TLD Application: Sponsoring Organization's Fitness Disclosure 15 August 2000

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Sponsoring Organization's Fitness Disclosure

The following disclosures are hereby made on behalf of the sponsoring organization.

G1. Within the past ten years, has any current director, officer, or employee of the sponsoring organization (or, if the sponsoring organization is not yet formed, any person intended to be a director, officer, or employee of the sponsoring organization) (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?
[INSTRUCTION: Answer "yes" or "no."]

G2. Within the past ten years, has the sponsoring organization 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?
[INSTRUCTION: Answer "yes" or "no."]

G3. Within the past ten years, has any current director, officer, or employee of the sponsoring organization (or, if the sponsoring organization is not yet formed, any person intended to be a director, officer, or employee of the sponsoring organization) 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?
[INSTRUCTION: Answer "yes" or "no."]

G4. Within the past ten years has the sponsoring organization 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?
[INSTRUCTION: Answer "yes" or "no."]

G5. Is any director, officer, or employee of the sponsoring organization (or, if the sponsoring organization is not yet formed, any person intended to be a director, officer, or employee of the sponsoring organization) currently involved in any judicial or regulatory proceeding that could result in a conviction, judgment, determination, or discipline of the type specified in items G1 or G3?
[INSTRUCTION: Answer "yes" or "no."]

G6. Is the sponsoring organization itself currently involved in any judicial or regulatory proceeding that could result in a conviction, judgment, determination, or discipline of the type specified in iems G2 or G4?
[INSTRUCTION: Answer "yes" or "no."]

G7. Within the past three years, has any current director, officer, or employee of the sponsoring organization (or, if the sponsoring organization is not yet formed, any person intended to be a director, officer, or employee of the sponsoring organization) been adjudged to be bankrupt or insolvent?
[INSTRUCTION: Answer "yes" or "no."]

G8. Has the sponsoring organization itself ever been adjudged to be bankrupt or insolvent?
[INSTRUCTION: Answer "yes" or "no."]

G9. If the response to any of G1 through G8 is affirmative, please provide complete details on separate sheets of paper attached to this disclosure.
[INSTRUCTION: Please attach one or more sheets with complete details.]

By signing this fitness disclosure, the undersigned certifies that he or she has authority to do so on behalf of the applicant(s). On his or her own behalf and on behalf of the applicant(s), 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(s) understand that any material misstatement or misrepresentation will reflect negatively on any application of which this disclosure is a part and may cause cancellation of any delegation of a top-level domain based on such an 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