2026 Prospective Candidate Packet

for the Goldbelt Board of Directors

Expectations for Directorship

Step 1 of 8

CONTACT INFORMATION
For administrative purposes only
Shareholder ID
Date of Birth(Required)
MM slash DD slash YYYY
Phone
Email(Required)

A copy of your submission will be emailed to the email address you provide upon submission.

Employer Name	Notes	Actions

There are no Entries.

Attendance Name	Type of Degree	Actions

There are no Entries.

Global Authorization

By signing or otherwise making a mark below, you authorize us, Sterling/First Advantage, and Sterling's service providers to do the following:
- • Collect and process your personal information as described above and here: https://privacy.sterlingcheck.com/, including collection and processing of sensitive personal information.
- • Share your personal information with, and obtain information from, the following third parties as necessary to carry out the requested services: police, courts, suppliers of court and police information, employers, employment agencies, educational institutions, credit and consumer reporting agencies, government agencies and other public bodies, regulatory or professional bodies, references you provide, other organizations with which you have been associated, and other publicly available print or online sources. You understand that these third parties may be located in countries or regions other than your country of residence, including places where you have previously lived, studied, or worked.
- • Where necessary, act as your agent to share or obtain your personal information when carrying out the services.
You declare that the information you provide to us and to Sterling is complete and accurate to the best of your knowledge. You understand that we will rely on the information you have provided when making a decision about your relationship with us, and that a false statement or omission of facts may disqualify you from, or otherwise affect, your relationship with us.

This authorization is valid for the duration of your relationship with us, to the extent permitted by law.
Signature(Required)
By signing the form below, you are authorizing Goldbelt to submit a background check with Sterling Check/First Advantage on your behalf.
Print Name(Required)
Date(Required)
YYYY dot MM dot DD

For additional information, please reference the 2026 Prospective Candidate Packet for the Goldbelt Board of Directors.

2026 Prospective Candidate Packet [PDF]

2026 Prospective Candidate Packet

Step 1 of 8

CONTACT INFORMATION

REQUIRED DISCLOSURES, AGREEMENTS, AND RESPONSIBILITIES TO BE INCLUDED IN THE PROXY MATERIALS

EMPLOYMENT OR OCCUPATION IN THE LAST FIVE YEARS

LEGAL, FINANCIAL, AND SOLICITATION DISCLOSURES

Legal and Financial Disclosures

In the last ten years have you been subjected to any of the following?

Solicitation Disclosures

Participants

REQUIRED CANDIDATE'S PERSONAL STATEMENT

PROSPECTIVE CANDIDATE AGREEMENTS AND RESPONSIBILITIES

Goldbelt Incorporated Code of Conduct Expectations for Candidates

Shareholders have the right to be free from harassment or threats.

Shareholders have the right to be free from financial coercion.

Shareholders have the right to vote for the candidate(s) of their choice.

Background Verification Section

Global Authorization