Planet CPR - Investor Questionnaire

Please complete the following form if you are a Foreign Investor or an Accredited US Investor of one of the following states and are interested in receiving an Offering Memorandum and Subscription Agreement offered pursuant to Regulation D 504 of the US Securities Act of 1933, and state Model Accredited Investor Exemption (MAIE).

ALABAMA (state variation), ARIZONA (state variation), ARKANSAS (MAIE), CALIFORNIA (state variation)
COLORADO (MAIE), CONNECTICUT (MAIE), DISTRICT OF COLUMBIA (Federal law applies)
DELAWARE (MAIE), HAWAII (MAIE), ILLINOIS (state variation), INDIANA (MAIE), IOWA (state variation)
KANSAS (MAIE), KENTUCKY (MAIE), MAINE (MAIE), MARYLAND (MAIE), MASSACHUSETTS (state variation)
MICHIGAN (state variation; full Form U-7 required), MISSOURI (state variation)
NEBRASKA (state variation), NEVADA (MAIE), NEW HAMPSHIRE (state variation), NEW JERSEY (MAIE)
NEW MEXICO (MAIE), NORTH DAKOTA (MAIE), OHIO (state variation), OKLAHOMA (MAIE)
PENNSYLVANIA (state variation), PUERTO RICO (MAIE), RHODE ISLAND (MAIE)
SOUTH CAROLINA (state variation), SOUTH DAKOTA (MAIE), TEXAS (state variation), UTAH (MAIE)
VIRGINIA (MAIE), WASHINGTON (MAIE), WEST VIRGINIA (MAIE), WISCONSIN (state variation)
WYOMING (MAIE)

All information will remain the strict and confidential property of Planet CPR Limited and will not be sold, leased or disseminated to third parties and will only be used for the purpose of determining investment eligibility under applicable US Securities Regulations.

Accredited Investor:
I hereby represent that I qualify as an "Accredited Investor" as defined in Rule 501(a) of Regulation D.
I acknowledge that the foregoing information provided by me in this Accredited Investor questionnaire is complete, true and accurate, and that the undersigned will promptly notify Planet CPR Limited of any changes in such information. I hereby consent to the disclosure of any such information, and any other information furnished to Planet CPR Limited, to any governmental authority, self-regulatory organization or, to the extent required by law, to any other person. I further acknowledge that Planet CPR, LLC is relying on the information provided by me in order to comply with applicable securities laws. I hereby agree to indemnify and hold harmless Planet CPR Limited and its officers, directors, shareholders, employees, affiliates, advisors and agents from and against any and all loss, damage or liability due to or arising out of any incomplete, untrue or inaccurate information provided by checking the "question-19, I agree" contained in this Accredited Investor Questionnaire.

I understand that Planet CPR Limited does not warrant or insure that its website (www.cprplanet.com) will be free from errors, omissions, interruptions, delays, losses or defects, whether human or mechanical. I further understand that Planet CPR Limited does not make any warranties, express or implied, of any kind whatsoever as to its website, including, but not limited to, any warranties of merchantability or fitness for a particular purpose. In no event will Planet CPR Limited be liable for any indirect, consequential, special, exemplary or incidental damages relating to the adequacy, accuracy or completeness of any information on its website or the use of any information retrieved from its website.

(Please complete this form as thoroughly as possible and Submit it. Do not leave blanks.)

Accredited Investor Questionnaire

E-mail Address: *
First Name: *
Middle Name:
Last Name: *
Address: *
City: *
State: *
Zip: *
Phone Number: *
Cell Number: *
Q-1) Please indicate the State in which the person is registered to vote: *

Q-2) Please indicate the State in which the person holds a valid Drivers License: *

Q-3) Please indicate the State of residence that the person identifies on their personal income tax return: *

Q-4) Are you a bank as defined in section 3(a)(2) of the ACT, or any savings and loan association or other institution as defined in section 3(a)(5)(A) of the Act whether acting in its individual or fiduciary capacity? *
Yes No
Q-5) Are you a broker or dealer registered pursuant to section 15 of the Securities Exchange Act of 1934? *
Yes No
Q-6) Are you an investment company registered under the Investment Company Act of 1940 or a business development company as defined in section 2(a)(48) of that Act? *
Yes No
Q-7) Are you an insurance company as defined in section 2(13) of the Act? *
Yes No
Q-8) Are you a Small Business Investment Company Iicensed by the U.S. Small Business Administration under section 301(c) or (d) of the Small Business Investment Act of 1958? *
Yes No
Q-9) Are you a plan established and maintained by a state, its political subdivisions, or any agency or instrumentality of a state or its political subdivisions, for the benefit of its employees, if such plan has total assets in excess of $5,000,000? *
Yes No
Q-10) Are you an employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974 if the investment decision is made by a plan fiduciary, as defined in section 3(21) of such act, which is either a bank, savings and loan association, insurance company, or registered adviser? *
Yes No
Q-11) Are you a private business development company as defined in section 202(a)(22) of the Investment Advisors Act of 1940? *
Yes No
Q-12) Are you an organization described in section 501(c)(3) of the Internal Revenue Code, corporation, Massachusetts or similar business trust, or partnership, not formed for the specific purpose of acquiring the securities offered, with total assets in excess of $5,000,000? *
Yes No
Q-13) Are you a director, executive officer, or general partner of the issuer of the securities being offered or sold, or any director, executive officer, or general partner of a general partner of that issuer? *
Yes No
Q-14) Are you a natural person whose individual net worth, or joint net worth with that persons spouse, at the time of his purchase exceeds $1,000,000? *
Yes No
Q-15) Are you a natural person who had an individual income in excess of $200,000 in each of the two most recent years or joint income with that persons spouse in excess of $300,000 in each of those years and has a reasonable expectation of reaching the same income level in the current year? *
Yes No
Q-16) Are you a trust, with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring the securities offered, whose purchase is directed by a sophisticated person as described in 230.506(b)(2)(ii)? *
Yes No
Q-17) Are you an entity in which all of the equity owners are accredited investors? *
Yes No
Q-18) I would consider an investment of: *
From $100,000 to $500,000 From $500,000 to $1,000,000 From $1,000,000 to $5,000,000
Q-19) Do you agree with the statements below? *
Yes, I fully understand that by agreeing and submitting this Accredited Investor Questionnaire Form, I am attesting that all my above statements are true and accurate to the best of my knowledge and belief and that I DO meet the criteria as established for an Accredited Investor. I furthermore attest that I have not been solicited or recruited in any manner whatsoever by Planet CPR Limited or any existing members of Planet CPR Limited. At no time has there been anything requested to contribute financially and no promises have ever been made other than what is shown in the business plan. Lastly, if my status as an Accredited Investor changes while I am reviewing the information I have requested, I will promptly notify Planet CPR Limited of the change in my status as an Accredited Investor.


* Required

Disclaimer: Planet CPR Limited is not a U.S. Securities Broker/ Dealer nor Investment Advisor. Planet CPR Limited makes no warranty as to the validity of any financial instruments presented either on this website or in any presented format By Planet CPR Limited and states that all required due diligence is the sole responsibility of the provider and/or purchaser, their legal representatives and/or assigns.

Planet CPR, LLC makes no representation, warranty or guarantee as to the accuracy or completeness of the information (including news, editorials, prices, statistics, analyses and the like) provided through this website. Any copying, reproduction and/or redistribution of any of the documents, data, content or materials contained on or within this website, without the express written consent of Planet CPR Limited is strictly prohibited. In no event shall Planet CPR Limited or its affiliates be liable to any person for any decision made or action taken in reliance upon the information provided herein.

An investment in the Fund involves a high degree of risk and is suitable only for accredited investors. No assurance can be given that the investment objectives will be achieved or that an investor will receive a return of all or part of his or her investment.

This website is intended for information purposes only, does not constitute investment advice, or a recommendation, or an offer or solicitation, and is not the basis for any contract to purchase or sell any security, or other instrument or any information contained herein. Although the information herein has been obtained from sources believed to be reliable, we do not guarantee its accuracy, completeness or fairness.

Opinions and estimates involve a number of assumptions, which may not prove valid and may be changed without notice. For more information, including a discussion of investment risks, please request the Offering Memorandum.

We advise that an investment should only be made after review of the Offering Memorandum.