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Franchise Application - Hilton Worldwide

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<strong>Franchise</strong> <strong>Application</strong>2012 Mexico All BrandsThis franchise application (“<strong>Application</strong>”) includes the following:• Instructions for submitting an <strong>Application</strong>• Part 1 - <strong>Application</strong> Checklist• Part 2 - <strong>Application</strong> Letter• Part 3 - <strong>Application</strong> Form• Part 4 - Due Diligence Checklist, including Individual Participant Information Form and Business Entity Participant Information Form.Instructions for Submitting an <strong>Application</strong>:For your convenience this application may be filled out electronically. Click in any field to type.When you are finished you can print your completed application.Please Note: You must have reader versions 7 or 8 or a full version of adobe acrobatto save this document to your hard drive with the information you filled in.1. Have a required signer for the Applicant (as noted on the next page) access the current <strong>Franchise</strong> Disclosure Document (“Disclosure Document”) for the applicablebrand through the E-Disclosure procedure and complete the procedure by clicking “Submit” on the Electronic Receipt page. If Applicant received a paperversion of the Disclosure Document, have a required signer for the Applicant sign and date the “Receipt” page at the end of the Disclosure Document and return itimmediately by mail to your development representative.2. Each part of this <strong>Application</strong> must be completed. Additional pages may be attached as necessary. All information must be legible and in English. Please type or printthe information in each part of the <strong>Application</strong>. For your convenience, this <strong>Application</strong> may be filled out electronically, saved and printed. However, a signed hardcopy, along with the <strong>Franchise</strong> <strong>Application</strong> Fee in Paragraph 5 below, must be submitted to your development representative.3. Attach supporting documents/information indicated in each part of the <strong>Application</strong>. If any part of the <strong>Application</strong> is not completed and/or supporting documentationis not attached, you must include an explanation of why the <strong>Application</strong> is not completed or the supporting documentation is not attached. Incomplete <strong>Application</strong>scannot be considered.4. The Applicant must be a natural person or an existing legal entity. You must provide a complete organizational chart up to the ultimate owning entity/entities and theultimate individual beneficial owners of the Applicant. You must provide us with the relevant Participant Information forms (Part 4) for the Applicant and each personor entity with a 25% or greater ownership interest in Applicant, and/or a controlling interest in Applicant (e.g., general partner, managing member, etc.).5. A check (or wire transfer) for the franchise application fee (“<strong>Franchise</strong> <strong>Application</strong> Fee”) must be submitted with the <strong>Application</strong>. The amount of the <strong>Franchise</strong><strong>Application</strong> Fee is:N o t i c eBrand<strong>Franchise</strong> <strong>Application</strong> FeeConrad ® $75,000Doubletree ® by <strong>Hilton</strong>$75,000, plus $300 per guest room/suite over 250 guest rooms/suitesDoubletree Suites ® by <strong>Hilton</strong>Embassy Suites ®$75,000, plus $300 per suite over 250 suitesHampton Inn$65,000, plus $450 per guest room/suite over 100 guest rooms/suitesHampton Inn & Suites ®<strong>Hilton</strong> ®$85,000, plus $300 per guest room/suite over 275 guest rooms/suites<strong>Hilton</strong> Garden Inn ®$75,000, plus $450 per guest room/suite over 150 guest rooms/suitesHomewood Suites by <strong>Hilton</strong> ®$60,000, plus $450 per guest room/suite over 150 guest rooms/suitesHome2 Suites by <strong>Hilton</strong> ® $50,000Waldorf Astoria ® $75,0001


<strong>Franchise</strong> <strong>Application</strong>2012 Mexico All BrandsFor a Relicensing <strong>Application</strong> (not involving a Change of Ownership), you must pay a Property Improvement Plan (“PIP”) fee in addition to the <strong>Franchise</strong> <strong>Application</strong> Fee,calculated as follows:BrandConrad or Waldorf Astoria $75,000Doubletree by <strong>Hilton</strong>, Doubletree Suites by<strong>Hilton</strong>, Embassy Suites or <strong>Hilton</strong>Hampton Inn, Hampton Inn & Suites, <strong>Hilton</strong>Garden Inn, Homewood Suites by <strong>Hilton</strong> orHome2 Suites by <strong>Hilton</strong><strong>Franchise</strong> <strong>Application</strong> Fee$25 per guest room/suite, multiplied by the number of years in the Relicensingterm$35 per guest room/suite multiplied by the number of years in the RelicensingtermRequired Signatures:The <strong>Application</strong> Letter must be signed and dated by the Applicant, or on behalf of the Applicant, by a person or persons with the capacity and authority to do so. Thesignatures required for valid execution of the <strong>Application</strong> Letter may vary depending on the laws under which the Applicant is established or resident. These laws must becomplied with. Our minimum requirements for signatures are as follows:ApplicantIndividual(s)Corporate EntityGeneral PartnershipLimited PartnershipLimited Liability CompanyTrustEstateSigner(s)Each IndividualPresident, Vice President or other authorized officerEach General PartnerAny General PartnerManaging Member(s) or other authorized Member(s)Trustee(s)Executor or AdministratorNOTE: APPLICANT SHOULD NOT SIGN OR SUBMIT A FRANCHISE AGREEMENT UNTIL AT LEAST THE DAY AFTER THE 30TH FULL BUSINESS DAYFOLLOWING THE DATE APPLICANT RECEIVED THE DISCLOSURE DOCUMENT IN PAPER FORM OR THROUGH THE E-DISCLOSURE PROCEDURE.2


Part 3: <strong>Application</strong> Form2012 Mexico All BrandsNAME OF APPLICANT:APPLICANT(entity name may not include any of our marks or any variations/initials thereof)State in which Applicant’s principal business address(or if Applicant is an individual, permanent residence) is located:Type: Corporation Limited Partnership General Partnership Limited Liability CompanyIndividual Trust Limited Liability Partnership Other (specify) ______________________Birth or Formation Information: Date: (Month/Day/Year) ______/______/______ State/Province, Country:U.S. Social Sec.# (last 4 digits only)/ Canada SIN#(Optional)/Gov’t ID#: _________________________________________________________PRINCIPAL CORRESPONDENTFOR LEGAL NOTICESName:Street Address:City:State/Province, Zip/Postal Code:FOR DAY-TO-DAY COMMUNICATIONSName:Street Address:City:State/Province, Zip/Postal Code:Telephone #: Telephone #:Fax #: Fax #:Email:Email:THE PROPOSED HOTEL WILL BE MANAGED BY:A General Manager who will be employed by the ApplicantThe General Manager will be:A Management Group under a Management Agreement with the ApplicantCompany Name and Contact:Address:MANAGEMENT INFORMATIONTelephone:Fax:Email:Attachments:(1) List of Hotels owned or managed by the management groupLIST ALL HOTELS OWNED AND/OR OPERATED BY APPLICANT AND ITS EQUITY OWNERS(attach additional pages if necessary)Owner/Operator Name Brand/Property Name, City/State Description of Interest % Equity6


Ownership Structure of Applicant Entity2012 Mexico All BrandsINSTRUCTIONS: Please provide a complete breakdown of the owners of the Applicant Entity and any related entity that holds/will hold fee title to the Hotel site or, forcomplex structures, please attach a detailed organizational chart (see next page). If these owners are other legal entities, please include a breakdown of their underlyingownership. That means you should provide the name and description/percentage of ownership interest of all individuals who own and/or control these entities. Copy thisform as needed to provide multiple structures.Example:Entity/Person’s Name SSN (last 4 digits), Description Of % Interest Business AddressEIN, Canada SIN or Interest & TelephoneGov’t ID#:XYZ Corp. 12-3456789 XYZ Corp. Address/Phone- John Doe, President 50% 1234 General Partner 1% John Doe Address/Phone- Jane Doe, Shareholder 50% 5678 Jane Doe Address/PhoneABC, L.L.C. 23-4567891 Limited Partner 99% ABC, L.L.C. Address/Phone- BDC, Inc., its managingmember 25% 34-5678912 BDC, Inc. Address/Phone- Bill Davis, President 100% 9012- Bill Davis Family Trust,member 25% 45-6789123 Trust ContactAddress/Phone- Bill Davis, Trustee 2345- Bill Davis, Jr. Beneficiary 100% 6789- Bill Davis, member 50% same as above Bill Davis Address/PhoneENTITY NAME:OWNERSHIP STRUCTURE(provide additional pages if necessary)Entity/Person’s Name SSN (last 4 digits), Description Of % Interest Business AddressEIN, Canada SIN or Interest & TelephoneGov’t ID#:Attachments: (1) Copies of recorded formation and governing documents of Applicant and its controlling entities (e.g., Articles of Incorporation,Partnership Agreement, Operating Agreement, etc.)(2) On request, completed Individual or Business Entity Participant Information Forms7


Organizational Chart2012 Mexico All BrandsPlease attach a full organizational chart for the Applicant entity and Applicant’s affiliate that will lease or sublease the Hotel or theHotel Site to Applicant, if applicable, showing all direct and indirect equity owners up to the ultimate individual beneficial owners(but excluding public shareholders or passive investors in an institutional investment fund).Attachments:Complete ownership structure of Applicant and related entity that is the title holder or lessor/sublessor of the the Hotel/Hotel Site(if applicable)For example:Ultimate Owner A(x% ownership interest)Ultimate Owner B(x% ownership interest)Ultimate Owner C(x% ownership interest)Entity A(x% shareholder)Entity B(x% shareholder)Entity C(x% shareholder)Applicant8


Hotel/Site/ Site Control Information2012 Mexico All BrandsLocation of Hotel/Hotel site:Street Address/Coordinates*:___________________________________________________________________________________________________* If no street address, provide coordinates or other location description:City, State/Province:______________________________________________________ Zip/Postal Code: ______________ Country:_________________BRAND (check one):Conrad ® Hampton Inn ® * Homewood Suites by <strong>Hilton</strong> ®Doubletree ® by <strong>Hilton</strong> Hampton Inn & Suites ® * Home2 Suites by <strong>Hilton</strong> ®Doubletree ® Suites by <strong>Hilton</strong> <strong>Hilton</strong> ® Waldorf Astoria ®Embassy Suites ® * <strong>Hilton</strong> Garden Inn ®* Brand may include the “by <strong>Hilton</strong>” tagline in Franchisor’s sole discretion.Development Type:New Development (new-build/adaptive reuse) Conversion Change of Ownership RelicensingHotel Affiliation:(for New Development/Conversion applications only)Has there ever been a franchise, branded management, affiliation or similar agreement pertaining to this hotel or site? No Yes/Describe: ________________________________________________________________________________________________________________________________________________________________________________If the hotel is currently affiliated with a hotel chain, what chain? No Yes/Describe: _____________________________________________________HOTEL FACILITIES:(existing and/or proposed)Total Guest Units: ________ # of Standard Rooms: __________ # of Suites:__________ # Stories: ____________ Year built: _____________Meeting space: No Yes _____________sq. ft. # Meeting Rooms: _________________ Ballroom: No Yes ________________sq. ft.Swimming Pool: Indoor Outdoor None Health Club: No Yes/Description: _____________________________________________Spa: No Yes/Description: _____________________________________________Food & Beverage facilities (list outlets, capacity, meals served, operated/leased, current/planned brand names): _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Other Retail Outlets (type, operated/leased, current/planned brand names): __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Other Amenities (specify): ________________________________________________________________________________________________________________________________Shared Facilities: No Yes/Description: ___________________________________________________________________________________Condo Residences: No Yes (#): ________________________________________________________________________________________Hote Rental Program?: No Yes : _______________________________________________________________________________________Attachments:Conversion Indemnity Letter (if applicable)City maps/aerial photograph showing location and perimeter of site (for New Development/Conversion)Copy of original Certificate of Occupancy for the hotel, if available (open hotel only)9


Hotel/Site/ Site Control Information2012 Mexico All BrandsHOTEL site/building information:Total sq footage of site: ___________ Zoned for hotel development: Yes No Max height allowed by zoning: Sq. ft _________________Stories: _______________ Site/Development Restrictions?: No Yes/Description: _______________________________________________________________________________________________________________________________________________________________________Please describe Applicant’s current form of site control for the Hotel or Hotel Site:Owned by Applicant (attach copy of recorded deed)Ground lease (attach copy of recorded ground lease) Expiration Date:_________________________Binding option agt (attach copy of recorded option agt.) Exercise Deadline:_______________________Binding purchase agt (attach copy of executed purchase agt.) Closing Deadline:________________________Other/Describe: _________________________________________________________________________________________________________If Hotel or Hotel Site is currently owned by someone else other than Applicant, please indicate:Hotel/Hotel Site owner name:___________________________________________________________________________________________________Street Address:_____________________________________________________________________________________________________________State/Province:_____________________________________________________________________________________________________________Zip/Postal Code Country:_____________________________________________________________________________________________________Tel: ________________________Fax:________________________ Email: _______________________________________________________Related to Applicant? No Yes/Describe: __________________________________________________________________________________If Hotel or Hotel Site will, upon close of purchase, be owned by someone other than Applicant, please indicate:Fee owner/Lessor name:___________________________________________________________________________________________________Street Address:_____________________________________________________________________________________________________________State/Province:_____________________________________________________________________________________________________________Zip/Postal Code Country:_____________________________________________________________________________________________________Tel: ________________________Fax:________________________ Email: _______________________________________________________Related to Applicant? No Yes/Describe and provide complete ownership structure of related entity that will be fee owner (see form on Page 7):Attachments:Site Plan (for New Development)Copy of applicable site control document10


Financial Information/Project Timeline2012 Mexico All BrandsESTIMATED PROJECT COSTS – NEW CONSTRUCTION:Costs: Overall: Per Key:Land: US$ ______________________ US$ ______________________Construction: US$ ______________________ US$ ______________________FF&E: US$ ______________________ US$ ______________________Other: US$ ______________________ US$ ______________________TOTAL Project costs US$ ______________________ US$ ______________________ESTIMATED PROJECT COSTS – CONVERSION or change of ownership (existing hotel):Costs: Aggregate: Per Key:Purchase Price/Current Market Value: US$ ______________________ US$ ______________________Renovations/Upgrades: US$ ______________________ US$ ______________________Other: US$ ______________________ US$ ______________________TOTAL Project costs US$ ______________________ US$ ______________________ESTIMATED PROJECT Timeline:Forecasted Construction/Renovation Start Date: ___________________ Forecasted Construction/Renovation Completion Date: ___________________OPERATING PROJECTIONSAssumptions Yr 1 Yr 2 Yr 3 Yr 4 Yr 5% OccupancyAvg. Daily Rate ($US)Financing/Refinancing Information:Do you have a loan or loan commitment for this project? No Yes (continue)Name of Lender(s):_____________________________________________________________________________________________Loan Amount(s): __________________ Percentage Equity: ____________ Loan Description:_________________________________________________New Loan Existing LoanIs the loan (or will the loan be) cross-collateralized by other hotels/real estate assets or cross-defaulted to any other loan(s)?No Yes/Describe:____________________________________________________________________________________________________Deadlines associated with Project or <strong>Application</strong>:Are there any critical deadlines we should know about in processing your application e.g. purchase closings or financing commitment deadlines?No Yes/Describe:____________________________________________________________________________________________________Attachments:Market or Feasibility Study (if available or on request)For Conversion projects, past three years’ operating statisticsFinancial statements for Applicant, its controlling equity owners, and each individual/entity with a 25% or greater direct or indirect ownership interest in Applicant11


part 4: Due Diligence2012 Mexico All BrandsIn addition to any documents requested in Parts 1 or 3, please provide the following documents to your development representative.1. Organizational Chart from the Applicant up to the ultimate owning entity/entities and the ultimate individual beneficialowners.2. Individual Participant Information Form for the day-to-day manager of the Applicant; Business Entity Participant InformationForm and a Individual Participant Information Form for the Applicant and any entity or individual who:a. Holds, directly or indirectly, an equity interest in the Applicant which is 25% or more; orb. Has a controlling interest in the Applicant (regardless of ownership percentage).3. Organizational Documents that:a. Evidence the entity is duly formed in its state/country of organization and state who is designated as theday-to-day manager for Applicant and any entity that, directly or indirectly:i. Holds, directly or indirectly, an equity interest in the Applicant which is 25% or more; orii. Has a controlling interest in the Applicant (regardless of ownership percentage).Examples of such documents include:• For LLCs: Articles of Organization, Certificate of Formation, Operating Agreement• For LPs: Certificate of Limited Partnership, Partnership Agreement• Private companies: Articles of Incorporation and Bylaws4. Most up-to-date audited or unaudited financial statements (clearly indicating period of time and signed by a Director/Officer) for Applicant and any entity or individual who:a. Holds, directly or indirectly, an equity interest in the Applicant which is 25% or more; orb. Has a controlling interest in the Applicant (regardless of ownership percentage).Attachments:Full Organizational ChartCompleted Business Entity Participant Information FormsCompleted Individual Participant Information FormsOrganizational DocumentsAudited or Unaudited Financial Statements12


Individual Participant Information Form (PIF)2012 Mexico All BrandsPlease complete an Individual Participant Information Form for: (1) Applicant; (2) each individual who holds, directly or indirectly, an equity interest in the Applicant whichis 25% or more; and (3) each individual who has a controlling interest in Applicant (regardless of ownership percentage) (e.g., general partners, managing members, etc.)Attach additional pages if necessary.Name of Individual:______________________________________________________________________________________________________________________(Full first name) (Middle name/initial) (Last name) (Former name/alias, if applicable)U.S. SSN/ Canada SIN/ or Gov’t. Number:________________________________________________________ Sex: [ ] Male[ ] FemaleDate of Birth (Mo/Day/Year): _______/_______/_______ Place of Birth: _____________________________ Country: _______________________________Telephone #:_________________________ Fax #:________________________ Email:___________________________________________________Home Address/Dates for the past 10 years:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Employment History, including name of Employer, address, position and dates for the past 10 years:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Relationship to Applicant:____________________________________________________ % Ownership of Applicant:_____________________________(i.e. Shareholder, Officer, General Partner, Managing Member, limited partner, member etc.)References (name, address and telephone number):1. Bank/financial institution:___________________________________________________________________________________________________________________2. Business:______________________________________________________________________________________________________________________________3. Personal:______________________________________________________________________________________________________________________________Have you or any legal entity in which you have been an officer, director, member, partner or held a management position, or in which you owned 10% or more of the entity,ever been: 1) a defendant in civil litigation alleging fraud, deceit or similar claims; 2) been convicted of a criminal offense or have a charge currently pending; 3) filed forprotection from creditors under applicable bankruptcy laws; 4) been a defaulting party in a foreclosure proceeding; or 5) been the subject of disciplinary action with respectto the suspension or revocation of a professional or gaming license? [ ] NO [ ] YES If yes, please provide details below:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I certify that to the best of my knowledge the statements contained in this Individual Participant Information Form are true and complete and I have not withheld any informationaffecting my reputation and credit standing. I understand that <strong>Hilton</strong> <strong>Worldwide</strong>, Inc. and its subsidiaries and affiliates (collectively, “HWI”) are relying on these statements toevaluate Applicant’s <strong>Application</strong>. In accordance with the Privacy Act, Freedom of Information Act, the Fair Credit Reporting Act, and any similar federal, state or local statutoryor common laws or regulations, I expressly authorize the above-named references and any other person, company, association, firm, agency, bureau, financial institution orcourt system to release to HWI any information it requests (including, but not limited to, information concerning my education, employment history, financial transactions, creditpayment history, civil record, criminal conviction record, legal proceedings or judgments or any other record or report) and for HWI to use such information for the purpose ofconducting any credit and/or background checks.13


Individual Participant Information Form (PIF)2012 Mexico All BrandsI hereby release, indemnify, defend and hold harmless HWI, and the officers, directors, employees, agents, representatives, successors and assigns of each HWI entity (collectively,“HWI Indemnitees”) and any and all other persons or entities, including without limitation those providing information, from any and all claims, losses, injuries,liabilities, or damages of whatsoever kind or nature, whether known or unknown, including without limitation those based on defamation, invasion of privacy, and rights ofpublicity and personality, against any or all of them which may at any time arise or accrue to me or my heirs, successors, parents, subsidiaries, assigns, officers, directors,employees, agents or other person or entities claiming by or though me, on account of the provision of such information or reliance on such information or on other informationgathered pursuant thereto and hereto. I hereby authorize this Individual Participant Information Form, indemnity and release to be shown and delivered to such persons, with acopy of this Individual Participant Information Form, indemnity and release to be as valid as the original.This document shall be governed by and construed in accordance with the substantive laws of the State of New York, without regard to its choice of law principles.SIGNATURE: _____________________________________________________________________________ DATED: ________/________/________mo day yr14


Business Entity Participant Information Form (BIF)2012 Mexico All BrandsPlease complete a Business Entity Participant Information Form for: (1) Applicant entity; (2) each entity that holds, directly or indirectly, a 25% or more equity interest in theApplicant; and (3) each entity that has a controlling interest in the Applicant, regardless of ownership percentage (e.g., general partners, managing members, etc.) You mayattach additional pages to complete the requested information.Name of Entity:_________________________________________________________________________________________________________________________Formation Date (Mo/Day/Year): _____/_____/_____Jurisdiction (State or Province/Country): ________________________________________________________Principal Business Address: __________________________________________________________________________________________________________________________________________________________________________________________________________________________EIN or Gov’t ID Number: ______________________________________________ Email:__________________________________________________Telephone #:_______________________________________________________ Fax #:__________________________________________________Relationship to Applicant:______________________________________________________________ Percentage of Ownership:______________________________(i.e. Shareholder, Officer, General Partner, Managing Member, limited partner, member etc.)References (name, address and telephone number):1. Bank/financial institution:___________________________________________________________________________________________________________________2. Business:______________________________________________________________________________________________________________________________3. Personal:______________________________________________________________________________________________________________________________Has the Entity or an affiliate of the Entity (or in which the Entity has held a management position or ownership interest of greater that 10%) ever been: 1) a defendant in civillitigation alleging fraud, deceit or similar claims; 2) been convicted of a criminal offense or have a charge currently pending; 3) filed for protection from creditors under applicablebankruptcy laws; 4) been a defaulting party in a foreclosure proceeding; or 5) been the subject of disciplinary action with respect to the suspension or revocation ofa professional or gaming license? [ ] NO [ ] YES If yes, please provide details below:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________The undersigned hereby certifies that the statements contained in this Business Entity Participant Information Form are true and complete, and that nothing affecting thereputation and credit standing of the Entity has been withheld. The undersigned understands that <strong>Hilton</strong> <strong>Worldwide</strong>, Inc. and its subsidiaries and affiliates and/or its representatives,owners, successors and assigns, and each of such entities’ officers, directors, members, shareholders, partners, owners, agents and employees (collectively,“HWI”) are relying on these statements to evaluate Applicant’s <strong>Application</strong>. In accordance with the Privacy Act, Freedom of Information Act, the Fair Credit Reporting Act,and any similar federal, state or local statutory or common laws or regulations, the undersigned expressly authorizes the above-named references, and any other person,company, association, firm, agency, bureau, financial institution or court system to release to HWI any information that is requested (including, but not limited to, informationconcerning the business and credit history, financial transactions, civil and criminal conviction records, legal proceedings or judgments or any other record or report)and HWI to request, obtain and use such information for the purpose of conducting any credit and/or background investigations or checks.The undersigned agrees to release, indemnify, defend and hold harmless HWI and any and all other persons or entities, including without limitation those providing information(“Indemnitees”) from any and all claims, damages, injuries, liabilities or losses of whatever kind or nature, whether known or unknown, including without limitationthose based on defamation, invasion of privacy, and rights of publicity and personality, against any or all of them which may at any time arise or accrue to the undersignedEntity or any persons or entities claiming by or through such Entity, on account of the provision of such information or reliance on such information or on other informationgathered pursuant to this Business Entity Participant Information Form or related to conducting any credit and/or background checks. The undersigned authorizes this BusinessEntity Participant Information Form, indemnity and release to be shown and delivered to such persons, with a copy of this Business Entity Participant Form, indemnityand release to be as valid as the original.15


Business Entity Participant Information Form (BIF)2012 Mexico All BrandsThe undersigned represents and warrants that he/she has authority to sign this Business Entity Participant Information Form on behalf of Entity.This document shall be governed by and construed in accordance with the substantive laws of the State of New York, without regard to its choice of law principles.BUSINESS ENTITY:_________________________________________________________________________________________________________SIGNATURE:______________________________________________________________________________________________________________Printed Name:___________________________________________________________________________________________________________Title:_________________________________________________________________________________ DATED: ________/________/_________mo day yr

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