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| * Please provide your full name below. | | |
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| * Do you currently maintain one or more brokerage accounts (securities, commodities or mutual funds) including any account where you are a joint party, exercise investment control, or are a fiduciary with respect to such accounts? |
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Please list account name, account number and outside firm for all accounts, even if previously approved or disclosed (attach list if necessary). |
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| * Are you, or to the best of your knowledge, is any family member a director or officer of any publicly traded company, or owner (individually, or as a member of a group) of more than five percent of the securities of any publicly traded company? |
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Please furnish name and company. |
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| * Are you a director or officer of any private corporation? |
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Please furnish name of corporation(s), even if previously approved or disclosed. |
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| * Are you a director or officer of any non-profit organization, club or association? |
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Please furnish name of organization, club or association, even if previously approved or disclosed. Do you receive remuneration of any kind in connection with the activities mentioned? |
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| * Are you engaged in any outside employment or business activity (including your own business) where you receive remuneration of any kind? |
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Please provide details, even if previously approved or disclosed. |
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| * Are you engaged in investing for yourself or others in private placements, limited/general partnerships, etc. outside of the Firm? |
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Please explain what type of investment. If any current or former clients of GFI Securities, L.L.C involved in any way with respect to these investments? |
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| * Have you or members of your Family received compensation or gratuities in any form from outside sources in connection with your activities at the Firm? |
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| * Have you borrowed funds or securities from, or lent funds or securities to, any client or prospective client of the Firm? |
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If yes, please provide details. |
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| * Have you been arrested or convicted of a felony in any jurisdiction (or foreign equivalent), or have you been the subject of an adverse decision or proceeding filed by the Securities and Exchange Commission within the past ten years, or have you been arrested or convicted of a misdemeanor involving a financial crime ? |
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