Text extracted via OCR from the original document. May contain errors from the scanning process.
GLDUS124 BBR Partners
Exhibit E
This exhibit is applicable only to Investors who arc "Plan Investors": (1) U.S. pension or other
employee benefit plans subject to Title I of the Employee Retirement Income Security Act of 1974, as
amended ("ERISA") (such as corporate retirement plans); (2) U.S. plans or accounts subject to Section
4975 of the Internal Revenue Code of 1986, as amended (the "Code") (such as IRAs or Keoghs); (3) entities
deemed to hold "plan assets" of the plans described in the preceding bullets (such as certain hedge funds
that manage ERISA assets); or (4) fiduciaries that otherwise manage or handle the assets of any of the plans
or entities described in Items 1-3. Each Plan Investor hereby represents and warrants as follows:
(Please Check "Yes" or "No" as Applicable)
1.
The Plan Investor is, or is acting on behalf of: (i) an "employee benefit plan" within the
meaning of Section 3(3) of ERISA, that is subject to Title I of ERISA; (ii) a "plan" within
the meaning of Section 4975(eX I) of the Code that is subject to Section 4975 of the Code;
or (iii) any other entity or account that is deemed under applicable law to hold the assets of
a plan described in (i) or (ii).
K
Yes
K
No
2.
The Plan Investor represents that it is, or is acting on behalf of, a person or entity the
underlying assets of which are "plan assets" within the meaning of Section 3(42) of ERISA.
K
Yes.
The Plan Investor holds "plan assets" and the percentage of
interests in the Plan Investor held by benefits plan investors,
determined in accordance with Section 3(42) of ERISA is
%.
K
No.
None of the Plan Investor's assets arc "plan assets" within the
meaning of Section 3(42) of ERISA.
THE PLAN
3.
The Plan Investor is, or is acting on behal f of: (i) a "governmental plan," within the meaning
of Section 3(32) of ERISA; or (ii) a partnership, limited liability company or other entity
in which such a governmental plan holds a majority of the interests or in which a
governmental plan holds an interest sufficient to subject the entity to applicable state or
local law governing governmental plans.
K
Yes
K
No
4.
The Plan Investor is, or is acting on behalf of: (i) a "church plan" within the meaning of
Section 3(33) of ERISA with respect to which no election has been made under
Section 410(d) of the Code; or (ii) a partnership, limited liability company or other entity
in which such a church plan holds a majority of the interests or in which a church plan holds
an interest sufficient to subject the entity to the Ades and policies governing the sponsoring
church.
K
Yes
K
No
PROPRIETARY AND CONFIDEN77AL
E- I
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0096451
CONFIDENTIAL
SDNY GM_00242635
EFTA01391510