PPM for Film - Investor Questionnaire

This is an Investor Questionnaire required for completion of a subscription agreement for a PPM for film production.

See Instructions here: PPM for Film - Instructions for Subscription Documents

INVESTOR QUESTIONNAIRE

All information furnished is for the sole use of Your Company LLC, a Delaware Limited Liability Company (the "Company"), and its counsel and will be held in confidence by such parties, except that this questionnaire may be furnished to such other parties as the Company and its counsel deem necessary to establish compliance with Federal or State Securities Laws or to the extent required by Law.


Investor Information.

1. For Individual Investors
(Please Print)

Name of Investor:

Street Address:

City, State or Territory, Zip:

Country:

Social Security Number:

Telephone Number (daytime):

Signature:

Date:

State and Country of Residency:

Check Type of Ownership:

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

Individual

Joint Tenants (all parties must sign)

Community Property (spouse must sign)

Tenants-in-Common (all parties must sign)

Other:

Print Name(s) of Spouse, Joint Tenant(s), or Tenant(s)-in-common:

Signature(s) of Spouse, Joint Tenant(s), or Tenant(s)-in-common:

Date:

Social Security Number(s):

Professional Adviser (if applicable):

________________________________
Signature

________________________________
Print Name

________________________________
Telephone Number

________________________________
Social Security Number

For Corporate, Partnership, Limited Liability Company, Trust or Other Entity Investors
(Please Print)

_______________________________
Mailing Street Address

_______________________________
City, State or Territory, Zip

_______________________________
Country

Name of Investor:

Street Address:

City, State or Territory, Zip:

Country:

Taxpayer ID Number:

Telephone Number (daytime):

Name of Authorized Signatory:

Authorized Signatory Signature:

Date:

Check Type of Ownership:

__________________________________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

____Corporation

____Partnership

____Limited Liability Company

____Trust or Pension Plan

____Other: _________________________________



2.
Accredited Investor Status. To determine “accredited investor” status for the purpose
of the offering of units of Class A limited liability company membership interest (“Class A
Units”), indicate by initialing in the space provided if the undersigned is:

For Individuals:

_____ (A)

_____ (B)

A natural person with individual net worth (or joint net worth with spouse) in
excess of $1,000,000. For purposes of this item, “net worth” means the excess of
total assets at fair market value, including home, home furnishings and
automobiles (and including property owned by a spouse), over total liabilities.

A natural person with individual income (without including any income of the
Investor’s spouse) in excess of $200,000, or joint income with spouse of
$300,000, in each of the two most recent years and who reasonably expects to
reach the same income level in the current year.

For Entities:

_____ (C)

_____ (D)

_____ (E)

_____ (F)

_____ (G)

_____ (H)

_____ (I)

_____ (J)

_____ (K)

_____ (L)

An entity, including a grantor trust, in which all of the equity owners are
accredited investors (for this purpose, a beneficiary of a trust is not an equity
owner, but the grantor of a grantor trust is an equity owner).

A bank as defined in Section 3(a)(2) of the Securities Act of 1933 or any savings
and loan association or other institution as defined in Section 3(a)(5)(A) of the
Securities Act of 1933, whether acting in its individual or fiduciary capacity.

An insurance company as defined in Section 2(13) of the Securities Act of 1933.

A broker-dealer registered pursuant to Section 15 of the Securities Exchange Act
of 1934.

An investment company registered under the Investment Company Act of 1940.

A business development company as defined in Section 2(a)(48) of the
Investment Company Act of 1940. A small business investment company
licensed by the Small Business Administration under Section 301(c) or (d) of the
Small Business Investment Act of 1958.

A private business development company as defined in Section 202(a)(22) of the
Investment Advisers Act of 1940.

An organization described in Section 501(c)(3) of the Internal Revenue Code, a
corporation, Massachusetts or similar business trust or partnership, not formed for
the specific purpose of acquiring Class A Units, with total assets in excess of
$5,000,000.

A trust with total assets in excess of $5,000,000 not formed for the specific
purpose of acquiring the Class A Units, whose purchase is directed by a person
with such knowledge and experience in financial and business matters as to be
capable of evaluating the merits and risks of an investment in the Class A Units.

An employee benefit plan within the meaning of ERISA if the decision to invest
in the Class A Units is made by a plan fiduciary, as defined in Section 3(21) of



_____ (M)

ERISA, which is either a bank, savings and loan association, insurance company,
or registered investment adviser, or if the employee benefit plan has total assets in
excess of $5,000,000 or, if a self-directed plan, with investment decisions made
solely by persons that are accredited investors.

A plan established and maintained by a state, its political subdivisions, or any
agency or instrumentality of a state or its political subdivisions, for the benefit of
its employees, if the plan has total assets in excess of $5,000,000.

3.
Representation as to Residence. To verify the residence of prospective investors and to
obtain a written representation from each as to its legal residence, please complete the following:

A.

For Entities:

Form of entity (e.g., corporation,
partnership, limited liability company, trust,
etc.)

Organized under the laws of:

Address of principal office:

Addresses of any other offices:

Has the investing entity been organized for
the specific purpose of acquiring securities
of Your Company LLC?

For Individuals:

The undersigned is a bona fide resident of the State of ____________ and has
been for _____ years.

The undersigned (__) does (__) does not maintain a residence at any location
other than that indicated above at Item 1(b). If so, where?

_______________________________________________

The undersigned has filed a State of ______________ Income Tax Return as an
in-state resident for the last _____ years.

The undersigned is registered to vote in _____________________,
(City)

___________________________, ______________________.
(County)
(State)

Yes _____

No _____

B.

(a)

(b)

(c)

(d)


4.
Business and Investment Background and Experience. The business and investment
background and experience of the undersigned, or the business and investment background and
experience of those individuals responsible for making investment decisions on behalf of the
undersigned, if the undersigned is an entity, are as follows:

Name and address of current employer:

Nature of employment:

If self-employed, nature of business:

Educational degrees received:

________________________________
________________________________
________________________________

________________________________
________________________________

________________________________
________________________________

________________________________
________________________________

Training or experience in financial or business matters: yes ( ) no ( )

If yes, please give details:

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Service on board of directors of any company:

Service as an elected officer of any company:

Other positions held during the last five years relating to business or financial matters:

yes ( )
no ( )
If yes, please give details:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

yes ( )

yes ( )

no ( )

no ( )

Professional licenses or registrations:

Bar admission:

Accounting certifications:

Broker-dealer registration:

Investment advisor registration:

Securities analyst certification:

Other: ______________________

( )

( )

( )

( )

( )

( )

( )

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