Instructions For Annual Certification Of Regional Center (Form I-924a) (Page 3 of 9) in pdf

Part 4. Information About the Organizational Structure, Ownership, and Control of Regional Center Entity

A “principal” is any person or legal entity or organization (for example, a corporation, limited liability company,

partnership, or governmental entity) that is an owner of the regional center entity, that is in a position of executive

managerial authority over the regional center entity, or that is otherwise in a position to control, influence, or direct the

management or policies of the regional center.

Item Numbers 1.a. - 11. Information About the Owners of the Regional Center Entity. For those persons that

hold an ownership interest in the regional center entity, provide each person’s full legal name, date of birth, country of

birth, social security number, the percentage of ownership held in the regional center entity, and the current position/

title held within the regional center entity (if applicable). All such principals are required to provide a copy of a valid

government-issued photo identification document and should provide a social security number. If the principal is an entity

or organization, such as a limited liability company or partnership, provide the entity’s legal name, Federal Employer

Identification Number, and the name of all persons having ownership, control or a 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 a beneficial interest in the entity or organization. For each owner, provide any other

names and aliases used (if applicable), as well as their mailing address, telephone number, email address, and website

address.

Item Numbers 12.a. - 12.i. Mailing Address for the Principal Owner of the Regional Center Entity. Provide the

principal’s mailing address.

Item Numbers 13. - 16. Contact Information for the Principal Owner of the Regional Center Entity. Provide the

principal’s current daytime telephone number, fax number, and email address (if any). Provide the principal’s website

address (if any).

NOTE: If there are multiple principals with ownership interest in the regional center entity, provide the information

requested in the space provided in Part 11. Additional Information.

Item Numbers 17.a. - 26. Information About Principal Non-Owner of the Regional Center Entity. Provide the full

legal name of each person who is a principal of, but does not hold an ownership interest in, the regional center entity,

as well as their date of birth, country of birth, social security number, and their current position/title held within the

regional center entity. All such principals are required to provide a copy of a valid government-issued photo identification

document and should provide a social security number. If the principal is an entity or organization, such as a limited

liability company or partnership, provide the entity’s legal name, Federal Employer Identification Number, and the name

of all persons having ownership, control, or a beneficial interest in that entity or organization. Also provide the date of

birth, country of birth, percentage of ownership interest, and the position held (if any) of all persons having ownership,

control, or a beneficial interest in the entity or organization. For each principal, provide any other names and aliases used

(if applicable), as well as their mailing address, telephone number, email address, and website address.

Item Numbers 27.a. - 27.i. Mailing Address for the Principal Non-Owner of the Regional Center Entity. Provide

the principal non-owner’s mailing address.

Item Numbers 28. - 31. Contact Information for the Principal Non-Owner of the Regional Center Entity. Provide

the principal non-owner’s current daytime telephone number, fax number, email address (if any), and website address (if

any).

NOTE: If there are multiple principal non-owners in the regional center entity, provide the information requested in the

space provided in Part 11. Additional Information.

Part 5. Information About the Regional Center’s Operations

Item Numbers 1. - 4. Aggregate Capital Investment and Job Creation. Provide the following information, in

aggregate, from all sponsored projects:

1. EB-5 investor capital invested through the regional center;

2. Non-EB-5 capital invested through the regional center;

Form I-924A Instructions 12/23/16 N

Page 3 of 9

Instructions For Annual Certification Of Regional Center (Form I-924a) Page 3

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