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Investor Accreditation Evaluation

The following Ivestor Accreditation Evaluation is essential to ensure that this offering is conducted in full complicance with Regulation D or Regulation S of the Securities Act of 1993, as amended. The Evaluation will remain on file in confidence in the office of Eb-5 International Gem Tower Fund LLC (The “Limited Liability Company”) for a period of 4 years. Your cooperation in the full completion of the Accreditation Evaluation is greatly appreciated.




1. Name and Contact Information

Full Name of Prospective Investor

Address

Telephone Number

Email Address

Firm Name

Business Address

Business Telephone Number

2. Occupation

Present Occupation 
(with date of commencement)

Occupation during last five years
(with dates):

3. Net Worth

My net worth (excluding home, home furnishings, and automobiles) is at least $ USD.

My proposed investment
exceed ten percent of my net worth.

4. Check each category that is applicable:

 A4

The Investor is a natural person whose individueal net worth1 (or joint net worth with such person’s spouse)exceeds $1,000,000;

 B4

The Investor is a natural person a natural person who had an individual income2 in excess of $200,000 in each of the two most recent years and who reasonably expects to have an individual income in excess of $200,000 in the current year, or who had joint income3 in excess of $300,000 in each of the two most recent years and who reasonably expects to have joint income in excess of $300,000 in the current year; or

 C4

Neither of (4A) or (4B) above.

I do not have any other investments or contingent liabilities which I reasonably anticipate could cause the need for sudden cash requirements in excess of cash readily available to me.

6. I have checked my investment objectives where applicable:

7. I can bear the risk of the proposed investment, including the loss of my entire investment, a lack of liquidity in the investment or an inability to sell the investment for an indefinite period of time.

8. I learned about this investment in the following manner:

9. I was not solicited by any general form of advertisement for this investment.

10. I am aware that there are limitations on my ability to sell the Interest and that the certificate evidencing this interest will carry a restrictive legend.

11. I am interested in purchasing the Interest for personal investment and without a view to redistribution.

1. For purposes of this item, “net worth” means the excess of total assets at fair market value, including any owned personal property, over total liabilities. The value of Investor’s home is EXCLUDED from this calculation of Investor’s net worth. In addition, if the mortgage debt on the home exceeds the fair market value of the home, that excess amount must be treated as a liability for the purpose of this calculation.

2. For purposes of this item, “individual income” means adjusted gross income as reported for U.S. federal income tax purposes, less any income attributable to a spouse or to property owned by a spouse, increased by the following amounts (but not including any amounts attributable to a spouse or to property owned by a spouse): (i) the amount of any interest income received which is tax-exempt under Section 103 of the United States Internal Revenue Code of 1986, as amended (the “Code”), (ii) the amount of losses claimed as a limited partner in a limited partnership (as reported on Schedule E of Form 1040), (iii) any deduction claimed for depletion under Section 611 et seq. of the Code, and (iv) any amount by which income from long-term capital gains has been reduced in arriving at adjusted gross income pursuant to the provisions of Section 1202 of the Code prior to its repeal by the Tax Reform Act of 1986.

3 For purposes of this item, “joint income” means adjusted gross income as reported for U.S. federal income tax purposes, including any income attributable to a spouse or to property owned by a spouse, increased by the following amounts (including any amounts attributable to a spouse or to property owned by a spouse): (i) the amount of any interest income received which is tax-exempt under Section 103 of the Code, (ii) the amount of losses claimed as a limited partner in a limited partnership (as reported on Schedule E of Form 1040), (iii) any deduction claimed for depletion under Section 611 et seq. of the Code, and (iv) any amount by which income from long-term capital gains has been reduced in arriving at adjusted gross income pursuant to the provisions of Section 1202 of the Code prior to its repeal by the Tax Reform Act of 1986.

Extell New York Regional Center 805 Third Ave. 7th Floor New York, NY 10022 T: 212-221-3137 F: 212-644-5188 info@eb5extell.com