ZecHub Contributor Form

Name

OFAC Certification. I certify that (1) I am not, nor am I owned or controlled by or acting on behalf of, any person, group, entity, or nation that is (i) designated on any sanctions-related list of restricted or blocked persons (including the U.S. Department of the Treasury, Office of Foreign Asset Control’s (OFAC) List of Specially Designated Nationals and Blocked Persons) or otherwise the subject of any restrictions under U.S. economic sanctions, anti-terrorism, or anti-money laundering law, or (ii) located, organized, or resident in any country or territory that is itself the subject of any U.S. economic or financial sanctions (currently Cuba, Iran, North Korea, Syria, Crimea, and the so-called Donetsk and Luhansk People’s Republics); and (2) I am not facilitating this transaction on behalf of any person, group, entity or nation described in clause (1), nor will the proceeds received be used in any way that violates U.S. economic sanctions, anti-terrorism, or anti-money laundering law.

Tax Certification. I certify that ZecHub, Inc. does not provide legal or tax advice, and I have consulted with my own tax advisor regarding the tax consequences to me of receiving any payment from ZecHub, Inc. I further certify that I will not, in any calendar year, perform services for ZecHub, Inc. in exchange for compensation exceeding $600 in U.S. dollar value.

Shielded Address

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