To: ACCOUNT_JOB_COMPANY
ACCOUNT_JOB_ADDRESS_SINGLE_LINE
1. DETAILS OF TRANSFER:
All capitalised words used but not defined herein shall have the meaning given to them in the Fund's Confidential Private Placement Memorandum.
2. DECLARATIONS BY THE TRANSFEROR:
The Transferor(s) must complete the following declarations:
Ø BENEFICIAL OWNERSHIP Please indicate the correct response:
o The above said transfer does represent a change in the underlying beneficial ownership; OR
o The above said transfer does not represent a change in the underlying beneficial ownership.
Ø PURPOSE OF TRANSFER Please indicate the type of transfer being requested:
o Sales or conveyances of securities from one party to another where there has been a change in beneficial ownership of the securities (a "True Transfer");
o Change in a nominee or custodian with no change in beneficial ownership ("Re-Registration");
o Change of name of the registered holder pursuant to a legal change of name (e.g.: marriage, merger of entities, change of entity name) ("Name-Change");
........................................