I, hereby confirm that I have read and understood all the sections of the Form provided to me. To the best of my knowledge and belief, all information provided by me in each section is true, accurate, and complete.

I acknowledge that it is my responsibility to update any information provided in this document promptly should there be any changes in circumstances that may affect its accuracy.

I understand the importance of providing truthful and complete information, and I consent to the use of this information for the intended purposes outlined in the Form.

I am aware that any false statements, misrepresentations, or omissions may have legal consequences.

This consent statement is made voluntarily and with the understanding that the information provided herein may be relied upon by the concerned parties.

09/18/2024

7:38:30 pm, EDT