Instructions For Application For Regional Center Designation Under The Immigrant Investor Program ( Form I-924) (Page 8 of 14) in pdf

Item Numbers 4. - 11.e. Information About the Owner of the New Commercial Enterprise. List all persons or

entities or organizations that own or have a percentage of ownership in the new commercial enterprise and indicate the

percentage of ownership of each. For persons that hold an ownership interest in the new commercial enterprise, provide

each person’s full legal name, date of birth, country of birth, and the position held within the new commercial enterprise

(if any). For entities or organizations that hold an ownership interest in the new commercial enterprise, also provide the

entity’s legal name, Federal Employer Identification Number, and the name of all persons having ownership, control, or

beneficial interest in that entity or organization. Also, provide the date of birth, country of birth, percentage of ownership,

and the position held (if any) of all persons having ownership, control, or beneficial interest in that entity or organization.

Item Number 12. Date the New Commercial Enterprise Was Established. If the new commercial enterprise has

already been established, provide the date when it was established in mm/dd/yyyy format.

Item Number 13. State or Territory Where the New Commercial Enterprise Was Formed. Indicate the U.S. state or

territory where the new commercial enterprise was formed.

Item Number 14. Documentary Evidence of the New Commercial Enterprise Ownership, Structure, Control and

Administration, and Oversight and Management Functions. Indicate the type of documentation you have submitted to

establish the new commercial enterprise ownership, structure, control and administration, and oversight and management

functions. If there are additional companies, agencies, agents, individuals, or groups that are or will be involved in the

management, oversight and administration of the new commercial enterprise, provide documentary evidence of such

relationships. The list of examples are not exclusive. If you have documentation that is not reflected in the examples

listed, describe and explain the nature of the documentation in Part 10. Additional Information.

Item Number 15. Equity Stake in the New Commercial Enterprise. Indicate whether the regional center or any of

its principals or agents will have an equity stake in the new commercial enterprise. You must submit documentation that

details such equity ownership.

Item Number 16. Fees, Profits, Surcharges and/or Other Remittances. Indicate whether the regional center or

any of its principals, managing companies or agencies, or agents have or will receive fees, profits, surcharges, or other

remittances through EB-5 capital investment activities from the new commercial enterprise or any current or prospective

EB-5 investors. You must submit documentation that describes the remittances and details when and under what

circumstances the remittances will be paid.

Part 7. Statement, Contact Information, Declaration, Certification, and Signature of the Authorized Individual

Item Numbers 1.a. - 8.b. This application must be signed and filed by an authorized individual of the regional center.

An “authorized individual” of the regional center is a principal of the regional center entity with the executive managerial

authority to seek the regional center designation, or amended designation, on behalf of a state or local governmental

agency, or any other existing entity established in the United States and its territories.

Select the appropriate box to indicate whether you read this application yourself or whether you had an interpreter assist

you. If someone assisted you in completing the application, select the box indicating that you used a preparer. Further,

you must sign and date your application and provide your title or position held within the regional center, daytime

telephone number, mobile telephone number (if any), and email address (if any). Every application MUST contain the

signature of the authorized individual. A stamped or typewritten name in place of a signature is not acceptable.

Part 8. Interpreter’s Contact Information, Certification, and Signature

Item Numbers 1.a. - 7.b. If you used anyone as an interpreter to read the Instructions and questions on this application to

you in a language in which you are fluent, the interpreter must fill out this section, provide his or her name, the name and

address of his or her business or organization (if any), his or her daytime telephone number, his or her mobile telephone

number (if any), and his or her email address (if any). The interpreter must sign and date the application.

Form I-924 Instructions 12/23/16 N

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Instructions For Application For Regional Center Designation Under The Immigrant Investor Program ( Form I-924) Page 8