📄 Extracted Text (402 words)
GLDUS113 Cliff Meg
4. Please indicate whether the Investor is investing the assets of any retirement plan, employee benefit
plan or other similar agreement that is subject to Section 4975 of the United States Internal Revenue Code
of 1986, as amended (the "Code") (such as an IRA or "Keogh" plan) (a "Plan Investor"):
❑ Yes ❑ No
(a) If the Investor answered "Yes", to Question 4 above, please indicate what percentage of the
Investor's assets invested in the Partnership arc the assets of a plan. individual retirement account
or other arrangement that is described in Section 4975 of the Code, whether or not such plan,
account or arrangement is subject to Section 4975 of the Code:
o Less than 25% and the percentage is %.
25% or more and the percentage is %.
(b) If the Investor answered "Yes", to Question 4 above, please indicate whether or not the Investor
is, or is acting (directly or indirectly) on behalf of, (A) an employee benefit plan (within the
meaning of Section 3(3) of the United States Employee Retirement Income Security Act of 1974,
as amended ("ERISA")) that is subject to Title I of ERISA. (B) an insurance company using general
account assets, if such general account assets are deemed to include the assets of any of the
foregoing types of plans, accounts or arrangements, for purposes of Tide I of ERISA or Section
4975 of the Code under Section 401(c)(1XA) of ERISA or the regulations promulgated thereunder,
or (C) an entity which is deemed to hold the assets of any of the foregoing types of plans, accounts
or arrangements:
❑ Yes ❑ No
5. Please indicate whether or not the Investor is subject to any other federal, state, local, non-U.S. or
other laws or regulations that could cause the underlying assets of the Partnership to be treated as assets of
the Plan Investor by virtue of its investment in the Partnership and thereby subject the Partnership and the
General Partner (or other persons responsible for the investment and operation of the Partnership's assets)
to laws or regulations that are similar to the fiduciary responsibility or prohibited transaction provisions
contained in Title I of ERISA or Section 4975 of the Code.
❑ Yes ❑ No
If the Investor answered "Yes" above, please contact the General Partner immediately.
PROPRfETARY AND CONFIDENTIAL
B-2
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0095582
CONFIDENTIAL SDNY_GM_00241766
EFTA01390916
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EFTA01390916
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