EFTA01354806.pdf

GLOUSI25 Gerald Ford FEE ACKNOWLEDGEMENT By signing below, I acknowledge that I have received and reviewed the Supplement to the Private Placement Memorandum that contains specific information relating to the fees in respect of my investment that will be paid to my advisor. UPFRONT PLACEMENT FEE ACKNOWLEDGEMENT By signing below, I acknowledge that I will be charged an upfront placement fee equal to the following percentage of my Subscription, which amount will be collected by and paid to my advisor %. The Placement Fee (as defined in the Memorandum) is charged in addition to your Subscription to the Partnership and not deducted from the Subscription amount and shall not constitute a capital contribution with respect to your investment in the Partnership. INVESTOR SIGNATURE PAGE IN WITNESS WHEREOF, the undersigned executes this Agreement and acknowledges by its signature below that it (i) has reviewed this Agreement, including all applicable Exhibits hereto, and such additional information it deems appropriate in connection with its investment in the Partnership, and (ii) agrees to be bound by the terms hereof on the date first set forth above. Upon acceptance below by the General Partner, the undersigned shall be admitted as a Limited Partner of the Partnership. (Sign here) (Sign here) Name of Signatory: Title of Signatory (if applicable): Country in which this Agreement was signed: Date: (Sign here) Name of Signatory: Title of Signatory (if applicable): Date: Net Amount of Interest Requested in USD: $ Name of Investor (Individual or Entity Name): PROPRIE'fARY AND CONFIDEN77AL 23 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0039404 CONFIDENTIAL SDNY GM_00185588 EFTA01354806