Investor Questionnaire (Part III) | Right Start Entertainment

Please complete the following information for use in preparation of investment documents, verifying eligibility, and completion of state and federal tax, BOIR (Business Ownership Information Report), and other filings. All collected information will be deemed confidential and used only for purposes of the contemplated transaction. Required fields are marked with an asterisk (*).

Accredited Investor Information Form - Part III

1. First Name

2. Middle Name

3. Last Name

4. Phone Number

5. Email Address

6. Are you an ACCREDITED INVESTOR, as defined by SEC Rule 501(a) of Regulation D?

Yes

+ Learn more about the definition of Accredited Investor.

Previous Investments

7. In the past 5 years, how many equity or debt investments have you made in a private company not owned or controlled by you or your spouse (an investment in non-registered securities)?

Please list below your three most recent investments (in private companies / non-registered securities) along with their date, type of investment and a point of contact in the recipient business who is familiar with the investment and who we may contact as a reference to confirm the information here provided (as required by any fiduciary and legal duties):

Most Recent Investment

8. Most Recent Investment Date

12. Most Recent Investment Reference Contact - Name

9. Most Recent Investment Company Name

13. Most Recent Investment Reference Contact - Phone Number

10. Most Recent Investment Amount (USD)

14. Most Recent Investment Reference Contact - Email

11. Most Recent Investment Type

Prior Recent Investment (if any)

15. Prior Recent Investment Date

19. Prior Recent Investment Reference Contact - Name

16. Prior Most Recent Investment Company Name

20. Prior Most Recent Investment Reference Contact - Phone Number

17. Prior Most Recent Investment Amount (USD)

21. Prior Most Recent Investment Reference Contact - Email

18. Prior Most Recent Investment Type

Prior Recent Investment (if any)

22. Prior Recent Investment Date

26. Prior Recent Investment Reference Contact - Name

23. Prior Most Recent Investment Company Name

27. Prior Most Recent Investment Reference Contact - Phone Number

24. Prior Most Recent Investment Amount (USD)

28. Prior Most Recent Investment Reference Contact - Email

25. Prior Most Recent Investment Type

Declaration

I hereby declare that the information provided in this form is accurate and complete. I confirm that any information found incorrect and/or incomplete that leads to a violation of any laws, rules, mandates, or regulations may expose me to negative tax consequences and even civil or criminal penalties, and could be considered a material breach of any agreements induced by this information.

First Name

Last Name

Date

Signature

Clear

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