Disclaimer. The below is an example Individual Accredited Investor Certification. You should always consult and retain counsel if you are selling securities.
INDIVIDUAL ACCREDITED INVESTOR CERTIFICATION
I hereby certify that I am familiar with the definition of the term “accredited investor” as defined in Rule 501 of Regulation D issued pursuant to the Securities Act of 1933, as amended, and that I meet the criteria to qualify as an accredited investor, in the category or categories indicated by my initials below.
[ ] I am a director, executive officer, or general partner of the issuer of the securities being offered or sold, or a director, executive officer, or general partner of a general partner of that issuer.
[ ] I am a natural person whose individual net worth, or joint net worth with that of my spouse, is in excess of $1,000,000, excluding the value of my primary residence (an in accordance with the below rules);
[ ] I am a natural person who had individual income in excess of $200,000 in each of the two most recent years or joint income with my spouse in excess of $300,000 in each of those years and I have a reasonable expectation of reaching the same income level in the current year.
Rules regarding primary residences: In calculating net worth, an investor: (1) must exclude the value of the investor’s primary residence as an asset; (2) may exclude debt secured by the primary residence, up to the estimated fair market value of the residence; (3) must include the amount of any increase on the debt secured by the primary residence incurred within 60 days prior to the purchase of the securities (unless related to the acquisition of the primary residence); and (4) must include debt in excess of the fair market value of the residence.
Definition of “accredited investor.” http://taft.law.uc.edu/CCL/33ActRls/rule501.html
From the SEC:
Section 179. Rule 215 – Accredited Investor
Question: Under Section 413(a) of the Dodd-Frank Act, the net worth standard for an accredited investor, as set forth in Securities Act Rules 215 and 501(a)(5), is adjusted to delete from the calculation of net worth the “value of the primary residence” of the investor. How should the “value of the primary residence” be determined for purposes of calculating an investor’s net worth?
Answer: Section 413(a) of the Dodd-Frank Act does not define the term “value,” nor does it address the treatment of mortgage and other indebtedness secured by the residence for purposes of the net worth calculation. As required by Section 413(a) of the Dodd-Frank Act, the Commission will issue amendments to its rules to conform them to the adjustment to the accredited investor net worth standard made by the Act. However, Section 413(a) provides that the adjustment is effective upon enactment of the Act. When determining net worth for purposes of Securities Act Rules 215 and 501(a)(5), the value of the person’s primary residence must be excluded. Pending implementation of the changes to the Commission’s rules required by the Act, the related amount of indebtedness secured by the primary residence up to its fair market value may also be excluded. Indebtedness secured by the residence in excess of the value of the home should be considered a liability and deducted from the investor’s net worth. [July 23, 2010]
Washington Department of Financial Institutions rule making.