Common use of SUITABILITY QUESTIONNAIRE Clause in Contracts

SUITABILITY QUESTIONNAIRE. This is a speculative investment (Each responding individual must complete his/her own Suitability Questionnaire) Name of Individual Investor OR Name of Person Answering Questions on behalf of an Entity/Trust/IRA Investor: A. Please provide the below Identification information: Are you a U.S. Citizen? ☐ Yes ☐ No B. Please provide your present employment status. If currently retired or unemployed, please provide your last/most recent employment history: C. Please provide the following information concerning your financial experience: C-1. Risk Tolerance (select one): ☐ Speculative – You are willing to accept substantial risk. May endure extensive volatility and very limited or no liquidity. You value the potential for maximizing long-term returns over principal preservation. ☐ Aggressive – You are willing to accept considerable risk. You may endure high volatility and limited or very limited liquidity. You value long-term appreciation over principal preservation. ☐ Moderate – You are willing to accept limited risk. You may endure some volatility and illiquidity. You value enhancing returns and principal preservation equally. You are willing to risk losing a substantial amount of your investment. ☐ Conservative – You are willing to accept low risk for greater stability and liquidity. You value minimizing risk and maximizing principal preservation. C-2. What is your primary investment objective? (select one): ☐ Investment speculation ☐ Steadily accumulate wealth over the long term ☐ Partially fund my retirement ☐ Other C-3. What are your time horizon and liquidity needs? (a) Time Horizon (select one): (b) Liquidity Needs (select one): ☐ 10 years or more ☐ Low ☐ 5 –10 years ☐ Medium ☐ 2 – 5 years ☐ High ☐ Under 2 years C-4. How much investment experience do you have? (select one): ☐ Extensive ☐ Substantial ☐ Moderate ☐ Limited ☐ None C-5. Please state the approximate number and total dollar amount of your prior investments in restricted securities (e.g., private placements): No. of Investments: _________________ Total Amount: _________________ C-6. Please indicate your Annual Income and Net Worth: (a) Annual Income (b) Net Worth (c) Liquid Net Worth ☐ Under $25,000 ☐ Under $25,000 ☐ Under $25,000 ☐ $25,000 – $50,000 ☐ $25,000 – $50,000 ☐ $25,000 – $50,000 ☐ $50,000 – $75,000 ☐ $50,000 – $75,000 ☐ $50,000 – $75,000 ☐ $75,000 – $100,000 ☐ $75,000 – $100,000 ☐ $75,000 – $100,000 ☐ $100,000 – $200,000 ☐ $100,000 – $150,000 ☐ $100,000 – $150,000 ☐ $200,000 – $300,000 ☐ $150,000 – $200,000 ☐ $150,000 – $200,000 ☐ $300,000 – $500,000 ☐ $200,000 – $250,000 ☐ $200,000 – $250,000 ☐ $500,000 – $1,200,000 ☐ $250,000 – $500,000 ☐ $250,000 – $500,000 ☐ Over $1,200,000 ☐ $500,000 – $1,000,000 ☐ $500,000 – $1,000,000 ☐ $1,000,000 – $5,000,000 ☐ $1,000,000 – $5,000,000 ☐ Over $5,000,000 ☐ Over $5,000,000 C-7. Please provide in the space below any additional information which would indicate that you have sufficient knowledge and experience in financial and business matters so that you are capable of evaluating the merits and risks of investing in restricted securities of private or thinly traded enterprise. D. Please provide the following information concerning your industry and other affiliations. D-1. Are you, your spouse or spousal equivalent, or any other immediate family members, including parents, in-laws, and siblings that are dependents, an officer, director or greater than ten percent (10%) shareholder of the Company offering securities? ☐ Yes ☐ No D-2. Are you, your spouse or spousal equivalent, or any other immediate family members, including parents, in-laws, and siblings that are dependents, employed by or associated with the securities industry (for example, investment advisor, sole proprietor, partner, officer, director, branch manager or broker at a broker-dealer firm or municipal securities dealer) or a financial regulatory agency, such as FINRA or the New York Stock Exchange? ☐ Yes ☐ No If yes, please provide the name and contact information for such firm. D-3. Are you a senior military, governmental or political official in a non-US country? ☐ Yes ☐ No If yes, please provide the name of the country.

SUITABILITY QUESTIONNAIRE. This is a speculative investment investment. (Each responding individual must complete his/her own Suitability Questionnaire) Name of Individual Investor OR Name of Person Answering Questions on behalf of an Entity/Trust/IRA Investor: A. Please provide the below Identification information: ID Number: Place of Issuance: Issue Date: Expiration Date: Are you a U.S. Citizen? ☐ ¨ Yes ☐ ¨ No B. Please provide your present employment status. If currently retired or unemployed, please provide your last/most recent employment history: C. Please provide the following information concerning your financial experience: C-1. Risk Tolerance (select one): ☐ ¨ Speculative – You are willing to accept substantial risk. May endure extensive volatility and very limited or no liquidity. You value the potential for maximizing long-term returns over principal preservation. ☐ ¨ Aggressive – You are willing to accept considerable risk. You may endure high volatility and limited or very limited liquidity. You value long-term appreciation over principal preservation. ☐ ¨ Moderate – You are willing to accept limited risk. You may endure some volatility and illiquidity. You value enhancing returns and principal preservation equally. You are willing to risk losing a substantial amount of your investment. ☐ ¨ Conservative – You are willing to accept low risk for greater stability and liquidity. You value minimizing risk and maximizing principal preservation. C-2. What is your primary investment objective? (select one): ☐ ¨ Investment speculation ☐ ¨ Steadily accumulate wealth over the long term ☐ ¨ Partially fund my retirement ☐ ¨ Other C-3. What are your time horizon and liquidity needs? (a) Time Horizon (select one): (b) Liquidity Needs (select one): ☐ ¨ 10 years or more ☐ ¨ Low ☐ ¨ 5 –10 years ☐ ¨ Medium ☐ ¨ 2 – 5 years ☐ ¨ High ☐ ¨ Under 2 years C-4. How much investment experience do you have? (select one): ☐ ¨ Extensive ☐ ¨ Substantial ☐ ¨ Moderate ☐ ¨ Limited ☐ None ¨ None C-5. Please state the approximate number and total dollar amount of your prior investments in restricted securities (e.g., private placements): No. of Investments: _________________ Total Amount: _________________ C-6. Please indicate your Annual Income and Net Worth: (a) Annual Income (b) Net Worth (c) Liquid Net Worth ☐ Under $25,000 ☐ Under $25,000 ☐ Under $25,000 ☐ $25,000 – $50,000 ☐ $25,000 – $50,000 ☐ $25,000 – $50,000 ☐ $50,000 – $75,000 ☐ $50,000 – $75,000 ☐ $50,000 – $75,000 ☐ $75,000 – $100,000 ☐ $75,000 – $100,000 ☐ $75,000 – $100,000 ☐ $100,000 – $200,000 ☐ $100,000 – $150,000 ☐ $100,000 – $150,000 ☐ $200,000 – $300,000 ☐ $150,000 – $200,000 ☐ $150,000 – $200,000 ☐ $300,000 – $500,000 ☐ $200,000 – $250,000 ☐ $200,000 – $250,000 ☐ $500,000 – $1,200,000 ☐ $250,000 – $500,000 ☐ $250,000 – $500,000 ☐ Over $1,200,000 ☐ $500,000 – $1,000,000 ☐ $500,000 – $1,000,000 ☐ $1,000,000 – $5,000,000 ☐ $1,000,000 – $5,000,000 ☐ Over $5,000,000 ☐ Over $5,000,000 C-7. Please provide in the space below any additional information which would indicate that you have sufficient knowledge and experience in financial and business matters so that you are capable of evaluating the merits and risks of investing in restricted securities of private or thinly traded enterprise. D. Please provide the following information concerning your industry and other affiliations. D-1. Are you, your spouse or spousal equivalent, or any other immediate family members, including parents, in-laws, and siblings that are dependents, an officer, director or greater than ten percent (10%) shareholder of the Company offering securities? ☐ Yes ☐ No D-2. Are you, your spouse or spousal equivalent, or any other immediate family members, including parents, in-laws, and siblings that are dependents, employed by or associated with the securities industry (for example, investment advisor, sole proprietor, partner, officer, director, branch manager or broker at a broker-dealer firm or municipal securities dealer) or a financial regulatory agency, such as FINRA or the New York Stock Exchange? ☐ Yes ☐ No If yes, please provide the name and contact information for such firm. D-3. Are you a senior military, governmental or political official in a non-US country? ☐ Yes ☐ No If yes, please provide the name of the country.):

SUITABILITY QUESTIONNAIRE. This is a speculative investment (Each responding individual must complete his/her own Suitability Questionnaire) Name of Individual Investor OR Name of Person Answering Questions on behalf of an Entity/Trust/IRA Investor: A. Please provide the below Identification information: Place of Issuance: Issue Date: Expiration Date: Are you a U.S. Citizen? ☐ Yes ☐ NoNo Please provide a copy of the photo page of your government-issued identification. B. Please provide your present employment status. If currently retired or unemployed, please provide your last/most recent employment history: C. Please provide the following information concerning your financial experience: C-1. Risk Tolerance (select one): ☐ Speculative – You are willing to accept substantial risk. May endure extensive volatility and very limited or no liquidity. You value the potential for maximizing long-term returns over principal preservation. ☐ Aggressive – You are willing to accept considerable risk. You may endure high volatility and limited or very limited liquidity. You value long-term appreciation over principal preservation. ☐ Moderate – You are willing to accept limited risk. You may endure some volatility and illiquidity. You value enhancing returns and principal preservation equally. You are willing to risk losing a substantial amount of your investment. ☐ Conservative – You are willing to accept low risk for greater stability and liquidity. You value minimizing risk and maximizing principal preservation. C-2. What is your primary investment objective? (select one): ☐ Investment speculation ☐ Steadily accumulate wealth over the long term ☐ Partially fund my retirement ☐ Other C-3. What are your time horizon and liquidity needs? (a) Time Horizon (select one): (b) Liquidity Needs (select one): ☐ 10 years or more ☐ Low ☐ 5 –10 years ☐ Medium ☐ 2 – 5 years ☐ High ☐ Under 2 years C-4. How much investment experience do you have? (select one): ☐ Extensive ☐ Substantial ☐ Moderate ☐ Limited ☐ None C-5. Please state the approximate number and total dollar amount of your prior investments in restricted securities (e.g., private placements): No. of Investments: _________________ Total Amount: _________________ C-6. Please indicate your Annual Income and Net Worth: (a) Annual Income (b) Net Worth (c) Liquid Net Worth ☐ Under $25,000 ☐ Under $25,000 ☐ Under $25,000 ☐ $25,000 – $50,000 ☐ $25,000 – $50,000 ☐ $25,000 – $50,000 ☐ $50,000 – $75,000 ☐ $50,000 – $75,000 ☐ $50,000 – $75,000 ☐ $75,000 – $100,000 ☐ $75,000 – $100,000 ☐ $75,000 – $100,000 ☐ $100,000 – $200,000 ☐ $100,000 – $150,000 ☐ $100,000 – $150,000 ☐ $200,000 – $300,000 ☐ $150,000 – $200,000 ☐ $150,000 – $200,000 ☐ $300,000 – $500,000 ☐ $200,000 – $250,000 ☐ $200,000 – $250,000 ☐ $500,000 – $1,200,000 ☐ $250,000 – $500,000 ☐ $250,000 – $500,000 ☐ Over $1,200,000 ☐ $500,000 – $1,000,000 ☐ $500,000 – $1,000,000 ☐ $1,000,000 1,000,000– $5,000,000 ☐ $1,000,000 – $5,000,000 ☐ Over $5,000,000 ☐ Over $5,000,000 C-7. Please provide in the space below any additional information which would indicate that you have sufficient knowledge and experience in financial and business matters so that you are capable of evaluating the merits and risks of investing in restricted securities of private or thinly traded enterprise. D. Please provide the following information concerning your industry and other affiliations. D-1. Are you, your spouse or spousal equivalent, or any other immediate family members, including parents, in-laws, and siblings that are dependents, an officer, director or greater than ten percent (10%) shareholder of the Company offering securities? ☐ Yes ☐ No D-2. Are you, your spouse or spousal equivalent, or any other immediate family members, including parents, in-laws, and siblings that are dependents, employed by or associated with the securities industry (for example, investment advisor, sole proprietor, partner, officer, director, branch manager or broker at a broker-dealer firm or municipal securities dealer) or a financial regulatory agency, such as FINRA or the New York Stock Exchange? ☐ Yes ☐ No If yes, please provide the name and contact information for such firm. D-3. Are you a senior military, governmental or political official in a non-US country? ☐ Yes ☐ No If yes, please provide the name of the country. E. Did anyone at Boustead Securities, LLC recommend the investment to you? ☐ Yes ☐ No If yes, please provide the name of the individual.