EFTA01452235.pdf

SOF III - 1081 Southern Financial LLC INVESTOR QUESTIONNAIRE FOR INDIVIDUALS INDIVIDUALS: Please complete Parts I through VI of this Questionnaire and then proceed to "Form PF." 1. General Information. A. Investor Contact Information (all fields required'. I) Print Full Legal Name ofInvestor. 2) Social Security Number. Tax Identification Number or other Government-Issued Identification Number (required): 3) Primary• Contact for All Correspondence: Address: 4) Telephone Number (home) (work) (other) 5) Facsimile Number 6) E-mail Address (required): 7) Permanent Address: (if different from above) B. Birth Information. 1) Date ofBirth: (Please provide month, date and year.) 2) Country of Origin or Birth: 3) Country of Citizenship: C. Additional Interested Party. In addition to the Primary Contact listed above, correspondence from the Onshore Feeder Fund will also be sent, at the Investor's option, to one additional interested party (e.g., Investor's financial advisor, accountant, attorney, etc.). Please note that correspondence will only be sent via the online reporting tool. Please provide relevant information listed below if applicable: Name of Interested Party: Telephone Number: E-mail Address: Investor Questionnaire - 1 Confidential CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0109150 CONFIDENTIAL SDNY_GM_00255334 EFTA01452235