Subscription Information. If an Individual: _____________________________________________________________________________ Full Name (type or print) Social Security Number _____________________________________________________________________________ Address, City, State, Zip Telephone If a Corporation: _____________________________________________________________________________ Full Corporation Name (type or print)Tax ID Number ____________________________________________________________________________ Head Office Address, City, State, Zip Telephone
Subscription Information. The Purchaser hereby subscribes, pursuant to this Subscription Agreement dated as of September 1 , 2015, for Units in the amounts set forth in Paragraph 14.1 below, and tenders payment in cash in consideration therefore, as further set forth below. Please make checks delivered in respect of subscriptions hereunder payable to “Bollente International, Inc.”
Subscription Information. Check the box for the Metric Asset Management Fund and series to which you are subscribing and input your subscription amount. Series details can be found in the Offering Memorandum.
Subscription Information. The Investor offers to purchase Units of the Fund as described in the Offering Memorandum (please select Series and indicate amount below): Gross Amount $ ■ PTL775 - Series A – Portland Special Opportunities Fund Sales Commision (between 0%-10%)* $/% ■ PTL785 - Series F – Portland Special Opportunities Fund Net Invested $ ■ PTL735 - Series O – Portland Special Opportunities Fund ■ Do you wish to invest into a registered plan or TFSA? If Client Name, please complete INVESTMENT/RRSP APPLICATION or TFSA APPLICATION. Note: this is not eligible for USD purchase options. ■ Do you wish to set up a Pre-Authorized Contribution Plan? Please complete PRE-AUTHORIZED CONTRIBUTION APPLICATION FOR PRIVATE/ALTERNATIVE INVESTMENTS Subscription Agreement and Application Form Portland India Select Business Portfolio inc. 3 PIC10-E(01/11) CANADIAN ACCOUNT * Applicable for Series A only (07/22)
Subscription Information. Trade must be placed by your registered dealer by no later than 4pm EST on the 20th calendar day of the month (or the preceding business day if the 20th falls on a non-business day). The Investor offers to purchase Units of the Fund as described in the Offering Memorandum (please select Series and indicate amount below): Gross Amount $ Sales Commision* $/% Net Invested $ ■ Do you wish to invest into a registered plan or TFSA? For new purchases, if Client Name, please complete INVESTMENT/RRSP APPLICATION or TFSA APPLICATION. Note: this is not eligible for USD purchase options. Do you wish to set up a Pre-Authorized Contribution Plan? Please ■ complete PRE-AUTHORIZED CONTRIBUTION APPLICATION FOR PRIVATE/ALTERNATIVE INVESTMENTS * Applicable only for Series A (between 0%-10%) and Series AP (between 0%-6%) ■ PTL140 - Series A – Portland Private Income Fund ■ PTL141 - Series F – Portland Private Income Fund ■ PTL142 - Series O – Portland Private Income Fund ■ PTL705 - Series AP – Portland Private Income Fund ■ PTL026 - Series FP – Portland Private Income Fund ■ PTL150 - Series A – Portland Private Income Fund - US$ ■ PTL151 - Series F – Portland Private Income Fund - US$ ■ PTL152 - Series O – Portland Private Income Fund - US$ ■ PTL706 - Series AP – Portland Private Income Fund - US$ ■ PTL027 - Series FP – Portland Private Income Fund - US$ SUBSCRIPTION AGREEMENT AND APPLICATION FORM PORTLAND INDIA SELECT BUSINESS PORTFOLIO INC. 3 PIC10-E(01/11) CANADIAN ACCOUNT (07/22)
Subscription Information. Check the box for the ReSolve Fund(s) and series to which you are subscribing and input your subscription amount. Series details can be found in the Offering Memorandum of the applicable ReSolve Fund(s).
Subscription Information. If an Individual: If a Corporation ------------------------------------- --------------------------------- Full Name Full Corporation Name ------------------------------------- --------------------------------- Residential Address Head Office Address ------------------------------------- --------------------------------- City Province/State Postal Code City Province/State Postal Code ------------------------------------- --------------------------------- Telephone Telecopier Attention ------------------------------------- --------------------------------- Social Security No. or Telephone Telecopier Tax Identification No. (US Persons) ------------------------------------- --------------------------------- Social Security No. or Revenue Canada Telephone Telecopier Corporation No. (Canadian Residents)
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Subscription Information. Check the box for the class to which you are subscribing and input your subscription amount. Class details can be found in the Offering Memorandum.
Subscription Information. Please complete the following information. Requested Subscription Amount: $_______________ (subject to Company acceptance) Name of Purchaser as it is to appear on the Senior Secured Convertible Promissory Note and Warrant Indicate ownership as: ____ (a) Individual ____ (b) Community Property ____ (c) Joint Tenants with Right of Survivorship ) All parties ____ (d) Tenants in Common ) must sign ____ (e) Corporate ____ (f) Partnership ____ (g) Trust ____________________________________ Address of Residence (or Business, if not an individual) __________________________________ Address for Sending Notices (if different) __________________________________ City, State and Zip Code __________________________________ City, State and Zip Code __________________________________ Telephone __________________________________ Telephone __________________________________ State of Residence (or State of Organization, if an entity) __________________________________ State of Residence (or State of Organization, if an entity) __________________________________ SSN/TIN __________________________________ SSN/TIN __________________________________ E-mail __________________________________ E-mail
