Attestation Page

OMB No. 1615-0061; Expires 00/00/2015

Department of Homeland Security Immigrant Investor Program Form I-526A,

U.S. Citizenship and Immigration Services I-526 Supplement A (Attestation) Supplement to Form I-526

_{► START HERE – Please type or print in black ink.}

_{Part 1. Information About You}

2.c. Deal Package Name2.c.

Investor Supplied

1.a.Family Name

(Last Name

Investor Supplied

1.b. Given Name

(First Name)

Investor Supplied

1.c. Middle Name

_{Part 2.} Information About Commercial Enterprise and Regional Center

2.i.

2.a. Regional Center Name 2.e. Invitation Identification Number

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2.b. Regional Center Identification Number 2.f. Attestation Identification Number

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Pre-populated by ELIS

2.c. Deal Package Name 2.g. Portfolio Admin USCIS ELIS Account Number

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Pre-populated by ELIS

2.d. Deal Package Identification Number

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_{Part 3. Deal Package Contents in Support of I-526 Petition} Pre-populated by ELIS

_{Document ID Number(s)}

_{File Names}

RC235.Business Plan.pdf EB5RC123-456789

RC236.Economic Analysis.pdf EB5RC234-567890

RC237.RC Entity Organizational Docs.pdf EB5RC345-678911

RC238.NCE Operating Agreement .pdf EB5RC456-789012

RC239.NCE Organizational Documents.pdf EB5RC567-891013

RC240.Subscription Agreement.pdf EB5RC678-910114

RC241.Private Placement Memorandum.jpeg EB5RC789-101115

RC242.Escrow Agreement.pdf EB5RC890-111216

_{Part 4. Certification, Signature and Contact Information of Petitioner}

I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true and correct. By my signature, I also certify, under penalty of perjury, that I have reviewed all the documents listed in Part 3 and Part 5 (if applicable) and certify that these documents are true and correct copies of the investment documents I have entered into related to my investment in the New Commercial Enterprise under the Regional Center identified above and are being submitted in support of my petition. Any copies of documents I submit are exact photocopies of unaltered original documents, and I understand that I may be required to submit original documents to U.S. Citizenship and Immigration Services (USCIS) at a later date. I have enclosed with my Form I-526 Immigrant Petition for Alien Entrepreneur the executed signature page(s) from any documents in the Deal Package that required signatures. I also authorize the release of any information from my records that USCIS may need to determine my eligibility for the benefit I am seeking. I further authorize release of information contained in this form, supporting documents, and my USCIS records to other entities and persons where necessary for the administration of U.S. immigration laws and law enforcement purposes.

1. Signature of Petitioner 3. Daytime Phone Number

2. Date of Signature 4. E-mail Address

_{Part 5. Deal Package Contents in Support of I-526 Petition} Pre-populated by ELIS

– Continuation Page

Deal Package ID Number: EB5RC000-00-0000

_{Document ID Number(s)}

_{File Names}

RC235.Business Plan.pdf EB5RC123-456789

RC236.Economic Analysis.pdf EB5RC234-567890

RC237.RC Entity Organizational Docs.pdf EB5RC345-678911

RC238.NCE Operating Agreement .pdf EB5RC456-789012

RC239.NCE Organizational Documents.pdf EB5RC567-891013

RC240.Subscription Agreement.pdf EB5RC678-910114

RC241.Private Placement Memorandum.jpeg EB5RC789-101115

RC242.Escrow Agreement.pdf EB5RC890-111216

Form I-526A (00/00/2015) Page 2