Governmentowned Company And Parastatal Grantee Information Form Page 4
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4ATTACHMENT B
USTDA‐Funded Feasibility Study, Technical Assistance, or Training Grant
Government‐Owned Company and Parastatal
Grantee Information Form
This form shall be completed for each shareholder that owns 15% of more shares in Grantee, as well as any parent corporation of
the Grantee (“Shareholder”). In addition, this form shall be completed for each Shareholder identified in Attachment B that owns
15% or more shares in Shareholder, as well as any parent identified in Attachment B.
USTDA Activity Number [To be completed by USTDA]
Activity Title [To be completed by USTDA]
Full Legal Name of Grantee
Full Legal Name of Shareholder
Business Address of Shareholder (street address
only)
Telephone number
Fax Number
Year Established
(include any predecessor company(s) and year(s) established, if appropriate). Please attach
additional pages as necessary.
Please provide a list of directors and principal officers as detailed in Attachment A. Attached?
Yes
Type of Ownership
Publicly Traded Company
(i.e., offers securities for sale to the general public through a stock exchange)
Private Company
Other
(please specify)
If Shareholder has shareholders, provide a list of
such shareholders and the percentage of their
ownership. In addition, for each shareholder that
owns 15% or more shares in Shareholder, please
complete Attachment B.
Is the Shareholder a wholly‐owned or partially
Yes
owned subsidiary?
No
If so, please provide the name of the Shareholder’s
parent(s). In addition, for any parent identified,
please complete Attachment B.
Shareholder may attach additional sheets, as necessary.
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