Statement of Investment Representation |
$10.00 |
| This is a sample form of investment representation, to be signed by a recipient of shares in a private company. This form is intended to help in perfecting an exemption from the regulation requirements of
the securities laws.
Format: |
Microsoft WordSTATEMENT OF INVESTMENT REPRESENTATION
The undersigned ("Recipient"), being a recipient of shares of ______________________________
("Company"), a corporation, hereby represents and acknowledges that Recipient is acquiring such shares for Recipient''s own account (or a trust account if Recipient is a trustee) and not with a view to or for sale in connection with any distribution of those shares. Recipient acknowledges that the shares have not been registered under the Securities Act of 1933, as amended, or qualified under the securities laws of any state. Recipient understands that the shares are restricted securities under the Securities Act of 1933 and that under such Act and applicable regulations such shares may be resold without registration under the Act only in certain limited circumstances and that otherwise such shares must be held indefinitely. Recipient has (i) a preexisting personal or business relationship with the Company or one or more of its officers, directors, or control persons or...
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