Virtual World Computing Investors: New Investor Questionnaire
Personal Information
Thank you for your interest in investing in Virtual World Computing, LLC ("Virtual World Computing"). In order to provide you details about investing in Virtual World Computing, we need to ask you a few questions in order to comply with securities regulations. This questionnaire will determine whether or not you are eligible to invest in the company. Please check all that apply:
□ I had an individual income of at least $200,000 in each of the two most recent years and have a reasonable expectation of reaching the same income level this year;
□ My joint income with my spouse was at least $300,000 in the last two years, and I have a reasonable expectation of having a joint income with my spouse of at least $300,000 this year;
□ I have a net worth, either on my own or jointly with my spouse, exceeding $1,000,000, excluding the value of my primary residence;
□ None of the above.
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Terms of Offering
Investor Suitability Questions
In order to invest, we will need to substantiate that you are an "accredited investor," as defined under 17 CFR § 230.501. Please answer the following questions.
Income Tax Bracket
□ 15% or less
□ 15-27%
□ 28% or more
When do you expect to need the funds from your investments?
□ Less than 1 year
□ 1-3 years
□ 4-5 years
□ 6-10 years
□ 11+ years
Net Worth (excluding your home)
□ 1-5K
□ 6-10K
□ 11-50K
□ 51-100K
□ 101-500K
□ 500-999K
□ 1M-5M
□ >5M
Annual Income
□ <15K
□ 15-25K
□ 26-50K
□ 51-100K
□ 101-150K
□ 151-200K
□ More than 200K
Household Income
□ <15K
□ 15-25K
□ 26-50K
□ 51-100K
□ 101-150K
□ 151-199K
□ 200-299K
□ More than 300K
Past Private Equity
□ None
□ 1 investment
□ 2-5 investments
□ 6+ investments
Employment Status
□ Student
□ Self-Employed
□ Employed in Field < 5 years
□ Employed in Field > 5 years
□ Retired
□ Unemployed
Education
□ None
□ GED
□ High School
□ College 2 year
□ College 4 year
□ Masters/PhD
Are you willing to take significant risk with your investment in Virtual World Computing?
□ No
□ Yes
Actual Expenses
□ 50K or under
□ 51-100K
□ 101-250K
□ 251-500K
□ Over 500K
Liquid Net Worth
□ 1-5K
□ 6-10K
□ 11-50K
□ 51-100K
□ 101- 500K
□ 501- 999K
□ 1m-5m
□ >5 m
Marital Status
□ Single
□ Married
□ Domestic Partner
□ Divorced
□ Widowed
Number of Dependents
[Dropdown: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, greater than 10]
Supporting Documents
If you wish to invest in Virtual World Computing, you will need to submit supporting evidence of your accredited investor status. You may qualify by providing us with one of the following: (a) proof of your income over the last two years; (b) documentation substantiating your assets and liabilities; or (c) a letter from a registered broker-dealer, an investment adviser, a licensed attorney, or a certified public accountant that meets the requirements set forth below.
A. Accredited Investors on Basis of Income
If you are an accredited investor on the basis of your income, please upload any Internal Revenue Service form that reports your income for the two most recent years, including, but not limited to, Form W-2, Form 1099, Schedule K-1 to Form 1065, and Form 1040, and select the first box if you are able to make the representation set forth next to it. If you are attempting to qualify on the basis of the joint income with your spouse, you must also submit such Internal Revenue Service forms of your spouse as well, and your spouse must select the second box below if he or she is able to make the representation set forth next to it.
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□ I hereby represent that I have a reasonable expectation of reaching the income level necessary to qualify as an accredited investor this year.
□ I am the spouse of the aforementioned investor and hereby represent that I have a reasonable expectation of reaching the income level necessary to qualify as an accredited investor this year.
B. Accredited Investors on Basis of Net Worth
If you are an accredited investor on the basis of your net worth, please upload documents substantiating both your assets and liabilities, and select the box below representing that you have made all the representations of your liabilities necessary for determining your net worth. If you are attempting to qualify as an accredited investor on the basis of joint net worth with that of your spouse, you must also submit such documents substantiating both your assets and liabilities and those of your spouse. In addition, your spouse will need to select the second box below representing that he or she has made all the representations of liabilities necessary for determining his or her net worth.
Assets
Please submit bank statements, brokerage statements and other statements of securities holdings, certificates of deposit, tax assessments, and appraisal reports issued by independent third parties by selecting the "Submit" button. These documents must be dated within the prior three months.
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Liabilities
Please submit a consumer report from at least one of the nationwide consumer reporting agencies. These reports must be dated within the prior three months by selecting the "Submit" button.
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□ I hereby represent that I have disclosed all liabilities necessary to make a determination of my net worth.
□ I am the spouse of aforementioned investor and hereby represent that I have disclosed all liabilities necessary to make a determination of my net worth.
C. Written Confirmation
Instead of submitting the documents required under Options A (Accredited Investors on Basis of Income) or Option B (Accredited Investors on Basis of Net Worth), you may also submit a written confirmation from one of the following persons or entities that such person or entity has taken reasonable steps to verify that you are an accredited investor within the prior three months and has determined that you are an accredited investor:
· A registered broker-dealer;
· An investment advisor registered with the Securities Exchange Commission;
· A licensed attorney who is in good standing under the laws of the jurisdictions in which he or she is admitted to practice law; or
· A certified public accountant who is duly registered and in good standing under the laws of the place of his or her residence or principal office.
To obtain a form of the letter, please click here.
If you chose this Option C, please provide us with contact information for the person on entity from which you have received the letter so that we may take reasonable steps to verify its genuineness. Once you have completed this contact information, please upload your letter by selecting the "Submit" button.
Name:
Address:
City:
State:
Country:
Phone:
Fax:
Email:
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