Sponsors And Selling Agents Broker Dealer Statement - New York Department Of Law Page 4

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10. The undersigned constitute all proprietors, officers, directors, members, principals, partners or managers of the registrant.
Each hereby represents that all statements contained herein are true and correct and understands that any false statement
shall constitute a violation of Article 23-A of the General Business Law.
Signatures must be dated, or form will be deemed incomplete.
Signature
Name and Title (Please type or print)
Date
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REF M-10 (06/2016) Page 4 of 4

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