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APPLICATION FOR ANEW LICENSE <br /> . CORPORATE STRUCTURE <br /> Entity Legal Structure Corporation Date of Incorporation Mar 21,2018 <br /> State of Incorporation Massachusetts Is the Corporation publicly traded? Q Yes e No <br /> 6. PROPOSED OFFICERS STOCK OR OWNERSHIP INTEREST <br /> List all individuals or entities that will have a direct or indirect,beneficial or financial interest in this license(E.g.Stockholders,Officers, <br /> Directors,LLC Managers,LLP Partners,Trustees etc.).Attach additional page(s)provided,if necessary,utilizing Addendum A. <br /> • The individuals and titles listed in this section must be identical to those filed with the Massachusetts Secretary of State. <br /> • The individuals identified in this section,as well as the proposed Manager of Record,must complete a CORI Release Form. <br /> • Please note the following statutory requirements for Directors and LLC Managers: <br /> On Premises(E.g.Restaurant/Club/Hotel)Directors or LLC Managers -At least SO%must be US citizens, <br /> Off Premises(Liquor Store)Directors or LLC Managers -All must be US citizens and a majority must be <br /> Massachusetts residents. <br /> • If you are a Multi-Tiered Organization,please attach a flow chart identifying each corporate interest and the individual owners of <br /> each entity as well as the Articles of Organization for each corporate entity. Every individual must be identified in Addendum A. <br /> Name of Principal Residential Address SSN DOB <br /> Zohaib Shahid <br /> Title and or Position Percentage of Ownershidirector/LLC Manager US Citizen MA Resident <br /> President,Treasurer,Secretary&Director 100% Yes )No Q Yes Q No Q« Yes Q No <br /> Name of Principal Residential Address SSN DOB <br /> F 11 - <br /> Title and or Position Percentage of Ownership Director/LLC Manager US Citizen MA Resident <br /> FQ Yes Q No d Yes Q No Q Yes Q No <br /> Name of Principal Residential Address SSN DOB <br /> Title and or Position Percentage of Ownership Director/LLC Manager US Citizen MA Resident <br /> F- ...... ()Yes Q No I ()Yes Q No Q Yes Q No <br /> Name of Principal Residential Address SSN DOB <br /> Title and or Position Percentage of ODirector/LLC Manager US Citizen MA Resident <br /> F- � 1- wnershi <br /> Q Yes Q No Q Yes Q No I Q Yes a No <br /> Name of Principal Residential Address SSN DOB <br /> Title and or Position Percentage of Ownership Director/LLC Manager US Citizen MA Resident <br /> Q Yes Q No Q Yes Q No Q Yes Q No <br /> Additional pages attached? <br /> ()Yes Q No <br /> CRIMINAL HISTORY <br /> Has any individual listed in question 6,and applicable attachments,ever been convicted of a Q Yes (Fj No <br /> State,Federal or Military Crime?If yes,attach an affidavit providing the details of any and all convictions. <br /> MANAGEMENT AGREEMENT <br /> Are you requesting approval to utilize a management company through a management agreement? <br /> Please provide a copy of the management agreement. Q Yes (Q No 1 2 <br />