INDIVIDUAL SUBSCRIBERS. If the securities subscribed for are to be owned by more than one person, you and the other co-subscriber must each complete separate Questionnaires (except if the co-subscriber is your spouse or spousal equivalent) and sign the Signature Page annexed hereto. If your spouse or spousal equivalent is a co-subscriber, you must indicate their name and social security number. CORPORATIONS,
INDIVIDUAL SUBSCRIBERS. Please complete Schedules 1 and 2 (if applicable) and Annex A attached hereto.
INDIVIDUAL SUBSCRIBERS. If the Common Stock subscribed for is to be owned by more than one person, you and the other co-subscriber must each complete a separate Subscription Agreement (except if the co-subscriber is your spouse and Statement B or C of Part I under Section IV below has been checked) and sign the Signature Page annexed hereto. If your spouse is a co-subscriber, you must indicate his or her name and social security number.
INDIVIDUAL SUBSCRIBERS. I certify that the information I have provided on this Schedule “C” is, to the best of my knowledge and belief, correct and complete. Signature: Date: SCHEDULE “D” PRIVACY POLICY The privacy of our investors is very important to us. Set forth below are our policies with respect to personal information of subscribers, investors and former investors that we collect, use and disclose. In connection with the offering and sale of Units of the Partnership, we collect and maintain personal information about subscribers. We collect their personal information to enable us to provide them with services in connection with their investment in the Partnership, to meet legal and regulatory requirements and for any other purpose to which they may consent in the future. Their personal information is collected from the following sources:
INDIVIDUAL SUBSCRIBERS. I certify that the information I have provided on this Schedule “C” is, to the best of my knowledge and belief, correct and complete. Signature: Date: SCHEDULE “D”
INDIVIDUAL SUBSCRIBERS a. A director or executive officer of the Company. or
INDIVIDUAL SUBSCRIBERS. In accordance with applicable Anti-Money Laundering and other requirements, the Fund, the Administrator and/or Investment Manager is required to obtain documentation supporting the identity of each of the Fund’s investors. Therefore, each Subscriber must submit with this Subscription Agreement the following (Subscribers who are unable to meet this requirement should contact the Administrator): • An original certified2, legible photocopy of a valid, government-issued photo identification (such as a driver’s license, passport or international identification card), together with proof of signature of the above; and • An original certified, proof of address (such as a certified copy of a recent (dated within a year) utility xxxx or a certified copy of a bank or mortgage bond statement). JOINT (INDIVIDUAL) INVESTORS: Same requirements as individual subscribers above; provided, however, that a married couple must submit a certified copy of their marriage certificate, showing both signatures.
INDIVIDUAL SUBSCRIBERS. Mr. Mrs. Miss Ms. Dr. Last Name Given Name(s) Address City Province Postal Code Telephone Email Address SIN Joint Subscribers Joint tenants with rights of survivorship; or Tenants in common Mr. Mrs. Miss Ms. Dr. Last Name Given Name(s) Joint Subscriber’s address same as above in Item 1A If different from 1A: Address City Province Postal Code SIN ENTITY SUBSCRIBERS: Corporation Partnership Trust Other: Name of Entity Address City Province Postal Code Telephone Email Address Incorporation/Registration Number CRA Business or Trust Number Authorized Representative: Name Position/Title Address City Province Postal Code Telephone Email Address Identification: For individuals, please include a photocopy of government issued picture ID. For entities, please include a copy of incorporation documents, a Directors’ Resolution authorizing the Authorized Representative to purchase shares, and a photocopy of government issued picture ID for the Authorized Representative.
INDIVIDUAL SUBSCRIBERS. I certify that the information I have provided on this Schedule “G” is, to the best of my knowledge and belief, correct and complete. Signature: X Date: SUBSCRIBERS THAT ARE ENTITIES Specified U.S. Person: Is the Subscriber a “Specified U.S. Person” as defined below? (Note – A corporation or partnership incorporated or organized in Canada and governed by Canadian law is not a “Specified U.S. Person”. See the definitions of “U.S. Person” and “Specified U.S. Person” below.) Yes No If yes, provide the U.S. Tax Information Number (TIN): If no, complete the boxes below. Financial Institution: (To be completed only if the Subscriber is NOT a “Specified U.S. Person”) Is the Subscriber a “Financial Institution” as defined below? Yes No If yes, indicate the Subscriber’s status: “Financial Institution” with a valid “GIIN”, as defined below GIIN: “Non-Participating Financial Institution”, as defined below Other – please provide status (e.g., deemed compliant Financial Institution or “exempt beneficial owner”, as defined below) Defined terms referred to below are set out under the Income Tax Act (Canada) (the “ITA”) and the Intergovernmental Agreement between Canada and the United States for the Enhanced Exchange of Tax Information under the Canada-U.S. Tax Convention (the “IGA”), and certain definitions have been reproduced below. When completing this form, please refer to the ITA and the IGA for any additional definitions or guidance as necessary, or consult with your legal or tax advisers. Name of Subscriber that is an Entity: Print Name – (Full Legal Name of Entity)
INDIVIDUAL SUBSCRIBERS. Please complete Schedules 1, 2 and 3 attached hereto.
