INSTRUCTIONS FOR COMPLETION OF THE CERTIFICATE PERTAINING TO FOREIGN INTERESTS
a. Do any foreign person(s), directly or indirectly, own or have beneficial ownership of 5% or more of the outstanding shares of any class of your organization's equity securities? If yes:
Identify the percentage of any class of stock or other securities issued which are owned by foreign persons, broken down
by country. Include indirect ownership through one or more intermediate level(s) of subsidiaries. Indicate voting rights of each class of stock.
Are there shareholder agreements? If yes, attach a copy(ies), and if none, so state.
Indicate whether a copy of SEC Schedule 13D/13G report has been received from any investor. If yes, attach a
Note: Ownership of less than 5% should be included if the holder is entitled to control the appointment and tenure of any management position.
b. (For entities which do not issue stock): Has any foreign person directly or indirectly subscribed 5% or more of your organization's total capital commitment? If yes:
Identify the percentage of total capital commitment which is subscribed by foreign persons.
Is there an agreement(s) with the subscriber(s)? If yes, attach a copy(ies), and if none, so state.
Question #2: Does your organization directly or indirectly through your subsidiaries and/or affiliates, own 10% or more of any foreign interest? If yes:
Identify the foreign interest by name, country, percentage owned, and personnel who occupy management positions
with the organizations.
If there are personnel from your organization who occupy management positions with the foreign firm(s), identify the
name(s), title, and extent of involvement in the operations of the organizations, (to include access to classified information).
Question #3: Do any non-U.S. citizens serve as members of your organization's board of directors (or similar governing body), officers, executive personnel, general partners, regents, trustees or senior management officials? If yes:
Identify the foreign person(s) by name, title, citizenship, immigration status and clearance or exclusion status.
Attach copies of applicable by-laws or articles of incorporation, which describe the affected position(s). However, if
you have already provided such copies to the Cognizant Security Agency Industrial Security Representative, so state.
Question #4: Does any foreign person(s) have the power, direct or indirect, to control the election, appointment, or tenure of members of your organization's board of directors (or similar governing body) or other management positions of your organization, or have the power to control or cause the direction of other decisions or activities of your organization? If yes: