ANTI-MONEY LAUNDERING REQUIREMENTS
The USA PATRIOT Act
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What is money laundering?
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How big is the problem and why is it important?
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The USA
PATRIOT Act is designed to detect, deter, and punish terrorists in
the United States and abroad. The Act imposes new anti-money
laundering requirements on brokerage firms and financial
institutions. Since April 24, 2002 all brokerage firms have been
required to have new, comprehensive anti-money laundering programs.
To help you understand these efforts, we want to provide you with
some information about money laundering and our steps to implement
the USA PATRIOT Act.
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Money
laundering is the process of disguising illegally obtained money so
that the funds appear to come from legitimate sources or
activities. Money laundering occurs in connection with a wide
variety of crimes, including illegal arms sales, drug trafficking,
robbery, fraud, racketeering, and terrorism.
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The use
of the U.S. financial system by criminals to facilitate terrorism
or other crimes could well taint our financial markets. According
to the U.S. State Department, one recent estimate puts the amount
of worldwide money laundering activity at $1 trillion a
year.
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What are we required to do to eliminate money laundering?
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Under
new rules required by the USA PATRIOT Act, our anti-money
laundering program must designate a special compliance officer, set
up employee training, conduct independent audits, and establish
policies and procedures to detect and report suspicious transaction
and ensure compliance with the new laws.
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As part
of our required program, we may ask you to provide various
identification documents or other information. Until you provide
the information or documents we need, we may not be able to affect
any transactions for you.
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ORBITAL TRACKING CORP.
SIGNATURE PAGE TO
SUBSCRIPTION AGREEMENT
Purchaser
hereby elects to purchase a total of $_________________,
representing ________Shares of Preferred Stock, at a purchase price
of $4.00 per Share.
Date
(NOTE: To be completed by the Purchaser): __________________,
2016
If
the Purchaser is an INDIVIDUAL, and if purchased as JOINT TENANTS,
as TENANTS IN COMMON, or as COMMUNITY PROPERTY:
____________________________
Print Name(s)
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____________________________
Social Security
Number(s)
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____________________________
Print Name(s)
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____________________________
Social Security
Number(s)
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____________________________
Signature(s) of Purchaser(s)
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____________________________
Signature
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Address:
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____________________________
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____________________________
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____________________________
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Date
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____________________________
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If the Purchaser is a PARTNERSHIP, CORPORATION, LIMITED LIABILITY
COMPANY or TRUST:
Name of Entity
____________________________
____________________________
Name of
Partnership,
Corporation,
Limited
Liability Company
or Trust
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__________________________
Federal Taxpayer
Identification Number
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By: _______________________
Name:
Title:
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__________________________
State of Organization
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Address:
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____________________________
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___________________________
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____________________________
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Date
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____________________________
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AGREED
AND ACCEPTED:
ORBITAL
TRACKING CORP.
By:
/s/ David
Phipps
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Date: October 13, 2016
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Name: David
Phipps
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Title: Chief Executive
Officer
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Schedules
Schedule
6.15
The Company has not
filed its federal and state tax returns for the 2015 year. The
Company had a net loss during such year and believes that no taxes
are due for 2015.
The Company has
been informed by the Internal Revenue Service that it has neglected
to file a Form W-3 Transmittal with accompanying Employee Form
W-2’s for tax year 2009. Failure to file the aforesaid forms
will result in an estimated penalty of $6,600. The Company has
reached out to its former officers to retrieve the forms, but has
been unsuccessful. The Company is in the process of requesting a
waiver for this penalty.
Schedule
6.7
Capitalization
Preferred Stock
– 50,000,000
shares authorized; $0.0001 par value
Series A –
20,000 authorized and -0- outstanding
Series B –
30,000 authorized and 6,666 outstanding
Series C –
4,000,000 authorized and 3,090,365 outstanding
Series D –
5,000,000 authorized and 3,613,984 outstanding
Series E –
8,746,000 authorized and 8,357,826 outstanding
Series F –
1,100,000 authorized and 1,099,998 outstanding
Series G –
10,090,000 authorized and 10,083,351 outstanding
Common Stock
– 750,000,000
authorized; $0.0001 par value, 46,123,701 issued and outstanding.
Reg S Common stock; 3,913 authorized, issued and
outstanding.
Options
– 2,850,000 fully vested
options to purchase common stock, at an exercise price of $0.05.
The Company intends to grant to its Chief Executive Officer, David
Phipps, 10,000,000 fully vested options at an exercise price of
$0.01.
Warrants
– 5,000 warrants to
purchase common stock at an exercise price of $4.50.
Upon the completion
of this Offering, the Company will be required to issue to
subscribers who participated in the Company’s private
offerings prior to February 15, 2015, pursuant to certain
anti-dilution protection, additional shares of Series C Preferred
Stock, Series F Preferred Stock and Series G Preferred Stock. The
Company will issue an aggregate of 550,000 shares of Series C
Preferred Stock. However, in lieu of issuing such additional shares
of Series F Preferred Stock and Series G Preferred Stock, the
Company will create a new series of preferred stock, to be
designated as “Series I Preferred Stock” and to issue
to such shareholder an aggregate of 114,944 shares of such Series I
Preferred Stock, each of which shall be convertible into one
hundred (100) shares of the Company’s common
stock.
Schedule A
FORM
OF INVESTOR QUESTIONNAIRE
ORBITAL
TRACKING CORP.
For
Individual Investors Only
(All
individual investors must
INITIAL
where appropriate. Where there
are joint investors both parties must
INITIAL
):
Initial _______
I certify
that
I have a
“net worth” of at least $1 million either individually
or through aggregating my individual holdings and those in which I
have a joint, community property or other similar shared ownership
interest with my spouse. For purposes of calculating net worth
under this paragraph, (i) the primary residence shall not be
included as an asset, (ii) to the extent that the indebtedness that
is secured by the primary residence is in excess of the fair market
value of the primary residence, the excess amount shall be included
as a liability, and (iii) if the amount of outstanding indebtedness
that is secured by the primary residence exceeds the amount
outstanding 60 days prior to the execution of this Subscription
Agreement, other than as a result of the acquisition of the primary
residence, the amount of such excess shall be included as a
liability.
Initial _______
I certify
that
I have had an
annual gross income for the past two years of at least $200,000 (or
$300,000 jointly with my spouse) and expect my income (or joint
income, as appropriate) to reach the same level in the current
year.
For
Non-Individual Investors
(all
Non-Individual Investors must
INITIAL
where
appropriate):
Initial _______
The undersigned
certifies that it is a partnership, corporation, limited liability
company or business trust that is 100% owned by persons who meet
either of the criteria for Individual Investors,
above.
Initial _______
The undersigned
certifies that it is a partnership, corporation, limited liability
company or business trust that has total assets of at least $5
million and was not formed for the purpose of investing in
Company.
Initial _______
The undersigned
certifies that it is an employee benefit plan whose investment
decision is made by a plan fiduciary (as defined in ERISA
§3(21)) that is a bank, savings and loan association,
insurance company or registered investment adviser.
Initial _______
The undersigned
certifies that it is an employee benefit plan whose total assets
exceed $5,000,000 as of the date of the Subscription
Agreement.
Initial _______
The undersigned
certifies that it is a self-directed employee benefit plan whose
investment decisions are made solely by persons who meet either of
the criteria for Individual Investors, above.
Initial _______
The undersigned
certifies that it is a U.S. bank, U.S. savings and loan association
or other similar U.S. institution acting in its individual or
fiduciary capacity.
Initial _______
The undersigned
certifies that it is a broker-dealer registered pursuant to
§15 of the Securities Exchange Act of 1934.
Initial _______
The undersigned
certifies that it is an organization described in §501(c)(3)
of the Internal Revenue Code with total assets exceeding $5,000,000
and not formed for the specific purpose of investing in
Company.
Initial _______
The undersigned
certifies that it is a trust with total assets of at least
$5,000,000, not formed for the specific purpose of investing in
Company, and whose purchase is directed by a person with such
knowledge and experience in financial and business matters that he
is capable of evaluating the merits and risks of the prospective
investment.
Initial _______
The undersigned
certifies that it is a plan established and maintained by a state
or its political subdivisions, or any agency or instrumentality
thereof, for the benefit of its employees, and which has total
assets in excess of $5,000,000.
Initial _______
The undersigned
certifies that it is an insurance company as defined in
§2(a)(13) of the Securities Act of 1933, as amended, or a
registered investment company.
ORBITAL
TRACKING CORP.
Investor
Questionnaire
(
Must
be completed by Purchaser)
Section
A - Individual Purchaser Information
Purchaser Name(s):
________________________________________________________________________
Individual
executing Profile or Trustee:
_______________________________________________________________________
Social Security
Numbers / Federal I.D. Number:
________________________________________________________________________
Date of Birth:
_________________ Marital Status: _________________
Joint Party Date of
Birth:________________
Investment
Experience (Years): ___________
Annual Income:
_________________
Net Worth:
________________
Home Street
Address:
________________________________________________________________________
Home City, State
& Zip Code:
________________________________________________________________________
Home Phone:
________________________ Home Fax:
_____________________
Home Email:
_______________________________
Employer:
________________________________________________________________________
Employer Street
Address:
________________________________________________________________________
Employer City,
State & Zip Code:
________________________________________________________________________
Bus. Phone:
__________________________ Bus. Fax:
_______________________
Bus. Email:
________________________________
Type of Business:
________________________________________________________________________
Please check if you
are a FINRA member or affiliate of a FINRA member firm:
_______
Section
B – Entity Purchaser Information
Purchaser Name(s):
________________________________________________________________________
Authorized
Individual executing Profile or Trustee:
_____________________________________________________________________
Social Security
Numbers / Federal I.D. Number:
_______________________________________________________________________
Investment
Experience (Years): ___________
Annual Income:
_______________
Net Worth:
________________
Was the Trust
formed for the specific purpose of purchasing the
Securities?
[ ] Yes [ ]
No
Principal Purpose
(Trust)_____________________________________
Type of Business:
________________________________________________________
Street Address:
________________________________________________________________________
City, State &
Zip Code:
________________________________________________________________________
Phone:
________________________ Fax: ________________________
Email:
__________________________
Section C – Form of Payment – Check or Wire
Transfer
____ Check payable
to “
ORBITAL TRACKING
CORP
”
____ Wire funds
from my outside account according to the “To subscribe for
Shares of Preferred Stock in the private offering of ORBITAL
TRACKING CORP.”
Section E – Securities Delivery Instructions (check
one)
____ Please deliver
my securities to the address listed in the above Investor
Questionnaire.
____ Please deliver
my securities to the below address:
______________________________________
______________________________________
______________________________________
______________________________________
Purchaser
Signature(s)
_______________________________________Date_______________
Purchaser
Signature(s)
_______________________________________Date_______________