- By completing this form, on your own behalf or in the capacity as a duly authorized representative of an entity (in either capacity, as applicable, “you”) hereby represent, warrant and covenant, in each case, as applicable, to, and for the benefit of, HDAC Technology AG (“HDAC”) (each, a “Certification” and, collectively, the “Certifications”) that:
- You neither are a citizen, resident nor tax resident of the United States of America (hereinafter referred to as the “U.S.”), Canada, Philippines nor otherwise constitute a “U.S. person” (as defined in Rule 902 of Regulation S under the U.S. Securities Act of 1933, as amended (the “U.S. Securities Act”)), “Canada person”, “Philippines person” and you are not otherwise present or located in the U.S., Canada, Philippines on and as of the date hereof;
- You are currently located in:
- the US or Canada or Philippines
- You are a legal resident of the following country:
-
Select a country
- the US or Canada or Philippines
- other countries(excluding the US or Canada or Philippines)