WealthForge Issuer Exemption Self-Assessment

Are you or will you be compensated with commission or other compensation directly or indirectly connected with the transaction of securities?

Yes

Please select all that apply:

I offer or sell securities to registered brokers or dealers, investment companies, insurance companies, banks, trusts or other savings and loan institutions.

I offer or sell securities only issued due to bankruptcy, securities issued to existing shareholders, and court or agency approved exchanges.

I offer or sell securities related to a plan submitted for a vote by shareholders, such as a merger or reorganization.

I offer or sell securities related to a pension, retirement, profit-sharing, other dividend reinvestment or employee benefit plan.

None of these apply.

Please select all that apply:

I prepare written communication approved by a partner, officer or director of the issuer that does not involve oral solicitation.

I respond to inquiries from potential purchasers with content limited to information contained in the registration statement and other offering documents.

I perform ministerial and/or clerical work involved the transaction of securities.

None of these apply.

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WealthForge Issuer Exemption Self-Assessment

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