Annual Financial Statement Affidavit

ANNUAL FINANCIAL STATEMENT AFFIDAVIT

This Annual Financial Statement Affidavit (the affidavit) is executed on by Affiant Name: whose principal address is (Affiant), in favor of Recipient Name: located at .

RECITALS

WHEREAS, Affiant is required to deliver a sworn annual financial statement for the fiscal period ending (Fiscal Year) to Recipient to confirm Affiant's financial condition and continued compliance with certain obligations; and

WHEREAS, Recipient has requested and is entitled to rely upon the accuracy of the financial information and supporting documentation provided by Affiant for purposes set forth in the agreement between the parties and for enforcement of rights afforded under applicable law; and

WHEREAS, Affiant has prepared and verified the Annual Financial Statement and accompanying schedules and attachments, which are attached hereto and by this reference incorporated (the Financial Statement).

NOW, THEREFORE

In consideration of the mutual covenants contained herein and other good and valuable consideration, the parties agree as follows:

1. DEFINITIONS

1.1 "Financial Statement" means the sworn statement of assets, liabilities, income and expenses of Affiant for the Fiscal Year, together with all supporting schedules and attachments submitted to Recipient as of the Statement Date: .

2. AFFIANT INFORMATION

Individual Entity Trust

3. FINANCIAL STATEMENT DETAILS

Affiant certifies that the Financial Statement furnished as of the Statement Date accurately and fairly represents Affiant's financial condition in all material respects. The principal amounts set forth below are true, correct and complete as of the Statement Date:

4. REPRESENTATIONS, WARRANTIES AND COVENANTS

4.1 Affiant represents and warrants that: (a) Affiant has the full power and authority to execute and deliver this Affidavit and to perform the obligations herein; (b) the Financial Statement and all schedules provided are prepared in accordance with generally accepted accounting principles consistently applied and present fairly, in all material respects, the financial condition of Affiant as of the Statement Date; and (c) there are no material omissions or misstatements in the Financial Statement.

4.2 Affiant covenants to promptly notify Recipient in writing of any material adverse change in Affiant's financial condition which occurs after the Statement Date and prior to the earlier of (a) the date on which a subsequent duly executed Annual Financial Statement Affidavit is delivered, or (b) termination of the related agreement between the parties. Notification shall be provided in accordance with the Notices provision below.

5. AFFIDAVIT, OATH AND PENALTIES

5.1 Affiant declares under penalty of perjury that the statements contained in the Financial Statement and this Affidavit are true, correct and complete to the best of Affiant's knowledge and belief. Affiant further acknowledges that willful false statements, omissions, or concealment of material facts may subject Affiant to civil and criminal penalties under applicable law.

5.2 Affiant authorizes Recipient and its authorized agents to verify any information provided in the Financial Statement, including obtaining credit reports and requesting verification from accountants, financial institutions and other third parties as necessary to confirm the accuracy of the Financial Statement. Affiant agrees to promptly provide any supporting documentation requested by Recipient, including but not limited to bank statements, tax returns, certified schedules, and audited financial statements.

Tax Returns Bank Statements Audit / Review Report Other

6. USE, CONFIDENTIALITY AND LIMITATIONS

6.1 Recipient may use the Financial Statement only for the purposes expressly authorized in writing by Affiant or as permitted by the underlying agreement between the parties. Recipient shall keep the Financial Statement and supporting documents confidential, except where disclosure is required by law, regulation, or court order, or disclosure to Recipient's professional advisors on a need-to-know basis under confidentiality obligations.

6.2 Nothing in this Affidavit limits Recipient's right to independently investigate or verify the financial condition of Affiant or to rely upon other available information in exercising any remedies permitted by the underlying agreement or applicable law.

7. NOTICES

All notices, requests and other communications under this Affidavit must be in writing and delivered to the addresses set forth below or to such other address as either party may designate by written notice in accordance with this section.

8. AMENDMENT, WAIVER AND COUNTERPARTS

This Affidavit may be amended only by a written instrument executed by both parties. No waiver of any provision shall be effective unless in writing and signed by the party waiving the right. This Affidavit may be executed in counterparts, each of which shall be an original and all of which together shall constitute one instrument.

9. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Affidavit shall be governed by and construed in accordance with the laws of the jurisdiction specified by the parties:

This Affidavit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements and understandings relating thereto. If any provision of this Affidavit is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

10. MISCELLANEOUS

10.1 Remedies provided in this Affidavit are cumulative and in addition to any other remedies available at law or in equity. 10.2 The headings in this Affidavit are for convenience only and shall not affect the interpretation of any provision. 10.3 Affiant agrees to execute such further documents and to take such further actions as may be reasonably necessary to carry out the intent and purpose of this Affidavit.

AFFIDAVIT CERTIFICATION

The undersigned Affiant affirms under penalty of perjury under the laws of the governing jurisdiction that the foregoing representations are true and correct, that the Financial Statement delivered herewith is a complete and accurate statement of Affiant's financial condition as of the Statement Date, and that Affiant understands legal consequences of knowingly making a false declaration.

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