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FORM ‘C’

[See Section 7 (3) and Section 12]

From of Medical Certificate in respect of an applicant for a Licence to drive any

transport Vehicle or to drive any Vehicle as paid Employee.

To be filled up by a Registered Medical Practitioner.

1) What is the applicant’s apparent age? ______________________________

2) Is the applicant, to the best of your

judgment subject to epilepsy, vertigo

to any mental ailment likely to effect

his efficiency?

______________________________

3) Does the applicant suffer from any

heart or lung disorder which might

interfere with the performance of his

duties as a driver?

______________________________

4) a) Is there any defect of vision? If

so, has it been corrected by

suitable spectacles?

______________________________

b) Does the applicant suffer from

night blindness or colour

blinds?

______________________________

c) Does the applicant suffer from

a degree of deafness which

would prevent his hearing

before ordinary sound signals?

______________________________

5) Has the applicant any deformity or

loss of members which would

interfere with the efficient

performance of his duties as a driver?

______________________________

6) Does he show any evidence of being

addicted to the excessive use of

alcohol, tobacco or drugs?

______________________________

7) Is he, in your opinion, generally fit as

regards

a) Bodily heath, and b) eye-sight?

______________________________

8) Marks of identification? ______________________________

I certify that to the best of my knowledge and belief the applicant _____________

is the person herein above described and at the attached photographs is reasonably correct

likeness.

Signature ______________________________

Name ______________________________

Designation ______________________________

Note: Special attention should be direct to distant vision and to the condition of the arm

and hands and the joints of both extremities.

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

OMB APPROVAL

OMB Number: 3235-0716

Expires: May 31, 2024

Estimated average burden

hours per response . .. . .49.96

Washington, D.C. 20549

FORM C

UNDER THE SECURITIES ACT OF 1933

(Mark one.)

􀆑 Form C: Offering Statem ent

􀆑 Form C-U: Prog ress Update: _____________________________________________________

􀆑 Form C/A: Am endm ent to Offering Statem ent: ______________________________________

􀆑 Check box if Am endm ent is m aterial and investors m ust reconfirm within five business days.

􀆑 Form C-AR: Annual Report

􀆑 Form C-AR/A: Am endm ent to Annual Report

􀆑 Form C-TR: Term ination of Reporting

Nam e of             issuer: _____________________________________________________________________

Leg al    status of              issuer:

Form :   __________________________________

Jurisdiction of   Incorporation/Org anization:     _________________________________________

Date of                org anization): __________________________________________________________

Physical               address of          issuer:                 ____________________________________________________________

Website of         issuer:                  ___________________________________________________________________

Is there a co-issuer? ___ yes ___ no. If                yes,

Nam e of             co-issuer:            _________________________________________________

Leg al    status of              co-issuer:           

Form :   ______________________________________________________

Jurisdiction of   Incorporation/Org anization:     _________________________

Date of                org anization:    ___________________________________________

Physical               address of          co-issuer:            __________________________________________

Website of         co-issuer:            _________________________________________________

Nam e of             interm ediary throug h which the offering          wil l        be conducted: ___________________________

CIK num ber of                 interm ediary:                  _______________________

SEC fil e num ber of        interm ediary:                                  ___________________

CRD num ber, if               appl icabl e, of interm ediary:                  ___________________

Am ount of        com pensation to be paid to the interm ediary, whether as a dol l ar am ount or a percentag e of          the offering

                am ount, or a    g ood f aith estim ate if                the ex act am ount is not avail abl e at the tim e of         the fil ing , f or conducting        

the offering , incl uding                the am ount of                 ref erral               and any other f ees associated with the offering :

Any other direct or indirect interest in the issuer hel d by the interm ediary, or any arrang em ent f or the interm ediary

to acquire such an interest:

Type of                security offered:             _______________________________________________________________

SEC 2930 (3/21) Persons who are to respond to the collection of information contained in this form are not 1

required to respond unless the form displays a currently valid OMB control number.

                                                                               

                                                                               

                                                                               

                               

                                                                                                                                               

                                                                                                                                                                                              

                                                                                                                               

Targ et num ber of         securities to be offered:              __________________________________________________

Price (or m ethod f or determ ining        price):   ___________________________________________________

Targ et offering                am ount:             ________________________________________________________________

Oversubscriptions accepted:     􀆑 Yes 􀆑 No

If             yes, discl ose how oversubscriptions wil l            be al l ocated:   􀆑 Pro-rata basis 􀆑 First-com e, first-served basis

􀆑 Other – provide a description: _________________________________________________________

Max im um         offering               am ount (if         different f rom                 targ et offering                am ount):                 ____________________________

Deadl ine to reach the targ et offering am ount:             ________________________________________________

NOTE: If the sum of the investment commitments does not equal or exceed the target offering

amount at the offering deadline, no securities will be sold in the offering, investment commitments

will be cancelled and committed funds will be returned.

Current num ber of        em pl oyees:                     __________________________________________________________

Total      Assets:                  Most recent fiscal          year-end:           ____     Prior fiscal          year-end:           ____

Cash & Cash Equival ents:            Most recent fiscal          year-end:           ____ Prior fiscal               year-end:           ____

Accounts Receivabl e:    Most recent fiscal          year-end:           ____     Prior fiscal          year-end:           ____

Short-term         Debt:     Most recent fiscal          year-end:           ____     Prior fiscal          year-end:           ____

Long -term         Debt:     Most recent fiscal          year-end:           ____     Prior fiscal          year-end:           ____

Revenues/Sal es Most recent fiscal        year-end:           ____     Prior fiscal          year-end:           ____

Cost of                 Goods Sol d:       Most recent fiscal          year-end:           ____     Prior fiscal          year-end:           ____

Tax es Paid:         Most recent fiscal          year-end:           ____     Prior fiscal          year-end:           ____

Net Incom e:      Most recent fiscal          year-end:           ____     Prior fiscal          year-end:           ____

Using    the l ist bel ow, sel ect the jurisdictions in which the issuer intends to offer the securities:

[List will include all U.S. jurisdictions, with an option to add and remove them

individually, add all and remove all.]

GENERAL INSTRUCTIONS

I. Eligibility Requirements for Use of Form C

This Form            shal l      be used f or the offering             statem ent, and any rel ated am endm ents and prog ress reports,

required to be fil ed by any issuer offering         or sel l ing           securities in rel iance on the ex em ption in Securities Act

Section 4(a)(6) and in accordance with Section 4A and Reg ul ation Crowdf unding         (§ 227.100 et seq.). The term   

“issuer” incl udes any co-issuer jointl y offering               or sel l ing           securities with an issuer in rel iance on the ex em ption

in Securities Act Section 4(a)(6) and in accordance with Securities Act Section 4A and Reg ul ation Crowdf unding

                (§ 227.100 et seq.) This Form     al so shal l           be used f or an annual report required pursuant to Rul e 202 of                

Reg ul ation Crowdf unding        (§ 227.202) and f or the term ination of                reporting            required pursuant to Rul e 203(b)(2)

of           Reg ul ation Crowdf unding        (§ 227.203(b)(2)). Caref ul           attention shoul d be directed to the term s, conditions

and requirem ents of    the ex em ption.

II. Preparation and Filing of Form C

Inf orm ation on the cover pag e wil l     be          g enerated based on the inf orm ation provided in XML f orm at.

Other than the cover pag e, this Form is not to be used as a bl ank       f orm     to be fil l ed in, but onl y as a      g uide in the

preparation of Form     C. General          inf orm ation reg arding               the preparation, f orm at and how to fil e this Form                 is contained

in Reg ul ation S-T (§ 232 et seq.).

2

                                                                                                                                                                                                                                               

                                                                                                                                                                                                                               

                                                                                                                               

                                                                               

III. Information to be Included in the Form

Item 1. Offering Statement Disclosure Requirements

An issuer fil ing                 this Form            f or an offering                 in rel iance on Section 4(a)(6) of              the Securities Act and pursuant

to Reg ul ation Crowdf unding   (§ 227.100 et seq.) m ust fil e the Form                prior to the com m encem ent of            the offering

                and incl ude the inf orm ation required by Rul e 201 of                 Reg ul ation Crowdf unding        (§ 227.201).

An issuer m ust incl ude in the XML-based portion of    this Form :          the inf orm ation required by parag raphs

(a),(e), (g ), (h), (l ), (n), and (o) of          Rul e 201 of        Reg ul ation Crowdf unding        (§ 227.201(a), (e), (g ), (h), (l ), (n),

and (o)); sel ected financial        data f or the prior two fiscal       years (incl uding              total      assets, cash and cash equival ents,

accounts receivabl e, short-term             debt, l ong -term             debt, revenues/sal es, cost of g oods sol d, tax es paid and net incom

e); the jurisdictions in which the issuer intends to offer the securities; and any inf orm ation required by Rul e

203(a)(3) of        Reg ul ation Crowdf unding        (§ 227.203(a)(3)).

Other than the inf orm ation required to be provided in XML f orm at, an issuer m ay provide the required

inf orm ation in the optional      Question and Answer f orm at incl uded herein or in any other f orm at incl uded on the

interm ediary’s pl atf orm , by fil ing       such inf orm ation as an ex hibit to this Form , incl uding              copies of             screen shots

of           the rel evant inf orm ation, as appropriate and necessary.

If             discl osure in response to any parag raph of      Rul e 201 of        Reg ul ation Crowdf unding        (§ 227.201) or

Rul e 203(a)(3) is responsive to one or m ore other parag raphs of         Rul e 201 of        Reg ul ation Crowdf unding       

227.201) or to Rul e 203(a)(3) of               Reg ul ation Crowdf unding        (§ 227.203(a)(3)), issuers are not required to m ak e

dupl icate discl osures.

Item 2. Legends

(a) An issuer fil ing          this Form            f or an offering                 in rel iance on Section 4(a)(6) of              the Securities Act and

pursuant to Reg ul ation Crowdf unding               (§ 227.100 et seq.) m ust incl ude the f ol l owing             l eg ends:

A crowdf unding              investm ent invol ves risk . You shoul d not invest any f unds in this offering     unl ess you

can afford to l ose your entire investm ent.

In m ak ing          an investm ent decision, investors m ust rel y on their own ex am ination of     the issuer and the

term s of             the offering , incl uding                the m erits and risk s invol ved. These securities have not been recom m ended or

approved by any f ederal            or state securities com m ission or reg ul atory authority. Furtherm ore, these

authorities have not passed upon the accuracy or adequacy of               this docum ent.

The U.S. Securities and Ex chang e Com m ission does not pass upon the m erits of       any securities offered

or the term s of               the offering , nor does it pass upon the accuracy or com pl eteness of                 any offering       docum ent or

l iterature.

These securities are offered under an ex em ption f rom            reg istration; however, the U.S. Securities and

Ex chang e Com m ission has not m ade an independent determ ination that these securities are ex em pt f rom

reg istration.

(b) An issuer fil ing          this Form            f or an offering                 in rel iance on Section 4(a)(6) of              the Securities Act and

pursuant to Reg ul ation Crowdf unding               (§ 227.100 et seq.) m ust discl ose in the offering            statem ent that it wil l                 fil e

a report with the Com m ission annual l y and post the report on its website, no l ater than 120 days af ter the end of                

each fiscal           year covered by the report. The issuer m ust al so discl ose how an issuer m ay term inate its reporting                

obl ig ations in the f uture in accordance with Rul e 202(b) of     Reg ul ation Crowdf unding        (§ 227.202(b)).

Item 3. Annual Report Disclosure Requirements

3

                                                                                                                                                                                                               

                                                                                                                                                                                                                                                                                                

                                                                                                                                                                                                                                                                                                                                                

                 

An issuer fil ing                 this Form            f or an annual    report, as required by Reg ul ation Crowdf unding          (§ 227.100

et seq.), m ust fil e the Form     no l ater than 120 days af ter the issuer’s fiscal                 year end covered by the report and

incl ude the inf orm ation required by Rul e 201(a), (b), (c), (d), (e), (f ), (m ), (p), (q), (r), (s), (t), (x ) and (y) of

Reg ul ation Crowdf unding        (§§ 227.201(a), (b), (c), (d), (e), (f ), (m ), (p), (q), (r), (s), (t), (x ) and (y)). For purposes

of           parag raph (t), the issuer shal l provide financial              statem ents certified by the principal    ex ecutive officer of                

the issuer to be true and com pl ete in al l           m aterial              respects. If , however, the issuer has avail abl e financial                 statem

ents prepared in accordance with U.S. g eneral l y accepted accounting              principl es (U.S. GAAP) that have been

reviewed or audited by an independent certified publ ic accountant, those financial    statem ents m ust be provided

and the principal             ex ecutive officer certification wil l         not be required.

An issuer m ust incl ude in the XML-based portion of    this Form :          the inf orm ation required by parag raphs

(a), and (e) of   Rul e 201 of        Reg ul ation Crowdf unding        (§ 227.201(a) and (e)); and sel ected financial   data f or the

prior two fiscal years (incl uding              total      assets, cash and cash equival ents, accounts receivabl e, short-term     debt,

l ong -term         debt, revenues/sal es, cost of g oods sol d, tax es paid and net incom e).

SIGNATURE

Pursuant to the requirem ents of           Sections 4(a)(6) and 4A of           the Securities Act of      1933 and Reg ul ation

Crowdf unding                 (§ 227.100 et seq.), the issuer certifies that it has reasonabl e   g rounds to bel ieve that it m eets al l                

of           the requirem ents f or fil ing      on Form              C and has dul y caused this Form             to be sig ned on its behal f                 by the dul y

authorized undersig ned.

                                                                                                                                                                 (Issuer)

                                                                                                                                                                 By

(Sig nature and Titl e)

Pursuant to the requirem ents of           Sections 4(a)(6) and 4A of           the Securities Act of      1933 and Reg ul ation

Crowdf unding                 (§ 227.100 et seq.), this Form    C has been sig ned by the f ol l owing    persons in the capacities and

on the dates indicated.

(Sig nature)

                                                                                                                                                                 (Titl e)

                                                                                                                                                                 (Date)

Instructions.

1. The f orm       shal l      be sig ned by the issuer, its principal      ex ecutive officer or officers, its principal            financial                 officer,

its control l er or principal            accounting         officer and at l east a m ajority of            the board of      directors or persons perf orm -

ing          sim il ar f unctions. If      there is a co-issuer, the f orm   shal l      al so be sig ned by the co-issuer, its principal     ex ecutive

officer or officers, its principal   financial               officer, its control l er or principal            accounting         officer and at l east a

m ajority of        the board of      directors or persons perf orm ing            sim il ar f unctions.

4

                                                                                                                                                                               

                                                                                                                               

                                                                                                                                                                                                                                                                                               

                                                                                                                                                                                                                                                                                               

                                                                                                                                                                                                                                                                                                               

                                                                                                                                                                                                                                                                                                

                                                                                                                                                                                                                                                                               

                                                                                                                                                                                                                               

                                                                                                                                                                                                 

2. The nam e of                each person sig ning      the f orm            shal l      be typed or printed beneath the sig nature.

Intentional         m isstatem ents or om issions of             f acts constitute f ederal              crim inal               viol ations. See 18 U.S.C. 1001.

OPTIONAL QUESTION & ANSWER FORMAT

FOR AN OFFERING STATEMENT

Respond to each question in each parag raph of             this part. Set f orth each question and any notes, but not

any instructions thereto, in their entirety. If      discl osure in response to any question is responsive to one or m ore

other questions, it is not necessary to repeat the discl osure. If               a question or series of questions is inappl icabl e or

the response is avail abl e el sewhere in the Form , either State that it is inappl icabl e, incl ude a cross-ref erence to

the responsive discl osure, or om it the question or series of    questions. The term      “issuer” in these questions and

answers incl udes any “co-issuer” jointl y offering          or sel l ing           securities with the issuer in rel iance on the ex em ption

in Securities Act Section 4(a)(6) and in accordance with Securities Act Section 4A and Reg ul ation Crowdf

unding (§ 227.100 et seq.). Any inf orm ation provided with respect to the issuer shoul d al so be separatel y

provided with respect to any co-issuer.

If             you are seek ing              to rel y on the Com m ission’s tem porary rul es to initiate an offering between May 4, 2020, and

February 28, 2021, intended to be conducted on an ex pedited basis due to circum stances rel ating                    to coronavirus

disease 2019 (COVID-19), you wil l          l ik el y need to provide additional          or different inf orm ation than described in

questions 2, 12, and 29. If           you are seek ing              to rel y on the Com m ission’s tem porary Rul e 201(bb) f or an offering              

initiated between March 1, 2021, and Aug ust 28, 2022, you wil l             l ik el y need to provide additional          or different

inf orm ation than described in questions 2 and 29. When preparing     responses to such questions, pl ease caref ul l y

review tem porary Rul es 100(b)(7), 201(aa), 201(bb), and 304(e) and tail or your responses to those requirem ents

as appl icabl e.

Be very caref ul                and precise in answering             al l          questions. Give f ul l      and com pl ete answers so that they are not

m isl eading        under the circum stances invol ved. Do not discuss any f uture perf orm ance or other anticipated event

unl ess you have a reasonabl e basis to bel ieve that it wil l         actual l y occur within the f oreseeabl e f uture. If           any

answer requiring             sig nificant inf orm ation is m aterial l y inaccurate, incom pl ete or m isl eading , the Com pany, its

m anag em ent and principal      sharehol ders m ay be l iabl e to investors based on that inf orm ation.

THE COMPANY

1. Nam e of        issuer: _______________________________________________________________

ELIGIBILITY

2. 􀆑 Check this box to certif y that al l of the f ol l owing statem ents are true f or the issuer:

• Org anized under, and subject to, the l aws of              a State or territory of    the United States or the District of        

Col um bia.

• Not subject to the requirem ent to fil e reports pursuant to Section 13 or Section 15(d) of     the Securities

Ex chang e Act of             1934.

• Not an investm ent com pany reg istered or required to be reg istered under the Investm ent Com pany Act

of           1940.

5

                                                                                                                                                                                                                                                                                

                                                                                                                                                               

                                                                                                               

                                                                                                                                                                                                                               

                                                                                                                               

                                                                                                                                                                                                               

• Not inel ig ibl e to rel y on this ex em ption under Section 4(a)(6) of   the Securities Act as a resul t of               a disqual

ification specified in Rul e 503(a) of        Reg ul ation Crowdf unding . (For m ore inf orm ation about these

disqual ifications, see Question 30 of     this Question and Answer f orm at).

• Has fil ed with the Com m ission and provided to investors, to the ex tent required, the ong oing      annual

reports required by Reg ul ation Crowdf unding              during   the two years im m ediatel y preceding               the fil ing                

of           this offering       statem ent (or f or such shorter period that the issuer was required to fil e such reports).

• Not a devel opm ent stag e com pany that (a) has no specific business pl an or (b) has indicated that its

business pl an is to eng ag e in a m erg er or acquisition with an unidentified com pany or com panies.

INSTRUCTION TO QUESTION 2: If any of these statements is not true, then you are NOT eligible to

rely on this exemption under Section 4(a)(6) of the Securities Act.

3. Has the issuer or any of           its predecessors previousl y f ail ed to com pl y with the ong oing           reporting

requirem ents of             Rul e 202 of        Reg ul ation Crowdf unding ? 􀆑 Yes 􀆑 No

Ex pl ain:              _______________________________________________________________________

DIRECTORS OF THE COMPANY

4. Provide the f ol l owing            inf orm ation about each director (and any persons occupying                 a sim il ar

status or perf orm ing   a sim il ar f unction) of   the issuer:

Nam e:                 _______________________________           Dates of             Board Service: _______________

Principal              Occupation:       _____________________________________________________

Em pl oyer:         Dates of              Service:               ________________________________________________

Em pl oyer’s principal    business:                                            _____________________________________________

List al l   positions and offices with the issuer hel d and the period of     tim e in which the director

served in the position or office:

Position:              ________________________________________ Dates of                Service:               _______________

Position:              ________________________________________ Dates of                Service:               _______________

Position:              ________________________________________ Dates of                Service:               _______________

Business Ex perience:   List the em pl oyers, titl es and dates of               positions hel d during    past three

years with an indication of          job responsibil ities:

Em pl oyer:         _____________________________________________________________________

Em pl oyer’s principal    business:                            ____________________________________________________

Titl e:     ___________________________________________ Dates of        Service:                                               ______________

Responsibil ities:                                             _______________________________________________________________

Em pl oyer:         _____________________________________________________________________

Em pl oyer’s principal    business:                            ____________________________________________________

Titl e:     ___________________________________________ Dates of        Service:                                               ______________

Responsibil ities:                                             _______________________________________________________________

Em pl oyer:         _____________________________________________________________________

6

                                                                                                                                                                                               

Em pl oyer’s principal    business:                            ____________________________________________________

Titl e:     ___________________________________________ Dates of        Service:                                               ______________

Responsibil ities:                                             _______________________________________________________________

OFFICERS OF THE COMPANY

5. Provide the f ol l owing            inf orm ation about each officer (and any persons occupying    a sim il ar status

or perf orm ing                 a sim il ar f unction) of   the issuer:

Nam e:                 ______________________________________________________________________________

Titl e:     __________________________________________________ Dates of     Service:                ______________

Responsibil ities:             ______________________________________________________________________

List any prior positions and offices with the issuer and the period of     tim e in which the officer

served in the position or office:

Position:              ________________________________________________ Dates of           Service:               __________

Responsibil ities:                             _____________________________________________________________________

Position:              ________________________________________________ Dates of           Service:               __________               

Responsibil ities:                             ________________________________________________________________

Position:              ________________________________________________ Dates of           Service:               __________               

Responsibil ities:                             ________________________________________________________________

Business Ex perience:   List any other em pl oyers, titl es and dates of positions hel d during    past three years with an

indication of      job responsibil ities:

Em pl oyer:         _____________________________________________________________________

Em pl oyer’s principal    business:                            ____________________________________________________

Titl e:     ___________________________________________ Dates of        Service:                                               ______________

Responsibil ities:                                             _______________________________________________________________

Em pl oyer:         _____________________________________________________________________

Em pl oyer’s principal    business:                            ____________________________________________________

Titl e:     ___________________________________________ Dates of        Service:                                               ______________

Responsibil ities:                                             _______________________________________________________________

Em pl oyer:         _____________________________________________________________________

Em pl oyer’s principal    business:                            ____________________________________________________

Titl e:     ___________________________________________ Dates of        Service:                                               ______________

Responsibil ities:                                             _______________________________________________________________

INSTRUCTION TO QUESTION 5:                For purposes of               this Question 5, the term            officer m eans a president, vice

president, secretary, treasurer or principal        financial               officer, com ptrol l er or principal             accounting                 officer, and any

person routinel y perf orm ing sim il ar f unctions.

PRINCIPAL SECURITY HOLDERS

6. Provide the nam e and ownership l evel         of           each person, as of          the m ost recent practicabl e date, who

                                                                                                                               

is the beneficial               owner of             20 percent or m ore of the issuer’s outstanding              voting   equity securities,

cal cul ated on the basis of          voting   power.

                                                                                                                                                                            % of Voting

No. and Cl ass of Power Prior to              

Nam e of             Hol der Securities Now Hel d    Offering

-----------------------------              --------------------------------        ------------------               

___________________ _____________________  ______________%

___________________ _____________________  ______________%

___________________ _____________________  ______________%

___________________ _____________________  ______________%

INSTRUCTION TO QUESTION 6:                The above inf orm ation m ust be provided as of             a date that is no m ore than

120 days prior to the date of      fil ing     of           this offering       statem ent.

To cal cul ate total           voting   power, incl ude al l         securities f or which the person directl y or indirectl y has or shares the

voting   power, which incl udes the power to vote or to direct the voting            of           such securities. If            the person has the

rig ht to acquire voting power of             such securities within 60 days, incl uding             throug h the ex ercise of             any option,

warrant or rig ht, the conversion of        a security, or other arrang em ent, or if                securities are hel d by a m em ber of                 the

f am il y, throug h corporations or partnerships, or otherwise in a m anner that woul d al l ow a person to direct or

control                 the voting           of           the securities (or share in such direction or control        — as, f or ex am pl e, a co-trustee) they

shoul d be incl uded as being     “beneficial l y owned.” You shoul d incl ude an ex pl anation of                these circum stances in

a f ootnote to the “Num ber of                and Cl ass of      Securities Now Hel d.” To cal cul ate outstanding             voting   equity securities,

assum e al l        outstanding       options are ex ercised and al l   outstanding       convertibl e securities converted.

BUSINESS AND ANTICIPATED BUSINESS PLAN

7. Describe in detail        the business of                the issuer and the anticipated business pl an of               the issuer.

RISK FACTORS

A crowdfunding investment involves risk. You should not invest any funds in this offering unless you can

afford to lose your entire investment.

In making an investment decision, investors must rely on their own examination of the issuer and the

terms of the offering, including the merits and risks involved. These securities have not been recommended

or approved by any federal or state securities commission or regulatory authority. Furthermore, these

authorities have not passed upon the accuracy or adequacy of this document.

The U.S. Securities and Exchange Commission does not pass upon the merits of any securities offered or

the terms of the offering, nor does it pass upon the accuracy or completeness of any offering document or

literature.

These securities are offered under an exemption from registration; however, the U.S. Securities and Exchange

Commission has not made an independent determination that these securities are exempt from

registration.

8. Discuss the m aterial                 f actors that m ak e an investm ent in the issuer specul ative or risk y:

8

                                                                                                                                                                                               

                                                                                                                                                                                                 

 

INSTRUCTION TO QUESTION 8:                Avoid    g eneral ized statem ents and incl ude onl y those f actors that are unique

to the issuer. Discussion shoul d be tail ored to the issuer’s business and the offering and shoul d not repeat the

f actors addressed in the l eg ends set f orth above. No specific num ber of      risk         f actors is required to be identified.

Add additional l ines and num ber as appropriate.

THE OFFERING

9. What is the purpose of            this offering ?

10. How does the issuer intend to use the proceeds of                this offering ?

If             Targ et If             Max im um

Offering              Am ount Am ount Sol d

                                                                                                                                 Sol d

Total      Proceeds $ $

Less:      Offering              Ex penses

(A)

(B)

(C)

Net Proceeds $ $

Use of Net Proceeds

(A)

(B)

(C)

Total      Use of Net Proceeds $ $

INSTRUCTION TO QUESTION 10:              An issuer m ust provide a reasonabl y detail ed description of any intended

use of   proceeds, such that investors are provided with an adequate am ount of          inf orm ation to understand how the

offering               proceeds wil l    be used. If          an issuer has identified a rang e of         possibl e uses, the issuer shoul d identif y and

describe each probabl e use and the f actors the issuer m ay consider in al l ocating      proceeds am ong            the potential                

uses. If                 the issuer wil l   accept proceeds in ex cess of    the targ et offering        am ount, the issuer m ust describe the purpose,

m ethod f or al l ocating               oversubscriptions, and intended use of               the ex cess proceeds with sim il ar specificity.

                                                                                                                                              

                                                                                                                                                                               

11. (a) Did the issuer m ak e use of         any written com m unication or broadcast script f or testing      the waters

either (i) under the authorization of      Rul e 241 within 30 days of          the initial             fil ing     of           the offering       statem ent, or (ii)

under the authorization of         Rul e 206? If       so, provide copies of     the m aterial s used.

(b) How wil l      the issuer com pl ete the transaction and del iver securities to the investors?

12. How can an investor cancel                 an investm ent com m itm ent?

NOTE: Investors may cancel an investment commitment until 48 hours prior to the deadline

identified in these offering materials.

The intermediary will notify investors when the target offering amount has been met.

If the issuer reaches the target offering amount prior to the deadline identified in the

offering materials, it may close the offering early if it provides notice about the new

offering deadline at least five business days prior to such new offering deadline (absent a

material change that would require an extension of the offering and reconfirmation of the

investment commitment).

If an investor does not cancel an investment commitment before the 48-hour period prior to

the offering deadline, the funds will be released to the issuer upon closing of the offering

and the investor will receive securities in exchange for his or her investment.

If an investor does not reconfirm his or her investment commitment after a material change

is made to the offering, the investor’s investment commitment will be cancelled and the

committed funds will be returned.

OWNERSHIP AND CAPITAL STRUCTURE

The Offering

13. Describe the term s of           the securities being       offered.

14. Do the securities offered have voting            rig hts? 􀆑 Yes 􀆑 No

15. Are there any l im itations on any voting       or other rig hts identified above? 􀆑 Yes 􀆑 No

Ex pl ain: _________________________________________________________________________

16. How m ay the term s of        the securities being       offered be m odified?

Restrictions on Transfer of the Securities Being Offered

The securities being       offered m ay not be transf erred by any purchaser of   such securities during   the one year

period beg inning            when the securities were issued, unl ess such securities are transf erred:

(1) to the issuer;

(2) to an accredited investor;

(3) as part of      an offering         reg istered with the U.S. Securities and Ex chang e Com m ission; or

(4) to a m em ber of       the f am il y of   the purchaser or the equival ent, to a trust control l ed by the

purchaser, to a trust created f or the benefit of               a m em ber of   the f am il y of   the purchaser or

the equival ent, or in connection with the death or divorce of the purchaser or other

sim il ar circum stance.

10

                                                                                                                                                                                               

                                                                                                                               

                                                                                              

                                                                                                                                              

                                                                                                                                                            

                                                               

               

NOTE: The term “accredited investor” means any person who comes within any of

the categories set forth in Rule 501(a) of Regulation D, or who the seller reasonably

believes comes within any of such categories, at the time of the sale of the securities

to that person.

The term “member of the family of the purchaser or the equivalent” includes a

child, stepchild, grandchild, parent, stepparent, grandparent, spouse or spousal

equivalent, sibling, mother-in-law, father-in-law, son-in-law, daughter-in-law,

brother-in-law, or sister-in-law of the purchaser, and includes adoptive

relationships. The term “spousal equivalent” means a cohabitant occupying a

relationship generally equivalent to that of a spouse.

Description of Issuer’s Securities

17. What other securities or cl asses of                 securities of       the issuer are outstanding ? Describe the m aterial

term s of             any other outstanding securities or cl asses of                 securities of       the issuer.

Securities Securities

(or Am ount) (or Am ount)

Cl ass of               Security Authorized Outstanding             Voting                 Rig hts Other Rig hts

-----------------------         ---------------     ---------------     ------------------                ---------------------

Pref erred Stock              (l ist

each cl ass in order of

pref erence):

___________________            􀆑 Yes 􀆑 No 􀆑     Yes 􀆑 No

Specif y:              ________

___________________            􀆑 Yes 􀆑 No 􀆑     Yes 􀆑 No

Specif y:              ________

Com m on Stock :             􀆑 Yes 􀆑 No 􀆑     Yes 􀆑 No

Specif y:              ________

Debt Securities:                􀆑 Yes 􀆑 No 􀆑     Yes 􀆑 No

Specif y:              ________

Other:

___________________            􀆑 Yes 􀆑 No 􀆑     Yes 􀆑 No

Specif y:              ________

___________________            􀆑 Yes 􀆑 No 􀆑     Yes 􀆑 No

Specif y:              ________

Securities

Reserved for

Issuance

upon

Exercise or

Class of Security Conversion

-----------------------         -------------------------

Warrants:

Options: 11

                                                                                                                                                                                                               

                                                                               

                                                                                                                                                                                                                               

                                                               

                                                                                                                                                                                                                                                                                

Other Rig hts:

18. How m ay the rig hts of         the securities being       offered be m aterial l y l im ited, dil uted or qual ified by the rig hts of                

any other cl ass of           security identified above?

19. Are there any differences not reflected above between the securities being           offered and each other

cl ass of                security of          the issuer? 􀆑 Yes 􀆑 No

Ex pl ain:              __________________________________________________________________________

20. How coul d the ex ercise of                 rig hts hel d by the principal       sharehol ders identified in Question 6 above affect the

purchasers of    the securities being       offered?

21. How are the securities being              offered being   val ued? Incl ude ex am pl es of               m ethods f or how such securities

m ay be val ued by the issuer in the f uture, incl uding during   subsequent corporate actions.

22. What are the risk s to purchasers of               the securities rel ating to m inority ownership in the issuer?

23. What are the risk s to purchasers associated with corporate actions incl uding :

• additional        issuances of       securities,

• issuer repurchases of                securities,

• a sal e of          the issuer or of                assets of             the issuer or

• transactions with rel ated parties?

24. Describe the m aterial           term s of             any indebtedness of     the issuer:

Am ount

Creditor(s)         Outstanding      Interest Rate Maturity Date      Other Material                Term s

--------------------              ----------------    ----------------    -------------------              ---------------------------

$ _________ __________%

$ _________ __________%

$ _________ __________%

25. What other ex em pt offering s has the issuer conducted within the past three years?

Date of                 Ex em ption

Offering               Rel ied Upon Securities Offered Am ount Sol d Use of                 Proceeds

------------           ----------------    ----------------------         ------------------                ---------------------

$ _________

$ _________

$ _________

26. Was or is the issuer or any entities control l ed by or under com m on control            with the issuer a party

to any transaction since the beg inning                of           the issuer’s l ast fiscal    year, or any currentl y proposed transaction,

where the am ount invol ved ex ceeds five percent of                 the ag g reg ate am ount of        capital   raised by the issuer in rel iance

on Section 4(a)(6) of      the Securities Act during             the preceding   12-m onth period, incl uding      the am ount the

issuer seek s to raise in the current offering , in which any of    the f ol l owing persons had or is to have a direct or

indirect m aterial             interest:

12

                                                                                                               

                                                                                                                                                                                                                                                                                               

                                                                                                                               

                               

(1) any director or officer of       the issuer;

(2) any person who is, as of       the m ost recent practicabl e date, the beneficial            owner of             20 percent or m ore

of           the issuer’s outstanding              voting   equity securities, cal cul ated on the basis of     voting   power;

(3) if      the issuer was incorporated or org anized within the past three years, any prom oter of            the issuer; or

(4) any im m ediate f am il y m em ber of             any of   the f oreg oing persons.

If             yes, f or each such transaction, discl ose the f ol l owing :

Rel ationship to Nature of           Interest Am ount of

Specified Person Issuer in Transaction Interest

---------------------            -------------------              ---------------------           -------------------             

$ _________

$ _________

$ _________

INSTRUCTIONS TO QUESTION 26:

The term             transaction incl udes, but is not l im ited to, any financial             transaction, arrang em ent or rel ationship (incl

uding    any indebtedness or     g uarantee of    indebtedness) or any series of                 sim il ar transactions, arrang em ents or

rel ationships.

Beneficial            ownership f or purposes of        parag raph (2) shal l        be determ ined as of     a date that is no m ore than 120

days prior to the date of              fil ing     of           this offering       statem ent and using    the sam e cal cul ation described in Question 6

of           this Question and Answer f orm at.

The term             “m em ber of    the f am il y” incl udes any chil d, stepchil d,       g randchil d, parent, stepparent,             g randparent,

spouse or spousal           equival ent, sibl ing , m other-in-l aw, f ather-in-l aw, son-in-l aw, daug hter-in-l aw, brother-in-l aw,

or sister-in-l aw of          the person, and incl udes adoptive rel ationships. The term      “spousal              equival ent” m eans a cohabitant

occupying           a rel ationship   g eneral l y equival ent to that of             a spouse.

Com pute the am ount of           a rel ated party’s interest in any transaction without reg ard to the am ount of                the profit

or l oss invol ved in the transaction. Where it is not practicabl e to state the approx im ate am ount of                 the interest,

discl ose the approx im ate am ount invol ved in the transaction.

FINANCIAL CONDITION OF THE ISSUER

27. Does the issuer have an operating history? 􀆑 Yes 􀆑 No

28. Describe the financial            condition of       the issuer, incl uding , to the ex tent m aterial , l iquidity, capital                 resources

and historical     resul ts of           operations.

INSTRUCTIONS TO QUESTION 28:

The discussion m ust cover each year f or which financial            statem ents are provided. Incl ude a discussion of          any

k nown m aterial             chang es or trends in the financial           condition and resul ts of              operations of    the issuer during   any

tim e period subsequent to the period f or which financial         statem ents are provided.

For issuers with no prior operating         history, the discussion shoul d f ocus on financial            m il estones and operational ,

l iquidity and other chal l eng es.

For issuers with an operating    history, the discussion shoul d f ocus on whether historical        resul ts and cash flows

13

                                                                                               

                                                                                                                                                                                               

are representative of    what investors shoul d ex pect in the f uture.

Tak e into account the proceeds of        the offering       and any other   k nown or pending         sources of          capital . Discuss how

the proceeds f rom        the offering       wil l        affect l iquidity, whether receiving         these f unds and any other additional                 f unds

is necessary to the viabil ity of the business, and how quick l y the issuer anticipates using       its avail abl e cash. Describe

the other avail abl e sources of                capital   to the business, such as l ines of              credit or required contributions by

sharehol ders.

Ref erences to the issuer in this Question 28 and these instructions ref er to the issuer and its predecessors, if              any.

FINANCIAL INFORMATION

29. Incl ude the financial              inf orm ation specified bel ow covering                the two m ost recentl y com pl eted

fiscal      years or the period(s) since inception, if              shorter:

Ag g reg ate Offering

Am ount Financial           Inf orm ation Financial Statem ent

(defined bel ow):             Required:           Requirem ents:

--------------------------    ----------------------------               -------------------------

(a) $107,000 or l ess:                       􀆑 The f ol l owing inf orm ation Financial statem ents m ust be certified

or their equival ent l ine by the principal              ex ecutive officer of

item s as reported on the the issuer as set f orth bel ow.

f ederal                incom e tax        return

fil ed by the issuer f or the If      financial               statem ents are avail abl e

m ost recentl y com pl eted that have either been reviewed or

year (if                 any):      audited by a publ ic accountant that is

o Total incom e independent of              the issuer, the issuer

o Tax abl e incom e; and m ust provide those financial

o Total tax ; statem ents instead al ong               with a sig ned

certified by the principal               audit or review report and need not

ex ecutive officer of      the         incl ude the inf orm ation reported on

issuer to reflect accuratel y the f ederal               incom e tax        returns or the

the inf orm ation reported on certification of    the principal      ex ecutive

the issuer’s f ederal       incom e officer.

tax         returns; and

􀆑 Financial statem ents of the

issuer and its predecessors,

if             any.

(b) More than 􀆑 Financial statem ents of the Financial statem ents m ust be

$107,000, but not issuer and its predecessors, reviewed by a publ ic accountant that

m ore than if     any. is independent of                 the issuer and m ust

$535,000: incl ude a sig ned review report.        

If             financial               statem ents of the issuer

14

                                                                                                                                                                                                                               

are avail abl e that have been audited

by a publ ic accountant that is

independent of               the issuer, the issuer

m ust provide those financial

statem ents instead al ong         with a

sig ned audit report and need not

incl ude the reviewed financial                

statem ents.

(c) More than

$535,000:           

􀆑 Financial statem ents of the

issuer and its predecessors,

if             any.

If the issuer has previousl y sol d

securities in rel iance on Reg ul ation

Crowdf unding :

Financial              statem ents m ust be

audited by a publ ic accoun       

tant that is independent of        the

issuer and m ust incl ude a

sig ned audit report.

If             the issuer has not previousl y sol d

securities in rel iance on Reg ul ation

Crowdf unding                 and it is offering              m ore

than $535,000 but not m ore than

$1,070,000:

Financial              statem ents m ust be

reviewed by a publ ic accountant

that is independent of the issuer

and m ust incl ude a sig ned review

                                                                                                                                                                 report.

If             financial               statem ents of the issuer

are avail abl e that have been

audited by a publ ic accountant that

is independent of           the issuer, the

issuer m ust provide those financial

statem ents instead al ong         with a

sig ned audit report and need not

incl ude the reviewed financial

statem ents.

INSTRUCTIONS TO QUESTION 29:           To determ ine the financial        statem ents required, the Ag g reg ate

Offering              Am ount f or purposes of            this Question 29 m eans the ag g reg ate am ounts offered and sol d by the

issuer, al l            entities control l ed by or under com m on control          with the issuer, and al l                predecessors of                 the

issuer in rel iance on Section 4(a)(6) of                 the Securities Act within the preceding                12-m onth period pl us the

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current m ax im um        offering               am ount provided on the cover of          this Form .

To determ ine whether the issuer has previousl y sol d securities in rel iance on Reg ul ation Crowdf unding

f or purposes of               parag raph (c) of              this Question 29, “issuer” m eans the issuer, al l              entities control l ed by or

under com m on control              with the issuer, and al l                predecessors of              the issuer.

Financial              statem ents m ust be prepared in accordance with U.S.              g eneral l y accepted accounting                 principl es

and m ust incl ude bal ance sheets, statem ents of         com prehensive incom e, statem ents of            cash flows,

statem ents of chang es in stock hol ders’ equity and notes to the financial      statem ents. If the financial

statem ents are not audited, they shal l               be l abel ed as “unaudited.”

Issuers offering               securities and required to provide the inf orm ation set f orth in row (a) bef ore fil ing                 a tax

return f or the m ost recentl y com pl eted fiscal              year m ay provide inf orm ation f rom   the tax                 return fil ed f or

the prior year (if              any), provided that the issuer provides inf orm ation f rom        the tax                 return f or the m ost

recentl y com pl eted fiscal         year when it is fil ed, if fil ed during       the offering       period. An issuer that

requested an ex tension of        the tim e to fil e woul d not be required to provide inf orm ation f rom                the tax

return until        the date when the return is fil ed, if      fil ed during       the offering       period.

A principal          ex ecutive officer certif ying      financial               statem ents as described above m ust provide the

f ol l owing          certification**:

I, [identif y the certif ying            individual ], certif y that:

(1) the financial                statem ents of [identif y the issuer] incl uded in this Form         are true and

com pl ete in al l               m aterial              respects; and

(2) the tax          return inf orm ation of [identif y the issuer] incl uded in this Form         reflects

accuratel y the inf orm ation reported on the tax            return f or [identif y the issuer] fil ed f or the fiscal

year ended [date of      m ost recent tax              return].

[Sig nature]

[Titl e]

** Intentional   m isstatem ents or om issions of             f acts constitute f ederal              crim inal               viol ations. See 18 U.S.C.

1001.

To qual if y as a publ ic accountant that is independent of           the issuer f or purposes of         this Question 29, the

accountant m ust satisf y the independence standards of          either:

(i) Rul e 2-01 of                 Reg ul ation S-X or

(ii) the AICPA.

The publ ic accountant that audits or reviews the financial         statem ents provided by an issuer m ust be (1)

dul y reg istered and in g ood standing as a certified publ ic accountant under the l aws of         the pl ace of      his or

her residence or principal           office or (2) in   g ood standing and entitl ed to practice as a publ ic accountant

under the l aws of          his or her pl ace of          residence or principal    office.

An issuer wil l    not be in com pl iance with the requirem ent to provide reviewed financial       statem ent if     the

issuer received a review report that incl udes m odifications. An issuer wil l       not be in com pl iance with the

requirem ent to provide audited financial           statem ents if   the issuer received a qual ified opinion, an adverse

opinion, or a discl aim er of         opinion.

                                                                               

The issuer m ust notif y the publ ic accountant of            the issuer’s intended use of      the publ ic accountant’s audit

or review report in the offering .

For an offering                 conducted in the first 120 days of           a fiscal year, the financial           statem ents provided m ay be

f or the two fiscal            years prior to the issuer’s m ost recentl y com pl eted fiscal       year; however, financial

statem ents f or the two m ost recentl y com pl eted fiscal         years m ust be provided if          they are otherwise

avail abl e. If      m ore than 120 days have passed since the end of         the issuer’s m ost recentl y com pl eted fiscal

year, the financial           statem ents provided m ust be f or the issuer’s two m ost recentl y com pl eted fiscal years.

If             the 120th day f al l s on a Saturday, Sunday, or hol iday, the nex t business day shal l     be considered the

120th day f or purposes of          determ ining     the ag e of          the financial       statem ents.

An issuer m ay el ect to del ay com pl ying           with any new or revised financial            accounting         standard until   the

date that a com pany that is not an issuer (as defined under section 2(a) of      the Sarbanes-Ox l ey Act of

2002 is required to com pl y with such new or revised accounting           standard, if        such standard al so appl ies to

com panies that are not issuers. Issuers el ecting            such ex tension of          tim e accom m odation m ust discl ose it

at the tim e the issuer fil es its offering                statem ent and appl y the el ection to al l            standards. Issuers el ecting

not to use this accom m odation m ust f org o this accom m odation f or al l       financial               accounting         standards and

m ay not el ect to rel y on this accom m odation in any f uture fil ing s.

30. With respect to the issuer, any predecessor of         the issuer, any affil iated issuer, any director,

officer, g eneral               partner or m anag ing    m em ber of      the issuer, any beneficial            owner of             20 percent or

m ore of              the issuer’s outstanding              voting   equity securities, cal cul ated in the sam e f orm              as

described in Question 6 of          this Question and Answer f orm at, any prom oter connected with the

issuer in any capacity at the tim e of      such sal e, any person that has been or wil l       be paid (directl y

or indirectl y) rem uneration f or sol icitation of                purchasers in connection with such sal e of

securities, or any             g eneral               partner, director, officer or m anag ing                 m em ber of      any such sol icitor,

prior to May 16, 2016:

(1) Has any such person been convicted, within 10 years (or five years, in the case of issuers, their pre            

decessors and affil iated issuers) bef ore the fil ing        of           this offering       statem ent, of any f el ony or m is        

dem eanor:

(i) in connection with the purchase or sal e of   any security? 􀆑 Yes 􀆑 No

(ii) invol ving      the m ak ing       of           any f al se fil ing               with the Com m ission?

􀆑 Yes 􀆑 No

(iii) arising           out of   the conduct of the business of                an underwriter, brok er, deal er, m unicipal      

securities eal er, investm ent adviser, f unding                 portal    or paid sol icitor of          purchasers of    securities?

􀆑 Yes 􀆑 No

If             Yes to any of     the above, ex pl ain:      __________________________________

(2) Is any such person subject to any order, judg m ent or decree of     any court of       com petent jurisdiction,

entered within five years bef ore the fil ing       of           the inf orm ation required by Section 4A(b) of the Securities

Act that, at the tim e of                fil ing     of           this offering       statem ent, restrains or enjoins such person f rom        eng ag ing          or

continuing          to eng ag e in any conduct or practice:

(i) in connection with the purchase or sal e of   any security? 􀆑 Yes 􀆑 No;

(ii) invol ving      the m ak ing       of           any f al se fil ing               with the Com m ission?

􀆑 Yes 􀆑 No

(iii) arising           out of   the conduct of the business of                an underwriter, brok er, deal er,

m unicipal           securities deal er, investm ent adviser, f unding              portal    or paid sol icitor

                               

of           purchasers of    securities? 􀆑 Yes 􀆑 No

If             Yes to any of     the above, ex pl ain:      __________________________________

(3) Is any such person subject to a final                order of               a state securities com m ission (or an ag ency

or officer of       a state perf orm ing       l ik e f unctions); a state authority that supervises or

ex am ines bank s, saving s associations or credit unions; a state insurance com m ission (or

an ag ency or officer of                a state perf orm ing       l ik e f unctions); an appropriate f ederal             bank ing

ag ency; the U.S. Com m odity Futures Trading                Com m ission; or the National   Credit Union

Adm inistration that:

(i) at the tim e of             the fil ing             of           this offering       statem ent bars the person f rom :

(A) association with an entity reg ul ated by such com m ission, authority,

ag ency or officer? 􀆑 Yes 􀆑 No

(B) eng ag ing    in the business of           securities, insurance or bank ing ?

􀆑 Yes 􀆑 No

(C) eng ag ing    in saving s association or credit union activities?

􀆑 Yes 􀆑 No

(ii) constitutes a final     order based on a viol ation of    any l aw or reg ul ation that

prohibits f raudul ent, m anipul ative or deceptive conduct and f or which the order

was entered within the 10-year period ending                 on the date of the fil ing             of           this

offering               statem ent? 􀆑 Yes 􀆑 No

If             Yes to any of     the above, ex pl ain:      _______________________________________

(4) Is any such person subject to an order of     the Com m ission entered pursuant to Section

15(b) or 15B(c) of            the Ex chang e Act or Section 203(e) or (f ) of    the Investm ent Advisers

Act of    1940 that, at the tim e of             the fil ing             of           this offering       statem ent:

(i) suspends or revok es such person’s reg istration as a brok er, deal er, m unicipal

securities deal er, investm ent adviser or f unding          portal ? 􀆑 Yes 􀆑 No

(ii) pl aces l im itations on the activities, f unctions or operations of        such person?

􀆑 Yes 􀆑 No

(iii) bars such person f rom         being    associated with any entity or f rom        participating      in

the offering       of           any penny stock ? 􀆑 Yes 􀆑 No

If             Yes to any of     the above, ex pl ain:      ______________________________________

(5) Is any such person subject to any order of   the Com m ission entered within five years

bef ore the fil ing            of           this offering       statem ent that, at the tim e of                the fil ing             of           this offering

statem ent, orders the person to cease and desist f rom            com m itting      or causing           a viol ation

or f uture viol ation of :

(i) any scienter-based anti-f raud provision of   the f ederal        securities l aws, incl uding

without l im itation Section 17(a)(1) of the Securities Act, Section 10(b) of         the

Ex chang e Act, Section 15(c)(1) of          the Ex chang e Act and Section 206(1) of             the

Investm ent Advisers Act of       1940 or any other rul e or reg ul ation thereunder?

􀆑 Yes 􀆑 No

(ii) Section 5 of                 the Securities Act? 􀆑 Yes 􀆑 No

If             Yes to either of                the above, ex pl ain:      _____________________________________

                                                                                                                                                               

(6) Is any such person suspended or ex pel l ed f rom   m em bership in, or suspended or barred

f rom     association with a m em ber of , a reg istered national securities ex chang e or a

reg istered national        or affil iated securities association f or any act or om ission to act

constituting       conduct inconsistent with just and equitabl e principl es of        trade?

􀆑 Yes 􀆑 No

If             Yes, ex pl ain:    _________________________________________________

(7) Has any such person fil ed (as a reg istrant or issuer), or was any such person or was any

such person nam ed as an underwriter in, any reg istration statem ent or Reg ul ation A

offering               statem ent fil ed with the Com m ission that, within five years bef ore the fil ing             of

this offering       statem ent, was the subject of                a ref usal             order, stop order, or order

suspending        the Reg ul ation A ex em ption, or is any such person, at the tim e of    such fil ing ,

the subject of   an investig ation or proceeding                to determ ine whether a stop order or

suspension order shoul d be issued?

􀆑 Yes 􀆑 No

If             Yes, ex pl ain:    ___________________________________________

(8) Is any such person subject to a United States Postal               Service f al se representation order

entered within five years bef ore the fil ing       of           the inf orm ation required by Section 4A(b)

of           the Securities Act, or is any such person, at the tim e of              fil ing     of           this offering

statem ent, subject to a tem porary restraining               order or prel im inary injunction with respect

to conduct al l eg ed by the United States Postal             Service to constitute a schem e or device

f or obtaining    m oney or property throug h the m ail by m eans of     f al se representations?

􀆑 Yes 􀆑 No

If             Yes, ex pl ain:    ____________________________________________

If you would have answered “Yes” to any of these questions had the conviction, order, judgment,

decree, suspension, expulsion or bar occurred or been issued after May 16, 2016, then you are NOT

eligible to rely on this exemption under Section 4(a)(6) of the Securities Act.

INSTRUCTIONS TO QUESTION 30:           Final      order m eans a written directive or decl aratory statem ent

issued by a f ederal        or state ag ency, described in Rul e 503(a)(3) of               Reg ul ation Crowdf unding , under

appl icabl e statutory authority that provides f or notice and an opportunity f or hearing , which constitutes a

final       disposition or action by that f ederal      or state ag ency.

No m atters are required to be discl osed with respect to events rel ating          to any affil iated issuer that

occurred bef ore the affil iation arose if               the affil iated entity is not (i) in control                 of           the issuer or (ii) under

com m on control            with the issuer by a third party that was in control          of           the affil iated entity at the tim e of

such events.

OTHER MATERIAL INFORMATION

31. In addition to the inf orm ation ex pressl y required to be incl uded in this Form , incl ude:

(1) any other m aterial inf orm ation presented to investors; and

(2) such f urther m aterial           inf orm ation, if                any, as m ay be necessary to m ak e the required

statem ents, in the l ig ht of       the circum stances under which they are m ade, not

m isl eading .

INSTRUCTIONS TO QUESTION 31:           If             inf orm ation is presented to investors in a f orm at, m edia or

other m eans not abl e to be reflected in tex t or portabl e docum ent f orm at, the issuer shoul d incl ude

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(a) a description of         the m aterial      content of          such inf orm ation;

(b) a description of         the f orm at in which such discl osure is presented; and

(c) in the case of              discl osure in video, audio or other dynam ic m edia or f orm at, a transcript or

description of   such discl osure.

ONGOING REPORTING

The issuer wil l fil e a report el ectronical l y with the Securities & Ex chang e Com m ission annual l y and post the

report on its website, no l ater than:

(120 days af ter the end of         each fiscal           year covered by the report).

Once posted, the annual             report m ay be f ound on the issuer’s website at:

The issuer m ust continue to com pl y with the ong oing              reporting            requirem ents until :

(1) the issuer is required to fil e reports under Section 13(a) or Section 15(d) of              the Ex chang e Act;

(2) The issuer has fil ed, since its m ost recent sal e of   securities pursuant to this part, at l east one

annual report pursuant to this section and has f ewer than 300 hol ders of       record;

(3) The issuer has fil ed, since its m ost recent sal e of   securities pursuant to this part, the annual       

reports required pursuant to this section f or at l east the three m ost recent years and has total          

assets that do not ex ceed $10,000,000;

(4) the issuer or another party repurchases al l                of           the securities issued in rel iance on Section 4(a)(6)

of           the Securities Act, incl uding      any paym ent in f ul l     of           debt securities or any com pl ete redem p-       

tion of redeem abl e securities; or

(5) the issuer l iquidates or dissol ves its business in accordance with state l aw.

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