Article

Accredited Investor Form

VERIFICATION OF STATUS AS “ACCREDITED INVESTOR” UNDER REGULATION D

The Investor represents and warrants that it is an “accredited investor” within the meaning of Regulation D under the Securities Act and has initialed the applicable statements below pursuant to which the Investor so qualifies.

1. You have total assets in excess of $5,000,000, AND were not formed for the specific purpose of acquiring the securities offered, AND are any of the following:

  • a corporation;
  • a partnership;
  • a limited liability company;
  • a Massachusetts or similar business trust; OR
  • an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986, as amended.

YESNO

2. You are any of the following:

  • a bank (as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution (as defined in Section 3(a)(5)(A) of the Securities Act) acting in its individual or fiduciary capacity;
  • a broker or dealer registered pursuant to Section 15 of the Securities Exchange Act of 1934;
  • an insurance company as defined in Section 2(13) in the Securities Act;
  • an investment company or a business development company under the Investment Company Act or a business development company as defined in Section 2(a)(48) of that Act;
  • a private business development company as defined in Section 202(a) (22) of the Investment Advisers Act;
  • a Small Business Investment Company licensed by the U.S. Small Business Administration under Section 301(c) or (d) of the Small Business Investment Act of 1958;
  • a plan established and maintained by a state, its political subdivisions, or any agency or instrumentality of a state or its political subdivisions, for the benefit of its employees, and such plan has total assets in excess of $5,000,000;
  • an employee benefit plan within the meaning of Title I of the Employee Retirement Income Security Act of 1974, and (i) the investment decision is made by a plan fiduciary, as defined in Section 3(21) of such Act, which is either a bank, savings and loan association, insurance company, or registered investment adviser, or (ii) the employee benefit plan has total assets in excess of $5,000,000 or, (iii) if a self-directed plan, the investment decisions are made solely by persons that are Accredited Investors; OR
  • a trust, not formed for the specific purpose of acquiring the securities offered, with total assets in excess of $5,000,000 AND whose purchase is directed by a person who has such knowledge and experience in financial and business matters that such person is capable of evaluating the merits and risks of the Interests.

YESNO

Cancel

You must answer Yes to both questions to continue to the page. Otherwise you will be redirected.

Comments Closed.