Form 2 — Beneficial Owner Information Report
(Section 112(2) of the Republic of the Marshall Islands Decentralized Autonomous Organization Act, 2022, as amended)
I, __________________________, a citizen of __________________________, declare under penalty of perjury under the laws of the Republic of the Marshall Islands in my capacity as Representative Agent of the decentralized autonomous organization (DAO) named below that the following information about the beneficial owner(s) of _________________________________________ is correct:
"Beneficial owner" is defined in Section 102(r) of the DAO Act and refers to natural person(s) who ultimately owns or controls, or has ultimate effective control of, the DAO LLC, whether directly or indirectly, or on whose behalf such interest in the DAO LLC is held.
Beneficial owners must be identified through A or B below. If no person meets the definition of "beneficial owner," select category C, an authorized representative member.
Categories
| Category | Description |
|---|---|
| A | All natural person(s) who ultimately have a controlling interest (holding more than 25% of the governance tokens/interests or voting rights, whether directly or indirectly) in the DAO LLC. |
| B | Where no natural person meets category A, all natural person(s) exercising managerial control of or managing the DAO LLC through other means, including any Managing Members. |
| C | Where no natural person meets category A or B, a person who is an authorized representative member of the DAO LLC. |
Beneficial Owner Information Table
| Full name (surname first and middle) (for C: full name or company name) | Date of birth (for C: date of birth or company formation date) | Residential address (for C: residential or business street address) | ID number and citizenship from a non-expired passport (for C: ID number and citizenship or company jurisdiction and registration number) | Address(es) and blockchain(s) of all wallets associated with DAO LLC held by or on behalf of person | Total % of membership interest (if any) | Category (A, B, or C) |
|---|---|---|---|---|---|---|
Signature
Date: ___________________________
_______________________________________ Signature
Name: _________________
Title: Beneficial Owner, Representative Agent, or Authorized Representative Member