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efta-01452237DOJ Data Set 10Other

EFTA01452237

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DOJ Data Set 10
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efta-01452237
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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
SOF III - 1081 Southern Financial LLC INVESTOR QUESTIONNAIRE FOR ENTITIES ENTITIES (non-individuals): Please complete Parts I through VIII of this Questionnaire and then proceed to "Form PF." 1. General Information. A. Investor Contact Information (all fields required). I) Print Full Legal Name of Investor. 2) Legal Form (corporation, partnership, trust, etc.): 3) Primary Contact for All Correspondence: Address: 4) Telephone Number: 5) Facsimile Number: 6) E-mail Address (required): 7) Permanent Address: (if different from above) 8) Tax Identification Number (required): B. Additional Interested Party. In addition to the Primary Contact listed above, correspondence from the Onshore Feeder Fund will also be sent, at the Investor's option, to one additional interested patty (e.g., Investor's financial advisor, accountant, attorney, etc.). Please note that correspondence will only be sent via the online reporting tool. Please provide relevant information listed below if applicable: Name of Interested Party: Telephone Number: E-mail Address: C. Authorized Signatories. Set forth below are the names, titles and roles within the Investor of persons authorized by the Investor to give and receive instructions between the Onshore Feeder Fund (or the Administrator or the Investment Manager) and the Investor, together with their respective signatures. Such persons are the only persons so authorized until further written notice to the Administrator signed by one or more of such persons is received by the Administrator. (Deutsche Bank reserves the right to request other names such as board members, senior management and principals.) Investor Questionnaire - 4 Confidential CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0109153 CONFIDENTIAL SDNY_GM_00255337 EFTA01452237

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