The following disclosures are hereby made on behalf of the applicant.

D1. Past of Directors/Officers/managers

Within the past ten years, has any current director, officer, or manager of the applicant (a) been convicted of any felony; (b) been convicted of any misdemeanor related to financial activities; (c) been judged by a court to have committed fraud or breach of fiduciary duty, or (d) been the subject of a judicial determination that is similar or related to any of these?

No

D2. Past of Applicant

Within the past ten years, has the applicant itself (a) been convicted of any felony; (b) been convicted of any misdemeanor related to financial activities; (c) been judged by a court to have committed fraud or breach of fiduciary duty, or (d) been the subject of a judicial determination that is similar or related to any of these?

No

D3. Disciplination of Directors/Officers/Managers

Within the past ten years, has any current director, officer, or manager of the applicant been disciplined by any government or by any organization of which he or she was a member for conduct involving dishonesty or misuse of funds of others?

No

D4. Disciplination of Applicant

Within the past ten years has the applicant itself been disciplined by any government or by any organization of which it was a member for conduct involving dishonesty or misuse of funds of others?

No

D5. Current proceedings against Directors/Officers/Mngrs

Is any director, officer, or manager of the applicant currently involved in any judicial or regulatory proceeding that could result in a conviction, judgment, determination, or discipline of the type specified in items D1 or D3?

No

D6. Current proceedings against Applicant

Is the applicant itself currently involved in any judicial or regulatory proceeding that could result in a conviction, judgment, determination, or discipline of the type specified in items D2 or D4?

No

D7. Insolvency in the past of Director/Officer

Within the past three years, has any current director, officer, or manager of the applicant been adjudged to be bankrupt or insolvent?

No

D8. Insolvency in the past of Applicant

Has the applicant itself ever been adjudged to be bankrupt or insolvent?

No

D9. Details of any affirmative responses

If the response to any of items D1 through D8 is affirmative, please provide complete details on separate sheets of paper attached to this disclosure.

Not Applicable

 

 

By signing this fitness disclosure, the undersigned certifies that he or she has authority to do so on behalf of the applicant. On his or her own behalf and on behalf of the applicant, the undersigned certifies that all information contained in this fitness disclosure, and all documents attached to this disclosure, is true and accurate to the best of his/her/its knowledge and information. The undersigned and the applicant understand that any material misstatement or misrepresentation will reflect negatively on the application of which this disclosure is a part and may cause cancellation of any delegation of a top-level domain based on that application.

 

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Signature

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Name (please print)

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Title

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Name of Applicant

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Date