Form I-924a - Annual Certification Of Regional Center Page 5
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913.
Name of Industry
Part 6. Information About the New Commercial
Enterprise (continued)
NOTE for New Commercial Enterprise Mailing Address: If
If more than one industry is associated with the job creating
the new commercial enterprise mailing address is different from
entity, provide the name for each additional industry category in
the physical address, please provide the physical address of the
the space provided in Part 11. Additional Information.
new commercial enterprise in the space provided in Part 11.
Additional Information.
Mailing Address
Other Information
14.a. In Care Of Name
4.
Name of Industry Receiving Investment Capital From the
New Commercial Enterprise
14.b.
Street Number and
Name or PO Box
14.c.
Apt.
Ste.
Flr.
5.
NAICS Code for the Industry Category
14.d.
City or Town
If more than one industry is receiving investment capital from
14.e.
State
14.f.
ZIP Code
the new commercial enterprise, provide the name and NAICS
code for each additional industry category in the space provided
15.
Aggregate EB-5 Capital Investment
in Part 11. Additional Information.
6.
Aggregate EB-5 Capital Investment
16.
Aggregate Non-EB-5 Capital Investment
7.
Aggregate Non-EB-5 Capital Investment
17.
Aggregate Number of Jobs Created
8.
Aggregate Number of Direct, Indirect, and/or Induced
Jobs Created
18.
Aggregate Number of Jobs Maintained Through
Investment in Troubled Businesses
9.
Aggregate Number of Jobs Maintained Through
Investments in Troubled Businesses
NOTE: If the address in Item Numbers 14.a. - 14.f. of this
section refers to the mailing address of the job creating entity,
please provide the physical address of the new commercial
10.
Does the new commercial enterprise serve as a vehicle for
enterprise in the space provided in Part 11. Additional
investment into other job creating entities that have or
Information.
will create or maintain jobs for EB-5 purposes?
Yes
No
Part 7. Petitions Filed by EB-5 Investors
If you answered “Yes” to Item Number 10., identify the name
Immigrant Petition by Alien Entrepreneur
and address of each job creating entity, its industry, as well as
(Form I-526)
the aggregate capital investment and job creation associated
with each job creating entity.
Provide the total number of approved, denied, and revoked Form
NOTE: Please indicate the number of jobs maintained through
I-526, Immigrant Petition by Alien Entrepreneur, petitions filed
investments in “troubled businesses” separate from aggregate
by EB-5 investors making capital investments in each new
job creation as indicated below.
commercial enterprise associated with the regional center.
Information About the Job Creating Entity
NOTE: If an adverse action was ultimately reversed and the
11.
Entity Name
petition was approved, then list the case as approved.
12.
Job Creating Entity Federal Employer Identification
Number
Form I-924A 12/23/16 N
Page 5 of 9
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