LGAM PRIVATE CREDIT LLC Common Units Subscription Booklet If you decide not to participate in this offering, please return this Subscription Booklet and the Confidential Private Placement Memorandum (together with all amendments thereof and...

Subscriber Questionnaire Section A: General Information (All Subscribers) S-2 1. Identity of Subscriber Full legal name of Subscriber: Telephone Number: Email Address: If IRA or ▇▇▇▇▇ Plan, natural person who established plan: Primary Subscriber Classification (check applicable category): ☐ Individual ☐ Tenants in Common ☐ Joint Tenants ☐ Tenants by the Entirety ☐ Community Property ☐ Individual Retirement Account (IRA)† ☐ 401(k) Account ☐ ▇▇▇▇▇ Plan ☐ General Partnership ☐ Limited Partnership ☐ Corporation ☐ Limited Liability Company ☐ Massachusetts or Similar Business Trust ☐ Foundation ☐ Private Foundation ☐ Estate ☐ Endowment ☐ Employee Benefit Plan ☐ Employee Benefit Plan Trust ☐ Personal Holding Company or Personal Investment Vehicle ☐ Trust Please Specify Type: ☐ Revocable Trust ☐ Complex Trust ☐ Simple Trust ☐ Grantor Trust ☐ Statutory Trust ☐ Non-Grantor Trust (other than Employee Benefit Plan Trust) - Please Specify Type: ☐ Financial Institution Please Specify FI Activities: ☐ Proprietary ☐ Non-Proprietary ☐ Charitable Organization *Please specify primary source of funding ☐ Other entity type - Please Specify Type: † If the Subscriber is an IRA, the Individual who established the IRA: (i) has directed the custodian or trustee of the Subscriber to execute the Subscription Agreement on the Subscriber Signature Page and (ii) has signed the signature page to this Subscription Agreement as such to indicate that he or she has reviewed, directed and certifies to the accuracy of the representations and warranties made by the Subscriber herein. Jurisdiction in which Subscriber received this Subscription Booklet (if United States, indicate state): Section A: To be completed by all subscribers

Subscriber Questionnaire Section A: General Information (All Subscribers) S-3 Business Address (for entities) or Residential Address (for individuals) (Note: A fixed address is required for anti-money laundering purposes; a Post Office box cannot be accepted): Number and Street Apt./Suite City State Zip Code Country Mailing Address (if different from above): Number and Street Apt./Suite City State Zip Code Country 2. Contact Information a) Primary Contact Name: (Prefix: Mr., Mrs., Dr. etc.) (First Name) (Middle Name/Initial) (Last Name) (Suffix: Jr., III, Ph.D. etc.) Position or title: Company name: Mailing Address (if different from above): Number and Street Apt./Suite City State Zip Code Country Telephone Number: Email Address:

Subscriber Questionnaire Section A: General Information (All Subscribers) S-4 b) Additional Contact (Optional) If you would like to provide more than one additional contact, please attach the information to this subscription document Name: (Prefix: Mr., Mrs., Dr. etc.) (First Name) (Middle Name/Initial) (Last Name) (Suffix: Jr., III, Ph.D. etc.) Position or title: Company name: Mailing Address (if different from above): Number and Street Apt./Suite City State Zip Code Country Telephone Number: Email Address: c) Delivery Information for Communications with Subscriber Please check the appropriate box to indicate to whom the listed information is to be sent. All Contacts Primary Contact ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Contact Additional Contact Drawdown/Distribution/ Fee Notices ☐ ☐ ☐ ☐ Quarterly Reporting (Statements & Reports) ☐ ☐ ☐ ☐ Tax Related Information (1099-DIV, etc.) ☐ ☐ ☐ ☐ 3. Wire Payment Information Please provide bank wire instructions. Required Items Bank Wire Payment Information Beneficiary Bank Name: Beneficiary Bank Country (location):

Subscriber Questionnaire Section A: General Information (All Subscribers) S-5 Beneficiary Bank ABA/Routing Number or SWIFT Code ABA Routing Number (nnn-nnn-nnn): SWIFT Code: Beneficiary Account Name: Beneficiary Account Number: Reference Information: If your bank account resides outside of the United States, you must provide U.S. Intermediary wire instructions below U.S. Intermediary Bank Name: U.S. Intermediary Bank Address: U.S. Intermediary Bank ABA/Routing Number or SWIFT Code ABA Routing Number (nnn-nnn-nnn): SWIFT Code: U.S. Intermediary Bank Account Number: (If ABA = “▇▇▇-▇▇▇-▇▇▇” or SWIFT = “▇▇▇▇▇▇▇▇”, then “Intermediary Account #” must be completed) a) Please provide a brief explanation of source of funds for this investment: b) Please indicate whether you are borrowing or are otherwise financing your acquisition of Units hereunder. ☐ Yes ☐ No If answered “Yes,” please indicate the amount financed and what, if any, collateral was given to secure the financing: 4. Additional Information a) Please provide the Subscriber’s jurisdiction of residence for tax purposes. (city, state, country)

Subscriber Questionnaire Section A: General Information (All Subscribers) S-6 b) United States tax status (choose one): ☐ Individual/sole proprietor or single-member LLC ☐ C-Corporation ☐ S-Corporation ☐ Partnership ☐ Trust/Estate ☐ Simple Trust ☐ Grantor Trust ☐ Complex Trust ☐ Limited Liability Company ☐ Central Bank of Issue ☐ Private Foundation ☐ Disregarded Entity ☐ Government ☐ Tax-Exempt Organization ☐ Other (please explain): NOTE: If the answer to Question 4(d) is yes, complete Politically Exposed Persons (“PEP”) Questionnaire in Appendix 2. ☐ Yes ☐ No c) Is the Subscriber treated as a partnership or a disregarded entity for U.S. federal income tax purposes? ☐ Yes ☐ No d) Is the Subscriber or any related person of the Subscriber, including any underlying beneficial owner or control person or any person for whom the Subscriber acts as agent/nominee in connection with an investment, a Politically Exposed Person (or an immediate family member or close associate of a Politically Exposed Person), as defined in Annex 1? NOTE: Public officials acting in their official capacity when establishing a relationship between a government entity and the Company are excluded from the definition of a “Politically Exposed Person” ☐ Yes ☐ No e) Is the Subscriber a Marijuana-Related Business8 , involved with a Marijuana-Related Business, or derives revenue from or substantially invests in a Marijuana-Related Business? ☐ Yes ☐ No f) Is the Subscriber or any Underlying Beneficial Owner of the Subscriber an employee, “affiliate” or director of ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ or of any affiliate of ▇▇▇▇▇▇ ▇▇▇▇▇▇▇? For purposes of this paragraph, the term “affiliate” shall include any person, directly or indirectly, through one or more intermediaries, controlling, controlled by or under common control with ▇▇▇▇▇▇ ▇▇▇▇▇▇▇. NOTE: If the answer to Question 4(f) is “Yes,” please notify the contact listed in Section 4 of the “General Instructions” in the Subscription Booklet. ☐ Yes ☐ No g) Is the Subscriber currently a senior officer, director or owner of 10% or more of the voting shares of a public company or other person identifiable as a “Corporate Insider” of a public company? 8 A Marijuana-Related Business includes: 1) an individual or entity directly involved in the manufacturing, production, sale or distribution of marijuana, whether for medicinal, recreational, or any other use; 2) an individual or entity that derives a substantial source of wealth, compensation, revenue or income from marijuana-related activity (e.g., service providers that cater largely to Marijuana-Related Businesses, commercial lessors that lease property to Marijuana-Related Businesses, etc.); or 3) an individual or entity that is directly and predominantly involved in supplying products, equipment or material intended or designed for use in furtherance of the manufacturing, production, sale, use or distribution of marijuana (e.g., marijuana LED grow-lights, marijuana grow tents, hydroponics, etc.).

Subscriber Questionnaire Section A: General Information (All Subscribers) S-7 If the answer to Question 4(g) is “Yes”, please identify the name of the public company and the Subscriber’s relationship to that company: Name: Relationship: In addition, if the answer to Question 4(g) is “Yes” the Subscriber agrees to update the Company as to any change in their status as above referenced “Corporate Insider.” ☐ Yes ☐ No h) Is the Subscriber acting on behalf of one or more Underlying Beneficial Owner(s)? A Subscriber acts on behalf of one or more Underlying Beneficial Owner(s) if the Subscriber is acting as an agent, representative, intermediary, nominee or in a similar capacity for any other person, nominee account or beneficial owner, whether a natural person or Entity (each such natural person or Entity, an “Underlying Beneficial Owner”) If the answer to Question 4(h) is “Yes,” please indicate the following: ☐ Yes ☐ No (i) The representations, warranties and agreements made in this Subscription Booklet, including the representations and warranties contained in the Subscription Agreement and the information contained in this Subscriber Questionnaire, are true, complete and accurate with respect to the Underlying Beneficial Owner(s). ☐ Yes ☐ No (ii) Was any Underlying Beneficial Owner formed for the specific purpose of purchasing the Units? ☐ Yes ☐ No (iii)Does any Underlying Beneficial Owner’s allocable portion of the Capital Contribution constitute 25% or more of such Underlying Beneficial Owner’s total assets, or 25% or more of such Underlying Beneficial Owner’s committed capital? ☐ Yes ☐ No (iv) Is any Underlying Beneficial Owner (i) a participant-directed contribution plan (such as a 401(k) plan) or (ii) a partnership or other investment vehicle (x) in which its partners or participants have or will have any discretion to determine whether or how much of such Underlying Beneficial Owner’s assets are invested in any investment made or to be made by such Underlying Beneficial Owner (including the Subscriber’s Capital Contribution) or (y) that is otherwise an entity managed to facilitate the individual decisions of its beneficial owners to invest in the Company? NOTE: If the answer to Question 4(h) (iii), (iv) or (v) above is “Yes,” with respect to any Underlying Beneficial Owner, each beneficial owner of such Underlying Beneficial Owner must complete a copy of this Subscriber Questionnaire (as if such person were directly purchasing the Units). ☐ Yes ☐ No i) Is the Subscriber or any Underlying Beneficial Owner, or will the Subscriber or any Underlying Beneficial Owner be, a person (including an entity) that has discretionary authority or control with respect to the assets of the Company or a person who provides investment advice with respect to the assets of the Company, or an “affiliate” of such a person? For purposes of this representation, an “affiliate” of any person is any person controlling, controlled by or under common control with such first person, including by reason of having the power to exercise a controlling influence over the management or policies of such person.

Subscriber Questionnaire Section A: General Information (All Subscribers) S-8 ☐ Yes ☐ No j) Is the Subscriber a private investment company that is not registered under the Investment Company Act in reliance on Sections 3(c)(1) or 3(c)(7) thereof? If the answer to Question 4(j) is “Yes,” please indicate the following: ☐ Yes ☐ No (i) Was the Subscriber formed on or before April 30, 1996? If the answer to Question 4(j)(i) is “Yes,” please indicate the following: ☐ Yes ☐ No (ii) Has the Subscriber obtained consent of its indirect and direct Underlying Beneficial Owners to be treated as a “qualified purchaser” as provided in Section 2(a)(51)(C) of the Investment Company Act and the rules and regulations thereunder?

Subscriber Questionnaire Section B: Consent to Electronic Delivery of Periodic Reporting and Tax Information (All Subscribers) S-9 Consent to Electronic Delivery of Periodic Reporting and/or Tax Information For Primary Contact of Subscriber • If you choose not to consent to electronic delivery of periodic reporting (including statements, commentary and notices) and/or tax information via the Company’s investor portal (the “Investor Portal”) or if you subsequently withdraw your consent to such electronic delivery, paper copies of such periodic reporting or tax information will be furnished to you via U.S. Mail or UPS / FedEx. • Such consent applies to all periodic reporting or tax information, as applicable, required to be furnished to you by the Company after this consent is given until you withdraw consent. • Notwithstanding your consent, you are entitled to receive paper copies of such periodic reporting and tax information upon request. The Company will NOT treat your request for paper copies as a withdrawal of consent. If you wish to withdraw consent, you understand that you must do so affirmatively. • You may withdraw consent by contacting MS Capital Partners Adviser Inc., ▇▇▇▇ ▇▇▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇, ▇▇ ▇▇▇▇▇, Attn: ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Investor Servicing Team (or at such updated address as the Company may communicate to the Subscribers from time to time), or via email to ▇▇▇▇.▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇. The withdrawal of consent will be effective within 60 (sixty) calendar days of receipt by the Company and will be confirmed in writing by the Company (including the date on which the withdrawal will take effect). A withdrawal of consent does not apply to any periodic reporting or tax information that was furnished electronically before the withdrawal takes effect. • You can contact MS Capital Partners Adviser Inc., ▇▇▇▇ ▇▇▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇, ▇▇ ▇▇▇▇▇, Attn: ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Investor Servicing Team (or at such updated address as the Company may communicate to the Subscribers from time to time), or via email to ▇▇▇▇.▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ to communicate any changes in your contact information. The Company will email you if the contact information for the Company changes. • If the Subscriber has received the Subscription Booklet (including this Subscriber Questionnaire) as a pdf (portable document format) file in an email attachment or in any other electronic format, the receipt thereof reasonably demonstrates that the Subscriber can access any tax information in the electronic format in which it will be furnished to the Subscriber. If the Subscriber received the Subscription Booklet in a non-electronic format, the Subscriber confirms that it consents to electronic delivery of any tax information in respect of the Units and that it is able to access documents delivered through electronic means. • If you consent to the electronic delivery of periodic reporting and/or tax information via the Investor Portal, such periodic reporting and/or tax information may be posted to the Investor Portal as a PDF (portable document format) file. You may download a free copy of Adobe Acrobat Reader, which will allow you to view any such periodic reporting and/or tax information, by visiting ▇▇▇▇://▇▇▇.▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇. This page contains information about the system requirements needed to use the software. Alternatively, you may be able to use an alternative PDF reader software. Certain tax information may be required to be printed and attached to a federal, state, or local income tax return. For all Contacts of Subscriber other than the Primary Contact • All periodic reporting (including statements, commentary and notices) and/or tax information to be provided to you will be delivered electronically via the Investor Portal. Paper copies of such periodic reporting or tax information will not be furnished to you via U.S. Mail or UPS / FedEx, even if you no Section B: To be completed by all subscribers

Subscriber Questionnaire Section B: Consent to Electronic Delivery of Periodic Reporting and Tax Information (All Subscribers) S-10 longer wish to continue receiving such period reporting or tax information electronically via the Investor Portal. • You can contact MS Capital Partners Adviser Inc., ▇▇▇▇ ▇▇▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇, ▇▇ ▇▇▇▇▇, Attn: ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Investor Servicing Team (or at such updated address as the Company may communicate to the Subscribers from time to time), or via email to ▇▇▇▇.▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇, to communicate any changes in your contact information. The Company will email you if the contact information for the Company changes. • The periodic reporting and/or tax information delivered to you electronically via the Investor Portal may be posted to the Investor Portal as a PDF (portable document format) file. You may download a free copy of Adobe Acrobat Reader, which will allow you to view any such periodic reporting and/or tax information, by visiting ▇▇▇▇://▇▇▇.▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇. This page contains information about the system requirements needed to use the software. Alternatively, you may be able to use an alternative PDF reader software. Certain tax information may be required to be printed and attached to a federal, state, or local income tax return. Instructions: Please check the box below and reply to the email by which the Subscriber received this Subscription Agreement (including a copy of the completed consent) or upload the signed consent to the secure website through which the Subscriber downloaded this Subscription Agreement to confirm that (a) the Subscriber consents to electronic receipt of periodic reporting and/or tax information in respect of its Units in the Company and (b) the Subscriber is able to open the pdf document sent to the Subscriber’s email address or posted to the Company’s secure website. ☐ I consent to electronic delivery of any tax information circulated by the Company on such terms and conditions as described in this Consent to Electronic Delivery of Periodic Reporting and/or Tax Information form.

Subscriber Questionnaire Section B: Consent to Electronic Delivery of Periodic Reporting and Tax Information (All Subscribers) S-11 Affirmative Indication of Independent Judgment (Pursuant to FINRA Rule 2111)9 In connection with the proposed investment in the Company, the undersigned, on behalf of the Subscriber, acknowledges and represents to ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ & Co. LLC, a registered broker-dealer, and any affiliated broker-dealers that may assist in the placement of Units (collectively, “▇▇▇▇▇▇ ▇▇▇▇▇▇▇”) that: ☐ Yes ☐ No 1) The Subscriber qualifies as an Institutional Account, as defined in FINRA Rule 4512(c):10 If the Subscriber answers “Yes” to Question 1 above, Subscriber hereby represents and warrants as follows: a) The Subscriber (i) is capable of evaluating investment risks independently, both in general and with regard to all transactions and investment strategies involving a security or securities, including private equity funds and other alternative investments; and (ii) will exercise independent judgment in evaluating an investment in the Company, unless it has otherwise notified ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ in writing; b) The Subscriber has consulted appropriate internal and/or external advisers to the Subscriber, other than ▇▇▇▇▇▇ ▇▇▇▇▇▇▇, in connection with the Subscriber’s investment in the Company; c) The Subscriber will notify ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ immediately at the address below if anything in this Subscriber Questionnaire ceases to be true; and d) The signatory below is authorized to sign on behalf of the Subscriber named below. ☐ Yes ☐ No 2) Is the Subscriber a client of ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Private Wealth Management Ltd., ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Bank International Limited, Bank ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇, Bank ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇, Hong Kong Branch (or ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Asia Limited, as the case may be) or Bank ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇, Singapore Branch (or ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Asia (Singapore) Pte., as the case may be)? By executing this subscription booklet, the undersigned affirms that the above statements are accurate but does not waive any rights afforded under U.S. federal or state securities laws, including any rights under Section 10(b) of the 1934 Act and the rules and regulations promulgated thereunder. NOTE: This letter shall apply with respect to an investment in the Company by the Subscriber, whether for its own account or for the account of any beneficial owner that has delegated decision making authority to the Subscriber. If you cannot respond to Question 1 or 2 above, please contact the person listed in Section 4 of the “General Instructions” in the Subscription Booklet. 9 Available at ▇▇▇▇://▇▇▇.▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇▇/▇▇▇▇▇▇▇▇▇▇/▇▇▇▇▇▇▇▇▇▇/. 10 “Institutional Account” means the account of: (1) a bank, savings and loan association, insurance company or registered investment company; (2) an investment adviser registered either with the SEC under Section 203 of the Investment Advisers Act or with a state securities commission (or any agency or office performing like functions); or (3) any other person (whether a natural person, corporation, partnership, trust or otherwise) with total assets of at least $50 million as of the date of execution of this Certificate whether such assets are invested for such person’s own account or under management for the account of others.

Subscriber Questionnaire Section C: Supplemental Information for Entities (Entities only) S-12 To be completed by, or on behalf of, a Subscriber that is a corporation, partnership, limited liability company, trust or other association or entity, including an individual retirement account (“IRA”), 401(k) account or ▇▇▇▇▇ Plan subscribing in its own name, but not including cases where a natural person is subscribing in his/her own name using the assets of an IRA, 401(k) account or ▇▇▇▇▇ Plan. 1. Supplemental General Information Full legal name of subscriber (First & Last Name) Date of incorporation or formation (mm/dd/yyyy): State of Incorporation or Formation: Country of Incorporation or Formation: Government-Issued Identification: Provide – Type of ID (e.g. EIN, TIN, Co. Registration Number, taxpayer identification number, Company Registration Number, Passport Number, etc.) / ID Number / and Country of Issuance: / / (Type of ID) (ID Number) (Country of Issuance) Nature of business: Jurisdictions of Markets Served (Charity/Foundation/Financial Institution clients “only”) Settlor/Grantor #1- Name Address Country of Domicile Date of Birth Government Issued ID# Citizenship Source of Wealth Settlor/Grantor #2 - Name Address Country of Domicile Date of Birth Government Issued ID# Citizenship Source of Wealth Source of Funds 2. Beneficial owner information of Subscriber ☐ Yes ☐ No ☐ N/A a) If the Subscriber is a privately held entity and is not a trust, do any of the Subscriber’s beneficial owners, directly or indirectly through Section C: To be completed by subscribers that are entities only

Subscriber Questionnaire Section C: Supplemental Information for Entities (Entities only) S-13 intermediaries, hold 10% or more of any voting or non-voting class of the Subscriber’s equity interests? ☐ Yes ☐ No ☐ N/A b) If the Subscriber is a trust, does the Subscriber have any beneficiaries, settlors/grantors and/or trustees that have, directly or indirectly, an equity interest of 10% or more in the trust? ☐ Yes ☐ No c) Is the Subscriber subscribing for Units with the intent to sell or transfer the Units to any other person or persons? If the answer is “Yes” to Question 2(c), please notify the contact listed in Section 4 of the “General Instructions” in the Subscription Booklet 3. Anti-Money Laundering Information ☐ Yes ☐ No a) Is the Subscriber a fund-of-funds entity? ☐ Yes ☐ No b) Are the Units being purchased by an agent, nominee, trustee, custodian or otherwise on behalf of, or for the account of, third parties? If yes, Anti-Money Laundering documentation, as outlined in Appendix 2, should also be provided for the underlying party. ☐ Yes ☐ No c) Will any other person or persons other than the Subscriber have a beneficial interest in the Units acquired (other than as a shareholder, partner, member, trust beneficiary or other beneficial owner of equity interests in the Subscriber)? Please refer to Investor Anti-Money Laundering Documentation Supplement in Appendix 2 for required documentation to be provided.

Subscriber Questionnaire Section C: Supplemental Information for Entities (Entities only) S-14 4. Benefit Plan Accounts ☐ Yes ☐ No a) Is the Subscriber, or will the Subscriber be, a “Benefit Plan Investor”? A Benefit Plan Investor is defined as: (i) any employee benefit plan subject to Part 4 of Title I of ERISA; (ii) any plan to which Code Section 4975 applies (which includes a trust described in Code Section 401(a) that is exempt from tax under Code Section 501(a), a plan described in Code Section 403(a), an IRA or annuity described in Code Section 408 or Section 408A, a medical savings account described in Code Section 220(d), a health savings account described in Code Section 223(d) and an education savings account described in Code Section 530); (iii) any entity whose underlying assets include plan assets by reason of a plan’s investment in the entity (generally because 25 percent or more of a class of equity interests in the entity is owned by plans). Benefit Plan Investors also include that portion of any insurance company’s general account assets that are considered “plan assets” and (except if the entity is an investment company registered under the Investment Company Act) the assets of any insurance company separate account or bank common or collective trust in which plans invest, as well as entities deemed to hold the assets of any of the foregoing accounts. b) If the answer to Question 4(a) is “Yes”, please indicate whether: ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No (1) The Subscriber is or will be an “employee benefit plan,” as defined in Section 3(3) of ERISA that is subject to the fiduciary responsibility provisions of ERISA. (2) The Subscriber is or will be a “plan” as defined in and that is subject to Section 4975 of the Code, including, for example, an IRA. (3) The Subscriber is, or will be, an entity, including an insurance company separate or general account or an investment fund, the underlying assets of which include “plan assets” that are subject to Part 4 of Subtitle B of Title I of ERISA or Section 4975 of the Code by reason of a plan’s investment in such entity. (4) If the Subscriber answered “Yes” to 4(b)(3) above, the percentage of the assets of the Subscriber that are held on behalf of Benefit Plan Investors subject to Part 4 of Subtitle B of Title I of ERISA or Section 4975 of the Code during the period of investment in the Company do not, and will not, exceed: % If the answer to Question 4(b)(2) is “Yes”, the Subscriber MUST complete Section C of the Subscriber Questionnaire and the Additional Representation with Respect to Investment for an IRA on the Subscriber Signature Page. ☐ Yes ☐ No c) Is the Subscriber (i) a bank as defined in section 202 of the Investment Advisers Act or similar institution that is regulated and supervised and subject to periodic examination by a state or federal agency; (ii) an insurance carrier which is qualified under the laws of more than one state to perform the services of managing, acquiring or disposing of assets of a plan; (iii) an investment adviser registered under the Investment Advisers Act or, if not registered as an investment adviser under the Investment Advisers Act by reason of paragraph (1) of section 203A of such Act, is registered as an investment adviser under the laws of the state (referred to in such paragraph (1)) in which it maintains its principal office and place of

Subscriber Questionnaire Section C: Supplemental Information for Entities (Entities only) S-15 business; (iv) a broker-dealer registered under the 1934 Act, or (v) an independent fiduciary that holds, or has under management or control at least $50 million? ☐ Yes ☐ No d) If the Subscriber is not a Benefit Plan Investor subject to Title I of ERISA or Section 4975 of the Code, please indicate whether such Subscriber is or will be subject to any other federal, state, local, non-U.S. or other laws or regulations that are similar to the fiduciary responsibility or prohibited transaction provisions contained in Title I of ERISA or Section 4975 of the Code that would apply to the management or operation of the Company as a result of the Subscriber’s investment in the Company.

Subscriber Questionnaire Section C: Supplemental Information for Entities (Entities only) S-16 5. Additional Information (all questions from 5(a) through 5(h) must be answered) ☐ Yes ☐ No a) Was the Subscriber formed for the specific purpose of acquiring the Units? If the answer to 5(a) is “Yes”, please notify the contact listed in Section 4 of the “General Instructions” in the Subscription Booklet and attach as an exhibit to this Subscription Booklet a completed Subscriber Questionnaire for each beneficial owner of the Subscriber. ☐ Yes ☐ No b) Is the Subscriber a participant-directed defined contribution plan (such as a 401(k) plan) or a partnership or other investment vehicle (i) in which its partners or participants have or will have any discretion to determine whether or how much of the Subscriber’s assets are invested in any investment made or to be made by the Subscriber (including the Subscriber’s Capital Contribution) or (ii) that is otherwise an entity managed to facilitate the individual decisions of its beneficial owners to invest in the Company? If the answer to 5(b) is “Yes”, please attach as an exhibit to this Subscription Booklet a completed Subscriber Questionnaire for each Beneficial Owner of the Subscriber. ☐ Yes ☐ No c) Is the Subscriber subject to the Bank Holding Company Act (the “BHC Act”) or directly or indirectly “controlled” (as that term is defined in the BHC Act) by a company that is subject to the BHC Act under the BHC Act? ☐ Yes ☐ No d) Does the Subscriber intend to enter, or has entered into, a swap, structured note or other derivative instrument with any third party, the return from which is or will be based in whole or in part on the return of the Company? ☐ Yes ☐ No If “Yes”, does any such third party include a Benefit Plan Investor (as defined in 4(b) above)? If the answer to 5(d) is “Yes,” each counterparty that is an entity must complete a copy of this Subscriber Questionnaire, in each case as if such counterparty were directly purchasing the Units. ☐ Yes ☐ No e) If the Subscriber is a grantor trust and is a “United States person” for U.S. federal income tax purposes (as defined in Annex 1), the Subscriber is submitting such documentation (e.g., Form W-8BEN, W-8BEN-E, W-8IMY, W-8ECI, W-8EXP or W-9) and information pertaining to each grantor or other owner that permits the Company to reliably associate each such grantor’s or other owner’s indirect share of the Company’s income with such grantor or other person. ☐ Yes ☐ No f) Is the Subscriber or any Underlying Beneficial Owner subject to the U.S. Freedom of Information Act, Section 552(a) of Title 5, United States Code (“FOIA”), any state public records access laws, any state or other jurisdiction’s laws with similar intent or effect to FOIA, or any other similar statutory or legal right that might result in the disclosure of confidential information relating to the Company? If the answer to 5(f) is “Yes,” please indicate the relevant laws to which the Subscriber (or any Underlying Beneficial Owner) is subject and provide any additional explanatory information in the space provided below.

Subscriber Questionnaire Section C: Supplemental Information for Entities (Entities only) S-17 ☐ Yes ☐ No g) To the best of the Subscriber’s knowledge, does the Subscriber control, or is the Subscriber controlled by or under common control with, any other investor in the Company? If the answer to 5(g) is “Yes,” please identify such related investor(s) below. ☐ Yes ☐ No h) Will any other person or persons have a beneficial interest in the Units to be acquired hereunder (other than as a shareholder, partner, policy owner or other beneficial owner of equity interests in the Subscriber)? (By way of example, and not limitation, “nominee” Subscribers or Subscribers who have entered into swap or other synthetic or derivate instruments or arrangements with regard to the Units to be acquired herein would be required to check “Yes” to the left.)

Section D: Subscriber Signature Page (if applicable) S-18 Subscriber Signature Page To be signed by all subscribers: Execution of this signature page constitutes execution by the Subscriber of this Subscription Booklet. This Subscription Agreement shall become a binding agreement between the Subscriber and the Company on the date accepted by the Company. With the signature(s) below, the Subscriber acknowledges, represents and agrees that it has carefully read, and is familiar with, this Subscription Booklet and the Memorandum, and agrees that signing below constitutes the receipt and agreement to the terms of this Subscription Booklet and the execution of this Subscription Booklet. The Subscriber hereby confirms that the information provided in the Subscriber Questionnaire and all of its representations, warranties and agreements set forth in this Subscription Agreement and other documents constituting the Subscription Booklet (including Appendices and Annexes hereto) are true, correct and complete. The Subscriber hereby confirms that the signatory hereto has the authority to sign this document on behalf of the Subscriber. By signing this signature page, the Subscriber hereby gives power of attorney to the officers of the Company to execute certain documents on the Subscriber’s behalf. Please refer to Section 5.14 on pages 6-7 of the Subscription Agreement. The Subscriber acknowledges that it has received from LGAM Private Credit LLC copies of the following: • Confidential Private Placement Memorandum • Certificate of Formation • LLC Agreement • Subscription Booklet Please write in your capital contribution amount in the line below and fill in the date of signature in the bolded sentence below. Subscriber’s Capital Contribution is $ IN WITNESS WHEREOF, the Subscriber has executed and unconditionally delivered this Subscription Booklet, this day of , 20 Section D: Subscriber Signature Pages (all subscribers)

Section D: Subscriber Signature Page (if applicable) S-19 Subscriber Signature Page (cont’d) Partnership, Corporation, Limited Liability Company, Trust, Custodial Account, Other Investor: Print Full Legal Name of Subscriber Signature of Authorized Signatory Print Name of Authorized Signatory Print Title of Authorized Signatory

Form of Company Acceptance of Subscription S-20 Form of Company Acceptance of Subscription Dear [Subscriber], This letter confirms your Capital Contribution to LGAM Private Credit LLC (the “Company”) was accepted by the Company in the amount of $[AMOUNT] effective as of [DATE] pursuant to the terms and conditions set forth in the subscription agreement executed by you. Very truly yours, LGAM Private Credit LLC By:________________________________ Name: Title:

Appendix 1 App 1-1 Read the instructions to the applicable Internal Revenue Service Tax Forms. The relevant IRS Forms and their instructions can also be accessed on the IRS website at ▇▇▇▇://▇▇▇.▇▇▇.▇▇▇. − If the Subscriber is a “United States person” for U.S. federal income tax purposes (e.g., a U.S. citizen or a U.S. resident), please complete and execute Form W-9 in accordance with the instructions accompanying the form. − If the Subscriber is not a “United States person” for U.S. federal income tax purposes (e.g., a nonresident alien), please complete and execute Form W-8BEN, Form W-8BEN-E, Form W-8IMY, Form W-8EXP or Form W-8ECI, as applicable. If the Subscriber is claiming benefits under an income tax treaty, please provide a U.S. taxpayer identification number on Form W-8BEN or Form W-8BEN-E, as applicable. − Please note that if the W-8BEN, Form W-8BEN-E, Form W-8IMY, Form W-8EXP or Form W-8ECI, as applicable, does not contain such U.S. taxpayer identification number or is otherwise missing information or has been incorrectly filled out, the income tax treaty benefits claimed will not be applied. Instead the Company will withhold at full U.S. tax rates. Attached are eight different tax forms. These tax forms and their instructions can also be accessed on the IRS website at ▇▇▇▇://▇▇▇.▇▇▇.▇▇▇. Please read the guidelines below and the instructions accompanying the forms to determine which form(s) applies to the Subscriber, and then complete and execute the relevant form(s) in accordance with such instructions. In the case of joint investors, each investor must complete and execute the relevant form. If the Subscriber is not a United States person, the Subscriber should notify the contact listed in Section 4 of the “General Instructions” in the Subscription Booklet. FATCA Compliance: In order to comply with the FATCA rules and avoid the imposition of U.S. federal withholding tax, the Company requires Subscribers to provide additional information as described in the Subscription Agreement and may from time to time require further information or documentation from the Subscriber and, if and to the extent required under FATCA, the Subscriber’s direct and indirect beneficial owners (if any), relating to or establishing such person’s identity, residence (or jurisdiction of formation) and income tax status, and may provide or disclose such information and documentation to the U.S. Internal Revenue Service. The Subscriber hereby agrees to indemnify and hold harmless the Company from any and all withholding taxes, interest, penalties and other losses or liabilities suffered by the Company on account of the Subscriber not providing all requested information and documentation in a timely manner. The Subscriber shall have no claim against the Company for any form of damages or liability as a result of any of the aforementioned actions. Appendix 1: Internal Revenue Service Form W-9 and W-8BEN

Appendix 2 App 2-1 1. Is the Subscriber or related individual a current or former public figure (as defined under “Politically Exposed Person” in Annex 1)? Yes ☐ No ☐ If the answer is YES, please provide the following: Official title/position(s) (current and former): Dates of Service: Country from which PEP Derives Status: Salary/compensation from official duties (current role only): Other sources of wealth/income: 2. Is the Subscriber or related individual an immediate family member of a current or former public figure (as defined under “Politically Exposed Person” in Annex 1)? Yes ☐ No ☐ If the answer is YES, please provide the following: Full Name of Public Figure: Relationship to Client: Official title/position(s) (current and former): Dates of Service: Country from which PEP Derives Status: 3. Is the Subscriber or related individual a known close associate of a current or former public figure (as defined under “Politically Exposed Person” in Annex 1)? Yes ☐ No ☐ If the answer is YES, please provide the following: Full Name of Public Figure: Relationship to Client: Official title/position(s) (current and former): Dates of Service: Country from which PEP Derives Status: Appendix 2: Politically Exposed Persons (“PEP”) Questionnaire

Appendix 2 App 2-2 To comply with applicable Anti-Money Laundering (“AML”) legislation and regulations, ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ is required to conduct due diligence on all investors. The attached supplement includes guidance on the specific information and documentary evidence required on each investor. In all cases, ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ reserves the right to request any further information we deem necessary for AML purposes. Please note that this list is not exhaustive, as additional documentation may be required based on specific criteria identified at onboarding. All Non U.S. Wealth Management subscribers must review and provide the applicable documents below: Investor Type Required Documentation Individuals • Valid government issued ID (e.g. passport, driver’s license, etc.) • Proof of residential address • Source of wealth/source of funds Personal Holding Company • Documentation showing formation of the entity (e.g. Certificate of Incorporation, etc.) • Identification of layers of organizational structure down to ultimate individual owner(s) • Authorized Signatory list, including name and country of domicile • Certification for Beneficial Owners and Key Controller of Legal Entity Customers (Complete Appendix 3) - Documentation requirements for individuals apply to each beneficial owner and key controller identified Trust • First and signature pages of Trust Agreement • Documentation identifying the Trustee/Protector (can be Trust Agreement) - Documentation requirements for individuals apply to each Trustee/Protector identified - A formation document is required for any corporate Trustee/Protector identified • Documentation identifying the Grantor/Settlor/Donor (can be Trust Agreement) - Documentation requirements for individuals apply to each Grantor/Settlor/Donor identified * For Statutory Trusts created by a filing with a Secretary of State or similar office (i.e., REITS), please contact GFC Partnership • Documentation showing formation of the entity (e.g. Partnership Agreement, etc.) • Identification of layers of organizational structure down to Ultimate Beneficial Owner(s) holding 10% or more of the equity interests • Certification for Beneficial Owners and Key Controller of Legal Entity Customer (Complete Appendix 3) - Documentation requirements for individuals apply to each beneficial owner and key controller identified Appendix 2 (cont’d) Investor Anti-Money Laundering Documentation Supplement

Appendix 2 App 2-3 Appendix 2 (cont’d) Investor Anti-Money Laundering Documentation Supplement Investor Type Required Documentation Private Corporation, Company or Limited Liability Company • Documentation showing formation of the entity (e.g. Certificate of Incorporation, etc.) • Identification of layers of organizational structure down to Ultimate Beneficial Owner(s) holding 10% or more • Certification for Beneficial Owners and Key Controller of Legal Entity Customers (Complete Appendix 3) - Documentation requirements for individuals apply to each beneficial owner and key controller identified Pension Fund • Documentation showing formation of the entity (e.g. Trust Agreement, etc.) • Proof of regulation, if applicable Certification for Beneficial Owners and Key Controller of Legal Entity Customers (Complete Appendix 3) - Documentation requirements for individuals apply to each beneficial owner and key controller identified • Identification of the Plan Sponsor, including documentation showing formation of the entity (e.g. Certificate of Incorporation, etc.) • Pension Fund Questionnaire Collective Investment Scheme / Pooled Investment Vehicle • Documentation showing formation of the entity (e.g. Certificate of Incorporation, etc.) • Fund structure • Investment Adviser: Full legal name and proof of regulation • Certification for Beneficial Owners and Key Controller of Legal Entity Customers (Complete Appendix 3) – {Not required if fund is managed by a SEC Registered Investment Adviser} - Documentation requirements for individuals apply to each beneficial owner and key controller identified • Full legal name of entity performing KYC on fund’s investors • Collective Investment Scheme Questionnaire • Collective Investment Scheme Sanctions Questionnaire Charity/ Charitable Foundation/ Religious Organization • Documentation showing formation of the entity (e.g. Certificate of Incorporation, etc.) • Listing in a central register of charities or other documentation from the regional organization of a denomination/religion, if applicable • Certification for Beneficial Owners and Key Controller of Legal Entity Customers (complete Appendix 3) - Only identification of one key controller is required. Documentation requirements for individuals apply to the key controller identified Sovereign Wealth Fund • Constitutional documentation evidencing the establishment or appointment as a SWF OR publicly available information • Certification for Beneficial Owners and Key Controller of Legal Entity Customers (complete Appendix 3) - Only identification of one key controller is required. Documentation requirements for individuals apply to the key controller identified • Documentation establishing the Sovereign Wealth Fund is 100% state owned

Appendix 3 App 3-1 I. General Instructions What is this form? U.S. law requires financial institutions to obtain, verify, and record information about the beneficial owners and key controllers of legal entity customers. Who has to complete this form? This form is applicable to legal entity customers and must be completed by the person opening a new account or establishing a customer relationship on behalf of a legal entity. For the purposes of this form, a legal entity includes a corporation, limited liability company, partnership, personal holding company, statutory trust, or other entity created by the filing of a public document with a Secretary of State or similar office, and any similar business entity formed in the United States or a foreign country. Legal entity does not include sole proprietorships, unincorporated associations, or natural persons opening accounts or establishing a customer relationship on their own behalf. What information do I have to provide? This form requires you to provide the name, address, date of birth and social security number (in the case of non-U.S. individuals, a social security number, a passport number or other similar information) for the following: (i) Each individual, if any, who owns, directly or indirectly, 10 percent or more of the equity interests of the legal entity customer (e.g., each natural person that owns 10 percent or more of the shares of a corporation); and (ii) An individual with significant responsibility for managing the legal entity customer (e.g., a Chief Executive Officer, Chief Financial Officer, Managing Member, General Partner, President, Vice President, or Treasurer). II. Certification of Beneficial Owner(s) and Key Controller Persons opening an account or establishing a customer relationship on behalf of a legal entity must provide the following information: a. Name of Natural Person Opening Account/Establishing Customer Relationship: b. Title of Natural Person Opening Account/Establishing Customer Relationship: Appendix 3: Beneficial Owner(s) (10% or More) and Key Controller Certification

Appendix 3 App 3-2 The following section refers to the Legal Entity for Which the Account is Being Opened/Relationship Established: c. Legal Entity Name: d. Legal Entity Type: e. Address of the Legal Entity: III. Exclusions (if applicable) If you believe the Legal Entity customer listed in Section II, paragraph (c) above falls under an express exclusion from the “legal entity customer” definition under 31 C.F.R. 1010.230(e)(2), please check the applicable box below and skip Section III.A and Section III.B. U.S. Publicly Listed Companies □ An issuer of securities registered under section 12 of the Securities Exchange Act of 1934 or that is required to file reports under section 15(d) of that Act. □ An entity (other than a bank) whose common stock or analogous equity interests are listed on the New York, American, or NASDAQ stock exchange (other than an entity whose equity interests are listed under the “NASDAQ Companies – Capital Market” heading). □ A subsidiary (other than a bank) of an entity described in the immediately preceding exclusion that is organized under the laws of the United States or of any state and at least 51% of whose common stock or analogous equity interests are held by the listed entity. Financial Institutions □ A financial institution regulated by a U.S. federal functional regulator or a bank regulated by a U.S. state bank regulator. Bank Holding Companies □ A bank holding company, as defined in section 2 of the Bank Holding Company Act of 1956 (12 U.S.C. 1841), or a savings and loan holding company, as defined in section 10(n) of the Home Owners’ Loan Act (12 U.S.C. 1467a). Commodity Futures Trading Commission (“CFTC”) Exemptions □ A registered entity, commodity pool operator, commodity trading advisor, retail foreign exchange dealer, swap dealer, or major swap participant, each as defined in section 1a of the Commodity Exchange Act, that is registered with the CFTC.

Appendix 3 App 3-3 Securities and Exchange Commission (“SEC”) Exemptions □ An investment company, as defined in section 3 of the Investment Company Act of 1940, that is registered with the SEC under that Act. □ An investment adviser, as defined in the Investment Advisers Act of 1940, that is registered with the SEC under that Act. □ An exchange or clearing agency, as defined in section 3 of the Securities Exchange Act of 1934, that is registered under section 6 or 17A of that Act. □ Any other entity registered with the SEC under the Securities Exchange Act of 1934. Financial Market Utilities □ A financial market utility designated by the Financial Stability Oversight Council under Title VIII of the ▇▇▇▇-▇▇▇▇▇ ▇▇▇▇ Street Reform and Consumer Protection Act of 2010. Public Accounting Firms □ A public accounting firm registered under section 102 of the ▇▇▇▇▇▇▇▇-▇▇▇▇▇ Act. Insurance Companies □ An insurance company regulated by a U.S. state. U.S. Governmental Entity Exemptions □ A department or agency of the United States, of any state, or of any political subdivision of a state □ An entity established under the laws of the United States, of any state, or of any political subdivision of any state, or under an interstate compact between two or more states, that exercises governmental authority on behalf of the United States or any such state or political subdivision. Non-U.S. Entity Exemptions □ A non-U.S. governmental department, agency or political subdivision that engages only in governmental rather than commercial activities. □ A foreign financial institution established in a jurisdiction where the regulator of such institution maintains beneficial ownership information regarding such institution. Pooled Investment Vehicles □ A pooled investment vehicle that is operated or advised by a financial institution excluded under one of the exclusions above. A. Beneficial Owner(s) For Nonprofit and Pooled Investment Vehicles legal entity customers, please skip to Section B (Key Controller) below. Please provide the following information for each individual (natural person), if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 10 percent or more of the equity interests (“Beneficial Owner”) of the legal entity customer listed above. Please Note: If a Trust directly or indirectly owns 10 percent or more of the equity interests of a legal entity customer, the beneficial owner shall mean the trustee and must be provided below. If the trustee is a Corporate Trustee, the Corporate Trustee’s information must be provided below (i.e., full legal entity name, principal

Appendix 3 App 3-4 business address and taxpayer identification number or other government issued identification number for non-US legal entities). ☐ Beneficial Owner Not Applicable (Check this box and skip to Section B (Key Controller) if there is no individual that meets the definition of a Beneficial Owner stated above.) Beneficial Owner 1 INDIVIDUAL NAME STREET ADDRESS DATE OF BIRTH CITY STATE ZIP COUNTRY SSN ONLY COMPLETE IF NO SSN AVAILABLE* GOVERNMENT-ISSUED IDENTIFICATION TYPE IDENTIFICATION NUMBER COUNTRY OF ISSUANCE ISSUANCE DATE EXPIRATION DATE

Appendix 3 App 3-5 Beneficial Owner 2 INDIVIDUAL NAME STREET ADDRESS DATE OF BIRTH CITY STATE ZIP COUNTRY SSN ONLY COMPLETE IF NO SSN AVAILABLE* GOVERNMENT-ISSUED IDENTIFICATION TYPE IDENTIFICATION NUMBER COUNTRY OF ISSUANCE ISSUANCE DATE EXPIRATION DATE Beneficial Owner 3 INDIVIDUAL NAME STREET ADDRESS DATE OF BIRTH CITY STATE ZIP COUNTRY SSN ONLY COMPLETE IF NO SSN AVAILABLE* GOVERNMENT-ISSUED IDENTIFICATION TYPE IDENTIFICATION NUMBER COUNTRY OF ISSUANCE ISSUANCE DATE EXPIRATION DATE

Appendix 3 App 3-6 Beneficial Owner 4 INDIVIDUAL NAME STREET ADDRESS DATE OF BIRTH CITY STATE ZIP COUNTRY SSN ONLY COMPLETE IF NO SSN AVAILABLE* GOVERNMENT-ISSUED IDENTIFICATION TYPE IDENTIFICATION NUMBER COUNTRY OF ISSUANCE ISSUANCE DATE EXPIRATION DATE Beneficial Owner 5 INDIVIDUAL NAME STREET ADDRESS DATE OF BIRTH CITY STATE ZIP COUNTRY SSN ONLY COMPLETE IF NO SSN AVAILABLE* GOVERNMENT-ISSUED IDENTIFICATION TYPE IDENTIFICATION NUMBER COUNTRY OF ISSUANCE ISSUANCE DATE EXPIRATION DATE

Appendix 3 App 3-7 Beneficial Owner 6 INDIVIDUAL NAME STREET ADDRESS DATE OF BIRTH CITY STATE ZIP COUNTRY SSN ONLY COMPLETE IF NO SSN AVAILABLE* GOVERNMENT-ISSUED IDENTIFICATION TYPE IDENTIFICATION NUMBER COUNTRY OF ISSUANCE ISSUANCE DATE EXPIRATION DATE Beneficial Owner 7 INDIVIDUAL NAME STREET ADDRESS DATE OF BIRTH CITY STATE ZIP COUNTRY SSN ONLY COMPLETE IF NO SSN AVAILABLE* GOVERNMENT-ISSUED IDENTIFICATION TYPE IDENTIFICATION NUMBER COUNTRY OF ISSUANCE ISSUANCE DATE EXPIRATION DATE

Appendix 3 App 3-8 Beneficial Owner 8 INDIVIDUAL NAME STREET ADDRESS DATE OF BIRTH CITY STATE ZIP COUNTRY SSN ONLY COMPLETE IF NO SSN AVAILABLE* GOVERNMENT-ISSUED IDENTIFICATION TYPE IDENTIFICATION NUMBER COUNTRY OF ISSUANCE ISSUANCE DATE EXPIRATION DATE Beneficial Owner 9 INDIVIDUAL NAME STREET ADDRESS DATE OF BIRTH CITY STATE ZIP COUNTRY SSN ONLY COMPLETE IF NO SSN AVAILABLE* GOVERNMENT-ISSUED IDENTIFICATION TYPE IDENTIFICATION NUMBER COUNTRY OF ISSUANCE ISSUANCE DATE EXPIRATION DATE

Appendix 3 App 3-9 Beneficial Owner 10 INDIVIDUAL NAME STREET ADDRESS DATE OF BIRTH CITY STATE ZIP COUNTRY SSN ONLY COMPLETE IF NO SSN AVAILABLE* GOVERNMENT-ISSUED IDENTIFICATION TYPE IDENTIFICATION NUMBER COUNTRY OF ISSUANCE ISSUANCE DATE EXPIRATION DATE *Where a social security number is unavailable, Non-U.S. Persons may provide a passport number, an alien identification card number, or number and country of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard. B. Key Controller All legal entities must complete this section. Please provide the following information for one individual (natural person) with significant responsibility to control, manage, or direct the legal entity listed above, such as: • An executive officer or senior manager (e.g., a Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President or Treasurer; with regards to a pooled investment vehicle, a portfolio manager, commodity pool operator, commodity trading advisor, or general partner); or • Any other individual who regularly performs similar functions. (Where applicable, an individual under the Beneficial Owner(s) section above may also serve as a Key Controller and be listed below.)

Appendix 3 App 3-10 Key Controller INDIVIDUAL NAME TITLE/RESPONSIBILITY OF KEY CONTROLLER AT LEGAL ENTITY DATE OF BIRTH STREET ADDRESS CITY STATE ZIP COUNTRY SSN ONLY COMPLETE IF NO SSN AVAILABLE* GOVERNMENT-ISSUED IDENTIFICATION TYPE IDENTIFICATION NUMBER COUNTRY OF ISSUANCE ISSUANCE DATE EXPIRATION DATE Certification I, (name of natural person opening account/ establishing a customer relationship), hereby certify, to the best of my knowledge, that the information provided above is complete and correct. I further agree to inform ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ of any changes to the Beneficial Owner(s) and Key Controller information provided, including if/when an individual becomes a 10 percent or more Beneficial Owner. SIGNATURE DATE LEGAL ENTITY IDENTIFIER (OPTIONAL) *Where a social security number is unavailable, Non-U.S. Persons may provide a passport number, an alien identification card number, or number and country of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard