EFTA01355081.pdf

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GLDLIS126 Pacific Life Insurance Co 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-0039858 CONFIDENTIAL SDNY GM_00188042 EFTA01355081
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5712de8edd68fcf218f123015ded6cbb15c28ec213e7e53951a3a8925ce4de65
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EFTA01355081
Dataset
DataSet-10
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document
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1

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