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Accredited Investor Verification Letter
Submission of this letter will assist Encore Energy, Inc. in its verification of your status as an SEC defined “accredited investor” and should be completed by a registered FINRA broker-dealer, an investment adviser, a licensed attorney or a certified public accountant. The “Client” has requested that the undersigned provide Encore Energy, Inc. (the “Company”) with this Accredited Investor Status Certification Letter (this “Certification Letter”) to assist the Company in its verification of Client’s status as an “accredited investor” within the meaning of Rule 501(a) of the Securities Act of 1933, as amended (the “Securities Act”) in connection with Client’s potential purchase of securities (the “Securities”) offered for sale by the Company. The Company will rely upon the accuracy and completeness of the information provided in this Certification Letter in establishing that the issuance of the Securities is exempt from the registration requirements of the Securities Act in accordance with 506(c) of Regulation D of the Securities Act.
For more information regarding this process, Encore Energy, Inc. and to determine if you qualify as an Accredited investor, please contact Joseph Hooper at (270) 842-1242, ext. 224.
* Required Field
[I/We] hereby certify that [I/We] [am/are] (please Check the appropriate box):
Option 1a registered broker-dealer, as described in the Securities Exchange Act of 1934;
an investment adviser registered with the Securities and Exchange
a licensed attorney in good standing under the laws of the jurisdictions in which I am admitted to practice law; or
a certified public accountant in good standing under the laws of the place of my residence or principal office
Based solely on a review of the Client Materials (as described below), [I/we] hereby advise you that Client satisfies one or more of the following criteria (check all boxes that apply):
a natural person whose individual “net worth,” or joint net worth with Client’s spouse, exceeds $1,000,000 (excluding primary residence); or
a natural person who had an individual income in excess of $200,000 in each of the two most-recent years or joint income with Client’s spouse in excess of $300,000 in each of those years.
a charitable organization, corporation, or partnership with assets exceeding $5 million
an entity in which each of the equity owners are accredited investors as described in Rule 501(a) of Regulation D (e.g., each owner qualifies under one of the categories set forth above).
In connection with this Certification Letter, the undersigned has reviewed the original or photocopies of the following documents as supplied by Client (the “Client Materials”). (please check the appropriate box or boxes)
Form 1040 led with the Internal Revenue Service by Client [and[his/her] spouse] for the two most recent years;
Form 1099 led with the Internal Revenue Service by Client [and[his/her] spouse] for the two most recent years;
Schedule K-1 of Form 1065 led with the Internal Revenue Service by Client [and [his/her] spouse] for the two most recent years;
Form W-2 issued by the Internal Revenue Service to Client [and [his/her] spouse] for the two most recent years;
other Internal Revenue Service documents (specify below)
bank statements, brokerage statements and other statements of securities holdings, certificates of deposit, tax assessments, or appraisal reports issued by independent third parties to Client, dated within three months of the date of this Certification Letter;
a consumer or credit report from at least one of the nationwide consumer reporting agencies indicating Client’s liabilities, dated within three months of the date of this Certification Letter;
The certifications in the foregoing are true and correct to the best of my knowledge, information and belief. I have taken reasonable steps to verify that the Investor is an Accredited Investor within the prior (3) three months of the date below and have determined that such Investor is indeed an Accredited Investor.
First and Last
The undersigned, being the Client identified above, by my signature below, hereby represents and warrants that the following statements are true, correct, and complete as of the date of my signature below (the “Certification Date”): • All Client Materials referenced above are true, correct and complete as of the Certification Date; • I have fully and accurately disclosed all liabilities that are required to be included in the calculation of my net worth as described above; and • If I am relying on my income and/or that of my spouse to satisfy the requirements for being an accredited investor, I have a reasonable expectation of reaching individual income in excess of $200,000 or joint income with my spouse in excess of $300,000 in the current year.
I hereby affirm that the foregoing is accurate and complete.
Client Phone Number:
For more information regarding this process, Encore Energy, Inc. and to determine if you qualify as an Accredited investor, please contact Encore Energy at (270) 842 - 1242.
Please list other Internal Revenue Service documents: