) That the limited liability company’s name, address of principal office, place of organization and Federal taxpayer identification number, as set forth in this Questionnaire, are true, correct and complete.
Appears in 1 contract
Sources: Subscription Agreement (First Pactrust Bancorp Inc)