EFTA Document EFTA01394720

GLDUS140 Lawrence Hirsch Exhibit C FOR ENTITIES (PARTNERSHIPS, TRUSTS, CORPORATIONS, ETC.) Any investor subscribing as an individual should skip this section. ACCREDITED INVESTOR STATUS (Please Check All That Apply) K The Investor is a corporation, partnership, limited liability company, a Maccarhusetts or similar business trust, or an organization described in Section 501(cX3) of the Internal Revenue Code of 1986, as amended, and the rules and regulations promulgated thereunder that w