EFTA Document EFTA01386716

GLDUS238 SOUTHERN FINANCIAL LLC Each prospective Investor is required to complete either the column titled "For Individuals" or the column titled "For Entities-. as applicable. I am investing as an: K Individual K Entity I am an Indk aka! H Entity that is a U.S. Person': K Yes K No FOR INDIVIDUALS: FOR ENTITIES: Type of Individual: Type of Entity: State/Province and Country of Residence of Jurisdiction of Organization: Investor for Tax Purposes: Domicile: Social Security No. or