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Accredited Investor: I hereby certify that I am an accredited investor in accordance with Rule 501(a) of Regulation D, in that (please select one)
A business in which all the equity owners are accredited investors

A natural person who has individual net worth, or joint net worth with the persons spouse, that exceeds $1 million at the time of the purchase

A natural person with an individual income in excess of $200,000 or in excess of $300,000 with his or her spouse in each of the two most recent years and who has a reasonable expectation of an income in excess of $200,000 individually or in excess of $300,000 with his or her spouse in the current year

A bank, insurance company, registered investment company, business development company, or small business investment company

A trust with assets in excess of $5 million, not formed to acquire the securities offered, whose purchases a sophisticated person makes

A charitable organization, corporation, or partnership with assets exceeding $5 million

An employee benefit plan, within the meaning of the Employee Retirement Income Security Act, if a bank, insurance company, or registered investment adviser makes the investment decisions, or if the plan has total assets in excess of $5 million

Qualified Investor: Is the investor a person, individual or entity that would be a "U.S. Person" under Regulation S of the U.S. Securities Act of 1933, as amended?
Yes     No    
For Swiss Investors: Is the Investor a regulated qualified investor within the meaning of Article 10(3)(a) or (b) of the Swiss Collective Investment Schemes Act of June 23, 2006, as amended?*
Yes     No     N/A    

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