Civitas Investor Confidential Questionnaire

1. Primary Investor Information

2. Investor Qualification

Qualified Client Status

¹ You need not deduct from your net worth the amount of mortgage debt secured by an excluded primary residence other than (i) the amount by which the mortgage liability exceeds the fair value of the residence, and (ii) any increase in the amount of the debt secured by the primary residence in the sixty (60) days preceding the date hereof, unless the increase was a result of the acquisition of the residence

3. Investor Certification Signature

I certify that all the information provided in this electronic form is true and correct to the best of my knowledge.