Cadwalader, Wickersham & Taft LLPDraft October 8,11, <strong>2012</strong>Attorney-Client Work ProductFor discussion purposes onlyBy executing this <strong>Questionnaire</strong>, the signatory represents as PCA Principal or PCA Agent forspecified PCA Principals that (a) all information provided by it in this <strong>Questionnaire</strong> is true,accurate and complete in every material respect as of the date hereof, and may be relied upon byeach counterparty to whom this <strong>Questionnaire</strong> is delivered, (b) any information that is requestedand not provided in Part II, Sections 2 through 5 of this <strong>Questionnaire</strong>, and that does not appearin the publicly available portion of an LEI/CICI database, has previously been provided inwriting by the relevant PCA Principals, and all such previously provided information is true,accurate and complete in every material respect as of the date hereof, and may be relied upon byeach counterparty to whom this <strong>Questionnaire</strong> is delivered, (c) if Part III, Section 6(a) has notbeen filled out with respect to a specified PCA Principal, such PCA Principal is not a SpecialEntity, and (d) it has agreed to enter into the <strong>DF</strong> Schedules indicated in the <strong>Questionnaire</strong>. Forpurposes of the foregoing, information appearing in the publicly available portion of theLEI/CICI database with respect to a specified PCA Principal is deemed provided to thecounterparty.[INSERT FULL LEGAL NAME OF PCA PRINCIPAL OR PCA AGENT] 48By: __________________________________________Name:Title:Date:By executing this <strong>Questionnaire</strong> on the relevant signature block below, the signatory agrees tomake the representations and agreements applicable to it in the relevant <strong>DF</strong> Schedule of the <strong>DF</strong>Supplement.[INSERT FULL LEGAL NAME OF DESIGNATED EVALUATION AGENT], 49 solely as PCAPrincipal’s Designated Evaluation Agent and solely to make the representations and agreements applicable to itas Designated Evaluation Agent in <strong>DF</strong> Schedule 3.4849If you are a PCA Agent acting on behalf of one or more PCA Principals insert the following in the signatureblock: “, acting on behalf of the clients, investors, funds, accounts and/or other principals listed in the column 1of the PCA Principal Answer Sheet.”Append additional signature blocks or add signature pages as necessary if PCA Principal has multipleDesignated Evaluation Agents.
Cadwalader, Wickersham & Taft LLPDraft October 8,11, <strong>2012</strong>Attorney-Client Work ProductFor discussion purposes onlyBy: __________________________________________Name:Title:Date:[INSERT FULL LEGAL NAME OF DESIGNATED QIR], 50solely as PCA Principal’s Designated QIR and solely to make the representations and agreements applicable toit as Designated QIR in <strong>DF</strong> Schedule 4.By: __________________________________________Name:Title:Date:[INSERT FULL LEGAL NAME OF DESIGNATED FIDUCIARY/FIDUCIARIES], 51 solely asPCA Principal’s Designated Fiduciary and solely to make the representations and agreements applicable to it in<strong>DF</strong> Schedule 5 and/or 6, as applicable.By: __________________________________________Name:Title:Date:5051Append additional signature blocks or add signature pages as necessary if PCA Principal has multipleDesignated QIRs.Append additional signature blocks or add signature pages as necessary if PCA Principal has multipleDesignated Fiduciaries.
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