Legal Annual Update Form

LEGAL ANNUAL UPDATE FORM

This Legal Annual Update Form (the "Form") is made and entered into as of Effective Date: by and between Company Name: (hereinafter "Company") and Reporting Party Name: (hereinafter "Reporting Party"). The Company and the Reporting Party may be referred to individually as a "Party" and collectively as the "Parties."

RECITALS

WHEREAS, the Company is required by its governing documents and applicable law to provide an annual update of its corporate records, officers, directors, registered agent information, beneficial owners and authorized signatories; and

WHEREAS, the Reporting Party prepares, maintains, or transmits the Company's corporate filings and records and is authorized to receive certifications and updates on behalf of the Company; and

WHEREAS, the Parties desire to record and certify the updates set forth herein as of the Effective Date.

NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties agree as follows:

1. ANNUAL CERTIFICATION

1.1 Certification. The Company hereby certifies that, to the best of its knowledge after reasonable inquiry, the information provided in this Form is true, complete and accurate as of the Effective Date and that the persons listed below are authorized to act on behalf of the Company in accordance with the Company's governing documents.

1.2 Change Declaration. Select one: No changes to report since last annual update Changes reported below

2. CORPORATE INFORMATION

Corporation Limited Liability Company (LLC) Partnership Other:

3. OFFICERS AND DIRECTORS

Provide current officers and directors. Add additional sheet if necessary and attach to this Form.

(If additional officers or directors are to be listed, attach a signed schedule bearing the Company's name and date.)

4. BENEFICIAL OWNERS

List any individual or entity owning, directly or indirectly, five percent (5%) or more of the Company's outstanding ownership interests or exercising significant control.

5. AUTHORIZED SIGNATORIES

List individuals authorized to sign agreements, filings, banking documents and other material instruments on behalf of the Company and specify the scope of authority.

6. COMPLIANCE REPRESENTATIONS

6.1 Legal Compliance. The Company represents and warrants that, as of the Effective Date, it is in compliance with all material federal, state and local laws, regulations and reporting obligations applicable to its business, except as disclosed below.

6.2 Tax Status. The Company further represents that all material tax returns required to be filed by the Company have been filed and all material taxes shown thereon to be due have been paid, except as listed above.

7. NOTICES

All notices, requests or other communications required or permitted under this Form shall be in writing and delivered to the Parties at the following addresses (or as otherwise designated in writing):

8. AMENDMENTS; WAIVER; COUNTERPARTS

8.1 Amendment. This Form may only be amended, supplemented or otherwise modified by a written instrument signed by both Parties.

8.2 Waiver. No waiver of any provision of this Form shall be effective unless in writing and signed by the Party granting the waiver.

8.3 Counterparts. This Form may be executed in one or more counterparts, each of which constitutes an original, and all of which together constitute one instrument. Signatures transmitted electronically shall be binding and deemed original signatures for all purposes.

9. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

9.1 Governing Law. This Form shall be governed by and construed in accordance with the laws of the State of , without regard to its conflict of laws principles.

9.2 Severability. If any provision of this Form is held to be invalid or unenforceable, such provision shall be struck and the remaining provisions shall remain in full force and effect.

9.3 Entire Agreement. This Form, together with any schedules or attachments expressly incorporated herein, constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings and communications, whether written or oral, relating thereto.

10. ATTACHMENTS

List attached schedules or documents provided in support of this Form (e.g., Schedule A — Additional Officers; Schedule B — Beneficial Owners):

11. CERTIFICATION AND SIGNATURES

The undersigned hereby certifies under penalty of perjury that the information contained in this Form and any attachments is true, correct, and complete, and that the signer is duly authorized to execute this Form on behalf of the Party indicated below.

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