To: Prospective purchasers of Membership Units (the “Units”) which may be offered by Bluegrass International Fund or its now existing or hereafter created subsidiaries (the “Company”).
The Purpose of this Questionnaire is to solicit certain information regarding your financial status to determine whether you are an “Accredited Investor,” as defined under applicable federal and state securities laws, and otherwise meet the suitability criteria established by the Company for purchasing Units. This questionnaire is not an offer to sell securities.
All information submitted to Bluegrass International Fund will be kept strictly confidential and submitting the questionnaire does not require you to invest in one of our projects. You agree, however, that this Questionnaire may be shown to such persons as the Company deems appropriate to determine your eligibility as an Accredited Investor or to ascertain your general suitability for investing in the Units. All amounts are in United States Dollars ($ USD).
Prospective Investor’s Representations
The information contained in this Questionnaire is true and complete, and the undersigned understands that the Company and its counsel will rely on such information for the purpose of complying with all applicable securities laws as discussed above. The undersigned agrees to notify the Company promptly of any change in the foregoing information, which may occur prior to any purchase by the undersigned of securities from the Company.
The undersigned acknowledges that due to anti-terrorism and anti-money laundering regulations, the Company, the Manager or any other manager, member, officer, employee or agent acting on behalf of the Company may require further documentation verifying the undersigned’s identity and the source of funds used to purchase the Unit(s) subscribed for before the Company can process or accept undersigned’s subscription agreement. To comply with applicable U.S. legislation and regulations, including but not limited to the International Anti-Money Laundering and Financial Anti-Terrorism Abatement Act of 2001 (Title III of the USA PATRIOT Act), the undersigned agrees that all payments by the undersigned to the Company and all distributions to the undersigned from the Company will only be made in the undersigned’s name and to and from a bank account of a bank based or incorporated in or formed under the laws of the United States or a bank that is not a “foreign shell bank” within the meaning of the U.S. Bank Secrecy Act (31 U.S.C. § 5311 et seq.), as amended, and the regulations promulgated thereunder by the U.S. Department of the Treasury, as such regulations may be amended from time to time. The undersigned further agrees to provide the Company with such information or certification as the Company determines to be necessary or appropriate to verify compliance with the anti-terrorism and anti-money laundering regulations of any applicable jurisdiction or to respond to requests for information concerning the identity of Subscriber or any person directly or indirectly controlling or owning an interest in Subscriber from any governmental authority, self-regulatory organization or financial institution in money laundering regulations and to update such information in a timely manner as necessary to make such information not materially incorrect or misleading. Such information may include, but not be limited to, the name, address, telephone number, date of birth, and Social Security or taxpayer identification number of any such individual person, or of the beneficial owners of any entity, if the undersigned is an entity. Identity may be verified using a current valid passport and other such current valid government-issued identification (e.g., a driver’s license). In addition, the undersigned certifies that neither it nor, if it is an entity, any person directly or indirectly controlling or owning any interest in it, is identified as a specially designated national or blocked person, or as affiliated with any such person, entity or organization on any list maintained by governmental authorities relating to anti-terrorism or anti-money laundering, including but not limited to lists maintained by the United States Treasury Department’s Office of Foreign Asset Control.
I UNDERSTAND THAT THE COMPANY MAKES NO REPRESENTATION OR WARRANTY OF ANY KIND CONCERNING WHETHER AN INVESTMENT IN THE COMPANY WILL MEET THE REQUIREMENTS OF EB-5 OR OTHER U.S. IMMIGRATION REQUIREMENTS. I FURTHER UNDERSTAND THAT NO ASSURANCES CAN BE GIVEN THAT AN INVESTMENT IN THE COMPANY WILL RESULT IN ME RECEIVING AN EB-5 VISA, CONDITIONAL OR PERMANENT RESIDENT STATUS, OR REMOVAL OF CONDITIONS.