TIN. Dated: (Signature must conform exactly to name of Hxxxxx as specified on the face of the Warrant) FORM OF ASSIGNMENT (To be signed only on transfer of Warrant) For value received, the undersigned hereby sells, assigns, and transfers unto ________________ the right represented by the within Warrant to purchase shares of Common Stock of Marizyme, Inc., a Nevada corporation, to which the within Warrant relates, and appoints _________________ attorney to transfer such right on the books of Marizyme, Inc., with full power of substitution in the premises. [insert name of Holder] Dated: By: Title: [insert address of Holder] Signed in the presence of:
TIN. You may be subject to penalties if you do not. For further information, please visit the Canada Revenue Agency website at: xxxx://xxx.xxx-xxx.xx.xx/tx/nnrsdnts/nhncdrprtng/menu-eng.html
TIN. (m) Restricted business operations in Sudan. By submission of its offer, the offeror certifies that the offeror does not conduct any restricted business operations in Sudan.
TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.
TIN. You may be subject to penalties if you do not. For further information, please visit the Canada Revenue Agency website at: xxxx://xxx.xxx-xxx.xx.xx/tx/nnrsdnts/nhncdrprtng/menu-eng.html 1 Agreement Between the Government of the United States of America and the Government of Canada to Improve International Tax Compliance through Enhanced Exchange of Information under the Convention Between the United States of America and Canada with Respect to Taxes on Income and on Capital. APPENDIX V FATCA SELF-CERTIFICATION (ENTITY) FINANCIAL INSTITUTION NAME AND ADDRESS: Marquest Mining 2021-I Super Flow-Through Limited Partnership To fulfill its legal obligations, the Financial Institution named above requires a person authorized by the Entity to complete and sign this form. For more information about your status and the meaning of the terms used in this certificate, please refer to the Canada Revenue Agency website at xxxx://xxx. xxx-xxx.xx.xx/ or consult your own tax advisor. FULL LEGAL NAME OF THE ENTITY:
TIN. 6. Payments shall be made in the amounts set forth in Attachment No. 3, provided the DARPA AOR has verified the accomplishment of the milestones.
TIN. 3.2 BIC (for commercial banks)
TIN. 6. Government funds shall be maintained in an interest-bearing account. This account shall not be in U. S. Treasury Notes. Any interest earned shall be remitted annually to the DARPA AO, or designee. Interest payments shall be made payable to the U. S. Treasury. Interest amounts less than $250 per year may be retained by the Performer for administrative expenses.
TIN. Dated: (Signature must conform exactly to name of Hxxxxx as specified on the face of the Warrant) FORM OF ASSIGNMENT (To be signed only on transfer of Warrant) For value received, the undersigned hereby sells, assigns, and transfers unto ________________ the right represented by the within Warrant to purchase shares of Common Stock of WiSA Technologies, Inc., a Delaware corporation, to which the within Warrant relates, and appoints _________________ attorney to transfer such right on the books of WiSA Technologies, Inc., with full power of substitution in the premises. [insert name of Holder] Dated: By: Title: [insert address of Holder] Signed in the presence of:
TIN. You may be subject to penalties if you do not. For further information, please visit the Canada Revenue Agency website at: xxxx://xxx.xxx-xxx.xx.xx/tx/nnrsdnts/nhncdrprtng/menu-eng.html 1 Agreement Between the Government of the United States of America and the Government of Canada to Improve International Tax Compliance through Enhanced Exchange of Information under the Convention Between the United States of America and Canada with Respect to Taxes on Income and on Capital. APPENDIX V FATCA SELF-CERTIFICATION (ENTITY) FINANCIAL INSTITUTION NAME AND ADDRESS: To fulfill its legal obligations, the Financial Institution named above requires a person authorized by the Entity to complete and sign this form. For more information about your status and the meaning of the terms used in this certificate, please refer to the Canada Revenue Agency website at xxxx://xxx. xxx-xxx.xx.xx/ or consult your own tax advisor. FULL LEGAL NAME OF THE ENTITY:
