Verification of not being a US citizen or tax resident

In making this statement I specifically declare and confirm that :

• I am not a US citizen or resident
• I do not directly or indirectly own more than 10% of the shares/voting rights/interests of US residents and/or I do not control US citizens or residents through other means
• I am not directly or indirectly owned and/or controlled through other means by a US citizen or resident in excess of 10% of the shares/voting rights/interest
• I am not affiliated with US citizens or residents as defined in FATCA Section 1504(a)
• I am aware of my liability for making false declarations

For the purposes of this statement, all US dependent countries and territories are equivalent to the mainland United States. I commit to defend Excolt Markets Incorporated, its directors and officers against any claims arising from or related to any violation of my statement.