Southeast Regional Center: USCIS approved EB-5 Regional Center

INVESTOR SUITABILITY QUESTIONNAIRE

The undersigned acknowledges and agrees that the Company and the Manager will rely upon the information furnished in this questionnaire for purposes of determining the exemption from registration that the Offering relies upon for the undersigned’s investment, and that the securities issued to the undersigned are not required to be registered under the Act. Information provided in this questionnaire will be treated confidentially; provided, however, that the undersigned expressly permits the Company and the Manager to present this questionnaire to such parties, including any USCIS-approved regional center, any government agencies, or, if necessary, financial institutions, as they may deem appropriate from time to time in order to establish that the Offering is exempt from registration under the Act and other applicable securities laws, for purposes of securing additional financing for the project, for regional center compliance, or as may otherwise be required by law.

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INVESTOR SUITABILITY QUESTIONNAIRE

NOTE TO INVESTOR: This questionnaire is designed, in part, to obtain certain information from you for purposes of assisting in the determination of whether the securities issued in the Offering are exempt from registration under Regulation S promulgated under the Act. If the Company, the Manager, or the applicable issuer determines that another exemption may be applicable to one or more investors, then the Company, Manager, and such issuer each reserve the right to request additional information from you for purposes of assisting with that determination.

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INVESTOR SUITABILITY QUESTIONNAIRE

ALL FIELDS MUST BE COMPLETED:

Name (Full legal name of the investor):

Date of Birth:

Principal Residence Address:

City:

Province/State:

Zip/Postal Code:

Country:

Telephone Number:

Email:

Unexpired Photo Government ID Number:

Type of ID:

Issuance Date of ID:

Expiration Date of ID:

Country Issuing ID:

State/Province Subdivision:

Name, date of birth, place of birth, and country of citizenship of spouse and children under age 21 (add extra sheet if necessary):

Note: A copy of the unexpired biographic and validity page of his or her own passport and those of each of any accompanying family member, and the duly executed IRS Form W-8 BEN included with the subscription materials for the Offering must be delivered by the undersigned to the issuer.

Occupation:

Number of Years:

Current Employer:

Position/Title:

Business Address:

City:

Province/State:

Zip/Postal Code:

Country:

Business or Professional Education and Degree:

U.S. ADMISSIBILITY VERIFICATION - PRELIMINARY	YES	NO
DO ANY OF THE FOLLOWING CLASSES APPLY TO YOU OR ANY FAMILY MEMBER WHO WILL IMMIGRATE WITH YOU? (CHECK THE YES/NO BOX THAT APPLIES TO YOU FOR EACH QUESTION. PLEASE PROVIDE BELOW A SEPARATE EXPLANATION FOR EACH “YES” RESPONSE.)	Yes	No
Someone convicted of, or who admits having committed, a crime involving moral turpitude or violation of a law relating to a controlled substance or who is the spouse, son or daughter of such traffickers who knowingly has benefited from the trafficking activities in the past five years; who has been convicted of two or more offenses for which the aggregate sentences were five years or more; who is coming to the United States to engage in prostitution or commercialized vice or controlled substance; who has committed a serious criminal offense in the United States and who has asserted immunity from prosecution; who, while serving as a foreign government official and within the previous 24-month period, was responsible for or directly carried out particularly severe violations of religious freedom; or whom the President has identified as a person who plays a significant role in severe form of trafficking in persons, who otherwise has knowingly aided, abetted, assisted or colluded with such a trafficker in severe forms of trafficking in persons, or who is the spouse, son, or daughter of such a trafficker who knowingly has benefited from the trafficking activities within the past five years.	Yes	No
Someone who seeks to enter the United States to engage in espionage, sabotage, export control violations, terrorist activities, the overthrow of the Government of the United States or other unlawful activity; who is a member of or affiliated with the communist or other totalitarian party; who participated in Nazi persecutions or genocide; who has engaged in genocide; or who is a member or representative of a terrorist organization as currently designated by the U.S. Secretary of State.	Yes	No
Someone who is permanently ineligible for U.S. citizenship; or who departed the United States to evade military service in time of war.	Yes	No
Someone who is coming to the United States to practice polygamy; who withholds custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court or intentionally assists another person to do so; who has voted in the United States in violation of any law or regulation; or who renounced U.S. citizenship to avoid taxation.	Yes	No
Someone who is a former exchange visitor who has not fulfilled the two-year foreign residence requirement.	Yes	No
Have you ever been convicted of any offense or crime?	Yes	No
Have you ever been refused admission to the United States at a port-of-entry?	Yes	No

Explanation:

ADDITIONAL INVESTOR INFORMATION PLEASE CHECK CORRECT OR INCORRECT, AND ATTACH A SEPARATE EXPLANATION FOR ANY “INCORRECT” RESPONSES.	CORRECT	INCORRECT
I am a legal resident of the country that is set forth above in the section of this questionnaire where I answered questions about my principal residence address.	Yes	No
I am not a citizen or permanent resident of the United States.	Yes	No
I am not a “U.S. Person” as such term is defined in Regulation S promulgated under the Act; I did not receive an offer to invest in the Offering from within the geographic area of the United States; I did not execute the subscription agreement for the Offering or make any payments for the Offering from within the United States; and I agree to and shall execute and deliver to the issuer in the Offering an IRS Form W-8 BEN certifying that I am a nonresident as defined by the U.S. Internal Revenue Service.	Yes	No
I certify that the funds to be invested by me in the Offering were earned in compliance with all applicable laws, and that such funds will be transferred in compliance with all applicable laws and, more specifically, via a wire transfer from an established financial institution where I have an account to the Company account set up for the Offering.	Yes	No
I have never done business or participated in a business or had residual ownership of a business in Iran, North Korea, Syria, South Sudan, Cuba or Myanmar.	Yes	No
I am not a senior military, governmental, or political official in a non-U.S. country or closely associated with an immediate family member of such an official.	Yes	No
I hereby certify that I am not, and am not affiliated with, a “Specially Designated National” or “Blocked Person” listed on the Specially Designated Nationals List published by the U.S. Department of the Treasury’s Office of Foreign Assets Control, which may be accessed at: http://sdnsearch.ofac.treas.gov/.	Yes	No

If the answers to any of the questions above are “incorrect,” please provide an explanation below, and add more sheets as necessary to include the full explanations.

Explanation:

SOURCE OF FUNDS AND BACKGROUND INFORMATION:

1. I certify that the funds to be invested by me in the Offering were earned in compliance with all applicable laws, and that such funds will be transferred in compliance with all applicable laws and, more specifically, via a wire transfer from an established financial institution where I have an account to the Company account set up for the Offering.

Check One:

True

Untrue

2. Please describe how you earned the funds you will invest in the Offering, including the source of those funds and the name(s) and address(es) of the financial institution from which those funds will be wired to the Company account (Please provide as much detail as possible and add additional pages as necessary. Further, if property will be sold to create the funds, please describe the property and indicate where it is located).

3. I certify that I hold or have held citizenship and/or residency in the following countries:

4. My native language is:

I speak and read the following language(s) fluently:

5. I have never done business or participated in a business or residual ownership of a business in Iran, North Korea, Syria, South Sudan, Cuba, or Myanmar.

Check One:

True

Untrue

If “Untrue”, describe with specificity which country(ies) and what business you have done or participated in there:

6. I am not a senior military, governmental, or political official in a non-U.S. country or closely associated with an immediate family member of such an official.

Check One:

True

Untrue

If “Untrue”, describe with specificity which country(ies), what official position you hold or your family member holds, and, if held by a family member, your relationship to that individual:

ADDITIONAL INVESTOR REPRESENTATIONS:

(1) I have such knowledge and experience in financial, tax and business matters that I am capable of analyzing the information made available to me in connection with the offering of the investments to evaluate the merits and risks of the investment and to make an informed investment decision.

Initial here:

(2) Any purchases of the investment will be solely for my account, and not for the account of any other person or with a view to any resale or distribution thereof.

Initial here:

(3) I understand that my investment in the Offering (i) is not guaranteed to result in my receiving an immigrant visa within any specific period of time or at all and (ii) may result in my loss of some or all of the capital that I invest and, further, that no assurance has been given me that my investment will earn a positive return.

Initial here:

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EB-5 Client Questionnaire

EB-5 Client Questionnaire

EB-5 Client Questionnaire

EB-5 Client Questionnaire

EB-5 Client Questionnaire

General EB-5 Info

EB-5 Client Questionnaire

EB-5 FAQs

FOR MORE INFORMATION
REGISTER WITH US

EB-5 Client Questionnaire

EB-5 Client Questionnaire

EB-5 Client Questionnaire

EB-5 Client Questionnaire

EB-5 Client Questionnaire

General EB-5 Info

EB-5 Client Questionnaire

EB-5 FAQs

FOR MORE INFORMATIONREGISTER WITH US

FOR MORE INFORMATION
REGISTER WITH US