Page 2,
Part 3. Information About the
Regional Center
Page 2,
Part 3. Information About the
Regional Center
|
(Use
a
continuation sheet,
if
needed,
to
provide
information for
additional
management
companies/agencies,
Regional
Center principals,
agents,
individuals
or
entities
who
are
or
will
be
involved
in
the
management,
oversight,
and
administration
of
the
regional center.)
A.
Name
of
Regional
Center:
Street
Address/P.O. Box:
City:
State:
Zip Code:
Telephone
Number (include area code):
Fax Number
(include area code):
Web site
address:
B.
Name of Managing Company/Agency:
C.
Name of Other Agent:
Street
Address/P.O. Box:
City:
State:
Zip Code:
Telephone
Number (include area code):
Fax Number
(include area code):
Web site
address:
D.
Continuation,
if
needed,
to
provide
information
for
additional
management
companies/agencies,
regional
center
principals,
agents, individuals
or
entities
who
are
or
will
be
involved
in
the
management,
oversight,
and
administration
of
the
regional
center.)
Note:
If
extra
space
is needed
to
complete
any
item,
attach
a
continuation
sheet,
indicate
the
item
number,
and
provide
the
response.
1a.
Describe
the
structure,
ownership
and
control
of
the
regional
center
entity.
1. b.
Date
the
Regional
Center
was
established(mm/dd/yyyy):
3.
Describe
the
geographic
area
of
the
regional
center.
Note:
This
area
must
be
contiguous.
Provide
a
map
of
the
geographic area.
4.
Describe
the
regional
center's
administration,
oversight,
and
management
functions
that
are
or
will
be
in
place
to
monitor
all
EB-5 capital
investment
activities
and
the
allocation
of
the
resulting
jobs
created
or maintained under
the
sponsorship of
the
regional center.
Corporation
3.
Partnership
(including
Limited
Partnership)
c.
Organization
Structure
for
the
Regional
Center:
1.
Agency
of
a
U.S.
State
or
Territory
(identify)
4.
Limited
Liability
Company
(LLC)
5.
Other
(Explain)
5.
Describe
the
past,
current,
and
future
promotional
activities
for
the
regional
center.
Include
a
description of
the
budget
for
this activity,
along
with
evidence
of
the
funds
committed
to
the
regional
center
for
promotional
activities.
Submit
a
plan
of
operation for
the
regional
center
that
addresses
how
EB-5
investors
will
be
recruited,
the method(s)
by
which
the
capital
investment opportunities
will
be
offered
to
the
investors,
and
how
they
will
subscribe
or
commit
to
the
investment
interest.
6. Describe
whether
and
how
the
regional
center
is
engaged
in
supporting
a
due
diligence
screening
of
its
alien
investor's
lawful source
of
capital
and
the
alien
investor's
ability
to
fully
invest
the
requisite
amount
of
capital.
Also,
describe
the
regional
center's prospective
plans
in
this
regard
if
they
differ
from
past
practice.
2.
Has
this
regional
center's
designation
ever
been
formally
terminated
by
USCIS,
or
has
the
regional
center
ever
filed
a Form
I-924 or
regional
center
proposal
or
amendment
that
was
denied?
[] No
[] Yes -
Attach
a
copy
of
the
adverse
decision,
with
an
explanation,
the
date
of
decision,
and
case
number,
if
any.
|
[Page 3]
[deleted]
Part 4.
Information About the Organizational Structure, Ownership, and
Control of the Regional Center Entity
1.
Organizational Structure of the Regional Center Entity
Select
the organizational structure. If the organizational structure is
different from the examples listed below, select “Other”
and describe the nature of the organizational structure.
1.a. []
Agency of a U.S. state,
territory, or local government
1.b.
[] Corporation
1.c.
[] Partnership (including limited partnerships)
1.d.
[] Limited Liability Company (LLC)
1.e.
[] Other (Describe below. If you need extra space to complete
this section, use the space provided in Part
10. Additional Information.)_______________________
Information
About the Principals of the Regional Center Entity – Owners
List
all persons or legal entities or organizations that own or have a
percentage of ownership in the regional center entity. For
persons, include each owner’s name, date of birth, country
of birth, social security number, the percentage of ownership, the
position/title held within the regional center (if any), and any
other names or aliases used. All
such principals are required to provide a copy of a valid
government-issued photo identification document and should provide
a social security number. For any owner that
is an entity or organization, provide
the entity’s name, its percentage of ownership, the
Federal Employer Identification Number, any trade name (DBA), and
list the name of all persons having ownership, control, or a
beneficial interest in that entity or organization, their date
of birth, country of birth, the percentage of ownership, and the
position held (if any) within the entity or organization.
For each owner, provide the mailing address, telephone
number, email address and Web
site address. If you need extra
space to complete this section, use the space provided in Part
10. Additional Information.
[page 4]
Information About the Owners of the
Regional Center Entity
2.a.
Family Name (Last Name)
2.b. Given
Name (First Name)
2.c.
Middle Name
3. Date
of Birth (mm/dd/yyyy)
4. Country
of Birth
5. Social
Security Number (if any)
6.
Percentage of Ownership in
the Regional Center Entity ____%
7. Position
Held Within the Regional Center Entity (if any).
8. Entity
Name (for an owner of the Regional Center Entity that is an entity
or organization)
9. Federal
Employer Identification Number (for an owner of the Regional
Center Entity that is an entity or organization)
10.a.
Persons Having Ownership, Control, or Beneficial Interest in the
Entity Listed in Part 4.,
Item Number 8.
10.b.
Date of Birth (mm/dd/yyyy)
10.c.
Country of Birth
10.d.
Percentage of Ownership in the
Entity Listed in Part 4.,
Item Number 8.
10.e.
Position Held (if any) in the Entity Listed in Part
4., Item
Number 8.
Other
Names Used By the Owners of the Regional Center Entity (if
applicable):
Provide
all other names the owner has ever
used,
including aliases, maiden name, and nicknames.
11.a.
Family Name (Last Name)
11.b.
Given Name (First Name)
11.c.
Middle Name
12.
Trade Name (DBA if any) (for the entity listed in Part
4., Item
Number 8.)
Mailing
Address for the Owners of the Regional Center Entity
13.a.
In Care Of Name (if any)
13.b.
Street Number and Name or PO Box
13.c.
Apt. Ste. Flr.
13.d.
City or Town
13.e.
State
13.f.
ZIP Code
13.g.
Province
13.h.
Postal Code
13.i.
Country
Contact
Information for the Owners of the Regional Center Entity
14.
Daytime
Telephone Number
15.
Fax Number
16.
Email Address (if any)
17.
Web site Address (if any)
[page 5]
Information
About the Principals of the Regional Center Entity –
Non-Owners
List all principals associated with the
regional center, other than those already identified in
Part 4., Item Numbers 2.a. - 12.
For each person,
include
the principal non-owner's name, date of birth, country of birth,
social security number, the position/title held within the
regional center entity, and any other
names or aliases used. All
principals are required to provide a copy of a valid
government-issued photo identification document and should provide
a social security number. For each principal that is an entity or
organization, provide the name of the
entity, the Federal Employer
Identification Number, any trade name
(DBA), and list the names of all persons having ownership,
control, or a beneficial interest in that entity or organization,
their date of birth, country of
birth, the percentage of ownership, and the position held (if any)
within the entity or organization.
For each principal, provide the mailing address, telephone number,
email address and Web site
address. If you need extra space to
complete this section, use the space provided in Part
10. Additional Information.
Information
About the Principal Non-Owner of the Regional Center Entity
18.a.
Family Name (Last Name)
18.b.
Given Name (First Name)
18.c.
Middle Name
19.
Date of Birth (mm/dd/yyyy)
20.
Country of Birth
21.
U.S. Social Security Number (if any)
22.
Position Held Within the Regional Center Entity
23.
Entity Name (for a principal of the Regional Center Entity that is
an entity or organization)
24.
Federal Employer Identification
Number (for a principal of the Regional Center Entity that is an
entity or organization)
25.a.
Persons Having Ownership, Control
or Beneficial Interest in the Entity Listed in Part
4.,
Item Number 23.
25.b.
Date of Birth (mm/dd/yyyy)
25.c.
Country of Birth
25.d.
Percentage Ownership in the Entity Listed
in Part
4.,
Item Number 27. %
25.e.
Position Held (if any) in the Entity Listed
in Part
4., Item
Number 27.
Other
Names Used By the Principal Non-Owner of the Regional Center
Entity (if applicable)
Provide
all other names the principal
non-owner has ever used, including
aliases, maiden name, and nicknames.
26.a.
Family Name (Last Name)
26.b.
Given Name (First Name)
26.c.
Middle Name
27.
Trade Name (DBA if any) (for the entity listed in Part
4., Item
Number 23.)
Mailing
Address For the Principal Non-Owners of Regional Center Entity
28.a.
In Care Of Name (if any)
28.b.
Street Number and Name or PO Box
28.c.
Apt. Ste. Flr.
28.d.
City or Town
28.e.
State
28.f.
ZIP Code
28.g.
Province
28.h.
Postal Code
28.i.
Country
[page 5]
Contact
Information For the Principal Non-Owners of the Regional Center
Entity
29.
Daytime
Telephone Number
30.
Fax Number
31.
Email Address (if any)
32.
Web site Address (if any)
[deleted]
Information
About the Regional Center
33.
Date the Regional Center Entity Was Established
(mm/dd/yyyy)
34.
State or Territory Where the
Regional Center Entity Was Formed
Geographic
Area of the Regional Center
35.
Have you provided a listing
of the geographic components that comprise the limited and
contiguous geographic area of the regional center?
Yes/No
NOTE: You
will need to provide a listing of the geographic components that
comprise the limited geographic area of the regional center. If
filing an amendment to expand the geographic area of a regional
center, you must describe both the currently approved geographic
area and the area of requested expansion, as well as provide
documentation that explains the economic rationale for the
expansion.
36.
Have you provided a
map or other illustration that
shows the geographic area of the regional center? Yes/No
NOTE: You
will need to provide a map or other illustration that shows the
geographic area of the regional center.
Have you
demonstrated that:
37.
The regional center focuses on a limited, contiguous geographical
area of the United States? [] Yes [] No
38.
The geographic boundaries are reasonable based on evidence that
the proposed economic activity will promote economic growth
in the proposed area?
[] Yes [] No
NOTE:
The geographic area covered by the regional center must
be a limited, contiguous, and clearly identified area.
39.
Regional Center Entity Federal
Employer Identification Number
Administration,
Oversight and Management Functions
40.
Have you submitted a plan that demonstrates that there are (or
will be) sufficient management, oversight, and administrative
functions in place to monitor all EB-5 capital investment
activities?
[] Yes [] No
NOTE:
You must provide a description and submit documentation of the
regional center’s administration, oversight, and management
functions that are or will be in place to monitor all capital
investment activities and the allocation of the jobs created or
maintained under its sponsorship.
Documentary
Evidence of Regional Center Ownership, Structure, Control and
Administration, Oversight and Management Functions
41.
Indicate the type of documentation you have submitted to
establish the regional center’s ownership, structure,
control and administration, oversight, and management functions.
This list is not exclusive and if you have documentation that is
not reflected in the examples listed below, select “Other”
and describe the nature of the documentation.
[] Equity
Ledger and/or Capitalization Table
[]
Organizational Chart
[] Articles or
Certificates of Formation
[] Partnership
Agreement, Operating Agreement, or Other Governing Documents
[] Meeting
Minutes or Written Consents
[] Annual
Report
[] Equity
Certificates
[]
Organizational Information Identifying the Regional Center as a
Unit of an Agency or Municipality of a U.S. State or Territory
[] Other
(Describe the nature of the documentation below.) If you need
extra space to complete this section, use the space provided in
Part 10. Additional Information.
[page 6]
Promotional
Activities
42.
Have you submitted documentation, such as a budget, that details
how the regional center has or will conduct promotional
activities?
[] Yes [] No
NOTE:
You will need to provide a description and submit documentation
of the regional center’s promotional activities.
Plan of
Operation
43.
Have you submitted a plan of operation that details how EB-5
investors will be recruited, the methods by which the capital
investment opportunities will be offered, and how potential
investors will subscribe or commit to the investment?
[] Yes [] No
NOTE:
You must provide a description and submit documentation of the
regional center’s operational plan regarding investor
recruitment, the types of investment offerings, and the methods by
which the investors will subscribe or otherwise commit to the
investments offered.
USCIS
Actions on Prior Form I-924 Approval or Requests for Designation
As a Regional Center
44.
Has U.S. Citizenship and Immigration Services (USCIS) ever
terminated this regional center’s designation; or has the
regional center entity, principal, managing company, or agent
involved with this application ever been associated with a
regional center whose designation was terminated; or has the
regional center entity, principal, managing company, or agent
involved with this application ever filed Form I-924, Application
for Regional Center Designation Under the Immigrant Investor
Program, or Form I-924 amendment
that was denied?
[] Yes [] No
If you
answered “Yes” to Item
Number 44.,
provide an explanation of the denial or termination and/or the
association between the regional center principal, managing
company, or owner and the denied or terminated regional center
in Part 10. Additional Information
and the following information associated with the denied or
terminated regional center:
45.
Regional Center Name
46.
Regional Center Identification Number
|
Page 2,
Part 3. Information About the
Regional Center
Page 2,
Part 3. Information About the
Regional Center
|
c.
Organization
Structure
for
commercial
enterprise:
1.
Corporation
2.
Partnership
(including
Limited
Partnership)
3.
Limited
Liability
Company
(LLC)
4.
Other
(Explain)
8a.
Describe
and
document
the
current
and/or
prospective
structure
of
ownership
and
control
of
the
commercial
entity(s)
in
which
the EB-5
alien
investors
have
or
will
make
their
capital
investments.
8.b.
Date
commercial
enterprise
established,
if
any
(mm
/dd/yyyy):
4.
Describe
the
regional
center's
administration,
oversight,
and
management
functions
that
are
or
will
be
in
place
to
monitor
all
EB-5 capital
investment
activities
and
the
allocation
of
the
resulting
jobs
created
or maintained under
the
sponsorship of
the
regional center.
d.
Has
or
will
the
Regional
Center
or
any
of
its
principals
or
agents
have
an
equity
stake
in
the
commercial
enterprise?
No
Yes-
Attach
an
explanation
and
documentation
that
outlines
when
and
under
what
circumstances
these
remittances will
be
paid.
e.
Has
or
will
the
Regional
Center
or
any
of
its
principals
or
agents
receive
fees,
profits,
surcharges,
or
other
like
remittances through
EB-5
capital
investment
activities
from
this
commercial
enterprise,
beyond
the
minimum
capital
investment
threshold required
of
the
EB-5
alien
entrepreneurs?
No
Yes-
Attach
an
explanation
and
documentation
that
outlines
when
and
under
what
circumstances
these
remittances will
be
paid.
|
[Page 7]
Part 6.
Organizational Structure, Ownership, and Control of Any New
Commercial Enterprises In Which Investors Have Made or Will Make
Their Capital Investments
Provide the
information below if the regional center requests to add a new
commercial enterprise associated with the regional center or if
the regional center requests to amend a previously added new
commercial enterprise. If the regional center seeks to add more
than one new commercial enterprise with this filing, provide the
information below for each new commercial enterprise in Part
10. Additional Information.
1.
Name of the New Commercial Enterprise
2. New
Commercial Enterprise Federal Employer Identification Number
Organizational
Structure of the New Commercial Enterprises
_________________________
3.
Select the organizational structure. If the organizational
structure is different from the examples listed below, select
“Other” and describe the nature of the organizational
structure in Part 10. Additional
Information. Also, if you need
additional space to add new commercial enterprises that are
established, use Part 10.
Additional Information.
[] Corporation
[]Partnership (including limited
partnerships)
[] Limited Liability Company (LLC)
[] Other
(Describe below. If you need extra space to complete this
section, use the space provided in Part
10. Additional Information.)
Ownership
List and
provide the required information for all persons or legal entities
or organizations that own or have a percentage of ownership in the
new commercial enterprise.
Information
About the Owner of the New Commercial Enterprise
4.a.
Family Name (Last Name)
4.b.
Given Name (First Name)
4.c.
Middle Name
5. Date
of Birth (mm/dd/yyyy)
6. Country
of Birth
7.
Percentage of Ownership
8. Position
Held Within the New Commercial Enterprise (if any)
9.
Entity Name (for an owner that is an entity or organization)
10.
Federal Employer Identification Number (for an owner that is an
entity or organization)
11.a.
Names of Persons Having Ownership, Control or Beneficial Interest
in the Entity Listed in Part 6.,
Item Number 9.
11.b.
Date of Birth (mm/dd/yyyy)
11.c.
Country of Birth
11.d.
Percentage of Ownership in the Entity Listed in Part
6., Item
Number 9. ___%
11.e.
Position Held Within the Entity
Listed in Item Number 8.a.
of This Section (if any)
12.
Date New Commercial
Enterprise Established (mm/dd/yyyy)
13.
State or Territory Where the New
Commercial Enterprise Was Formed
[page 8]
Documentary
Evidence of New Commercial Enterprise Ownership, Structure,
Control and Administration, Oversight and Management Functions
14.
Indicate the type of documentation you submitted to establish the
ownership, structure, control and administration, oversight, and
management functions of the new commercial enterprise. If you
have documentation that is not reflected in the examples listed
below, describe and explain the nature of the organization in Part
10. Additional Information.
[] Equity
ledger and/or Capitalization table
[]
Organizational Chart
[] Articles or
Certificates of Formation
[] Governing
Document (for example, partnership agreement, operating agreement)
[] Meeting
Minutes or Written Consents
[] Annual
Report
[] Equity
Certificates
[] Other
(Describe the nature of the documentation below.) If you need
extra space to complete this section, use the space provided in
Part 10. Additional Information.
15.
Does or will the regional center or
any of its principals or agents have an equity stake in the new
commercial enterprises? [] Yes []
No
If you
answered “Yes” to
Item Number 15.,
provide an explanation in Part 10.
Additional Information and submit
documentation with this application that details such equity
ownership.
16.
Does or will the regional center or any of its principals,
managing companies, or agents
receive fees, profits, surcharges, or other
remittances through EB-5 capital investment activities
from any current or prospective new commercial enterprise or any
current or prospective EB-5 investor (beyond the minimum capital
investment threshold required of the EB-5 investors)? [] Yes []
No
If you
answered “Yes” to Item
Number 16.,
provide an explanation in Part 10.
Additional Information and submit
documentation of the circumstances under which these remittances
will be paid.
|
Page 5
|
Part
4.
Applicant
Signature Read
the
information
on
penalties
in
the
instructions
before
completing
this
section.
If someone
helped
you
prepare
this
petition,
he
or she
must
complete
Part
5.
Printed
Name
of
Applicant
Daytime
Phone
Number
(Area/Country
Codes)
E-Mail
Address
I
certify,
under
penalty
of
perjury
under
the
laws
of
the
United
States
of
America,
that
this
form
and
the
evidence
submitted
with
it
are all
true
and
correct.
I
authorize
the
release
of
any
information
from
my
records
that
U.S.
Citizenship
and
Immigration
Services
needs to
determine
eligibility
for
the
benefit
being
sought.
I
also
certify
that
I
have
authority
to
act
on
behalf
of
the
Regional
Center.
Signature
of
Applicant
Date
(mm/dd/yyyy)
Relationship
to
the
Regional
Center Entity
(Managing
Member,
President,
CEO,
etc.)
|
[Page 9]
Part 7.
Statement, Contact
Information, Declaration, and Signature of the Authorized
Individual
NOTE:
Read the Penalties
section of the Form I-924 Instructions before completing this
part.
Authorized
Individual’s Statement
NOTE:
Select the box for either Item
Number 1.a. or 1.b.
If applicable, select the box for Item
Number 2.
1.a. []
I can read and understand
English, and I have read and understand every question and
instruction on this application, and my answer to every question.
1.b. []
The interpreter named in Part
8. has read to me every
question and instruction on this application, and my answer to
every question in [Fillable Field], a language in which I am
fluent. I understood all of this information as interpreted.
2.
[]At my request, the preparer named in Part
9., [Fillable Filed], prepared
this application
for me based only upon information I provided or authorized.
Authorized
Individual’s
Contact Information
3.a.
Authorized Individual’s
Family Name (Last Name)
3.b.
Authorized Individual’s
Signatory's Given Name (First Name)
4.
Authorized Individual’s
Title
5.
Authorized Individual’s
Daytime Telephone Number
6.
Authorized Individual’s
Mobile Telephone Number (if any)
7.
Authorized Individual’s
Email Address (if any)
Authorized
Individual’s
Declaration and
Certification
Copies
of any documents submitted are exact photocopies of unaltered,
original documents, and I understand that, as the Authorized
Individual,
I may be required to submit original documents to USCIS
at a later date.
I
authorize the release of any information from my records, or from
the petitioning organization’s records, to USCIS or other
entities and persons where necessary to determine eligibility for
the immigration benefit sought or where authorized by law. I
recognize the authority of USCIS to conduct audits of this
application using publicly available open source information. I
also recognize that any supporting evidence submitted in support
of this application may be verified by USCIS through any means
determined appropriate by USCIS, including but not limited to,
on-site compliance reviews.
If
filing this application on behalf of an organization, I certify
that I am authorized to do so by the organization.
I
certify, under penalty of perjury, that I have reviewed this
application, I understand all of the information contained in, and
submitted with, my application, and all of this information is
complete, true, and correct.
Authorized
Individual’s Signature
8.a.
Authorized Individual’s
Signature
8.b. Date
of Signature (mm/dd/yyyy)
NOTE
TO ALL APPLICANTS
AND AUTHORIZED INDIVIDUALS:
If you do not completely fill out this application or fail to
submit required documents listed in the Instructions, USCIS may
delay a decision on or deny your application.
[Deleted]
|