SANCTIONS COMPLIANCE CERTIFICATION The undersigned member of the Indiegogo website and online service (hereafter, “Member”)  is  promoting a campaign related to Iran. The Campaign is currently being promoted, among other places, at www.indiegogo.com/_______________________________________. To ensure compliance with U.S. law in connection with the Campaign, Member hereby represents, warrants, certifies, and covenants the following: No funds from the Campaign shall be used to finance travel to or activities in Iran, except as affirmatively authorized by the U.S. Treasury Department Office of Foreign Assets by means of a general or specific license, even in cases where local law would not require prior government approval to travel to Iran; The Campaign is independent of the Government of Iran and has not been undertaken at the direction or suggestion of that government; The Member is not an official or agent of the Government of Iran and is not acting at the direction or suggestion of an official or agent of that government; The Member is not a blocked national of Iran as defined by the U.S. Treasury Department Office of Foreign Assets; No funds from the Campaign will be provided directly or indirectly to the Government of Iran,  any  entity  or  person  on  the  U.S.  Treasury  Department’s  List  of  Specially  Designated   Nationals and Blocked Persons (available at www.treasury.gov/resourcecenter/sanctions/SDN-List/Pages/default.aspx)  (hereafter,  “SDN  List”),  except  as   authorized by the U.S. Treasury Department Office of Foreign Assets Control by general or specific license; and No funds for the Campaign will be solicited or knowingly accepted from the Government of Iran, any official or agent of the Government of Iran, any entity or person on the SDN List, or any person subject to blocking; and none of the aforementioned persons or entities has any property interest in the Campaign of any nature whatsoever -- present, future, contingent, direct, or indirect. Neither Member nor Indiegogo is being requested to take nor shall take (or be required to take) any action that is prohibited or penalized under the laws of the United States or any applicable foreign jurisdiction. Member agrees to promptly notify Indiegogo if there is any change of facts or intentions described in this certification that occur after the date below for the duration of the Campaign. This certification shall be deemed to be continuing in effect for the duration of the Campaign. This certification supplements the terms of the Indiegogo Terms of Use  agreement  (hereafter,  “Agreement”),  available  at  www.indiegogo.com/about/terms.    Failure   to make and adhere to this certification will be considered a violation of the Agreement and subject the Member to permanent or temporary termination or suspension at any time at Indiegogo’s  sole  discretion  and  Indiegogo  will  have  no  further  obligations  to  Member   whatsoever including without limitation any obligation to disburse funds received in support of the Campaign. To the extent there is any material change to the content or purpose of the Campaign, Member agrees to provide notice to Indiegogo of such change and Indiegogo may, at its sole discretion, require Member to provide additional information and further certifications as a condition of continuing to allow the promotion of the Campaign through the Indiegogo website and online service. On request from Indiegogo, Member will provide a copy of any U.S. Government specific license issued in connection with the Campaign. _________________________ Member Signature _________________________ Date _________________________ Member Printed Name Member/Organization Address of Residence: _________________________ Street Line 1 _________________________ Street Line 2 _________________________ City, State/Province _________________________ Zip/Postal Code _________________________ Country _________________________ Telephone Number (Including Country Code)