EFTA Document EFTA01372455

Number and Street 1: Number and Street 2: City: State: Country: ZIP+4/Postal Code: If this address is a private residence, check this box: r Yes No 9. (a) If the related person is an investment adviser, is it exempt from registration? (b) If the answer is yes, under what exemption? RELYING ADVISER fi r 10. (a) Is the related person registered with a foreign financial regulatory authority ? (b) If the answer is yes, list the name and country, in English of each foreign financial regu