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APPLICATION FOR ANEW LICENSE <br /> 5. CORPORATE STRUCTURE . <br /> Entity Legal Structure Corporation Date of Incorporation Mar 21,2018 <br /> —� Is the Corporation publicly traded? ()Yes Q No <br /> State of Incorporation Massachusetts <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 50%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 /> Director/LLC Manager US Citizen MA Resident <br /> Title and or Position Percentage of Ownershi <br /> Presiden=Trea=surer,Secretary&Director F1 QYes ()No Q Yes ()No Q=Yeso <br /> Name of Principal <br /> Residential Address SSN DOB _ <br /> 71 <br /> Title and or Position ercentacie of Ownership Director/LLC Manager"US Citizen MA Resident <br /> FF QYes QNo Q=s-- Q.Yes: QNo <br /> Name of Principal Residential Address SSN DOB <br /> F=- <br /> Title and or Position Percentage of Ownershi Director/LLC Manager US Citizen MA Resident <br /> QYes ()No I ()Yes QNo QYes ()No <br /> Name of Principal <br /> Residential Address SSN DOB _ <br /> F F-- F= <br /> Title and or Position Percentage of Ownershi Director/LLC Manager US Citizen MA Resident <br /> F [— <br /> Q Yes QNo Yes Q No QYes QNo <br /> Q <br /> Name of Principal <br /> Residential Address SSN DOB <br /> F= <br /> Title and or Position Percentage of Owners hi P Director/LLC Manager US Citizen _ MA Resident <br /> QYes QNo QYes QNo (7)YesQNo <br /> Additional pages attached? Q Ye:s::iN o <br /> CRIMINAL HIS <br /> Has any individual listed in question 6,and applicable attachments,ever been convicted of a F QYes j=No <br /> State,Federal or Military Crime?If yes,attach an affidavit providing the details of any and all convictions. <br /> MANAGEMENT AGREEMENT <br /> roeqng approval to utilize a management company through a management agreement? QYes QNo 2 <br /> Please provide a copy of the management agreement. <br />