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Disclosures for Continuing Directors

Disclosures for Continuing Directors

for the Goldbelt Board in 2023

2023 Board of Directors Disclosures

Step 1 of 4

25%

REQUIRED DISCLOSURES, AGREEMENTS, AND RESPONSIBILITIES TO BE INCLUDED IN THE PROXY MATERIALS
Name(Required)
First Middle Last Suffix
Alaska Native or Tlingit Name (Optional)
Age(Required)
Residence Address(Required)
"Residence" means residence for purpose of voting, as determined under Alaska Statute 15.05.02

City State / Province / Region

EMPLOYMENT OR OCCUPATION IN THE LAST FIVE YEARS
Title or Occupation(Required)
If you are considered retired, self-employed, or unemployed please indicate in your title
Current Employer(Required)
Start Date(Required)
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY

Employment History

Employer or Occupation	Title	Actions

There are no Entries.

Maximum number of entries reached.

Have you ever held, or do you currently hold any contracts, positions, or offices at Goldbelt or Goldbelt-funded organizations, including any affiliiates, subsidiaries, limited liability corporations, non-profit organizations, or trusts?(Required)
- Yes
- No
List all positions(Required)
Between January 2017 and present, have you served as a director for any non-Goldbelt entities or companies?(Required)
- Yes
- No
List all positions(Required)

REQUIRED DISCLOSURES FROM ALASKA DIVISION OF BANKING AND SECURITIES
If Goldbelt believes there are any materially false or misleading statements or omissions in any material submitted by a candidate, then Goldbelt will refer those items to banking and securities for investigation and disclose such information to shareholders as it deems appropriate which may result in disqualification from appearing on the corporate proxy.
Legal and Financial Disclosures
Have you had any legal proceedings in which you are or were a party to any legal action with interests adverse to the corporation or its subsidiaries during the last ten years? (If there is a question as to whether or not an issue is considered a legal proceeding, please submit the query to Goldbelt and the Alaska Division of Banking and Securities, and include the status and/or ruling with this form).(Required)
- Yes
- No
Provide an explanation of all instances to be included in the proxy statement.(Required)
Between January 1, 2022 and present, have you been involved in financial transactions, or have any presently proposed financial transactions, with the corporation or its subsidiaries where: transaction(s) in the aggregate exceed $20,000; and you or a member of your family is a party to this transaction(s) or is with an entity, other than an affiliate of the corpororation, where you or your family is employed by, is an officer or director of, or owns, directly or indirectly, an interest in the entity. The term "entity" includes individuals, sole proprietorships, partnerships, joint ventures, trusts, associations, firms, corporations, or other organizations, whether or not operated for profit, which are not wholly owned subsidiaries of Goldbelt.(Required)
- Yes
- No
Please provide an explaination below of all instances to be included in the proxy statement.(Required)
In the last ten years have you been subjected to any of the following?
Bankruptcy, whether voluntary or involuntary(Required)
- Yes
- No
Appointment of a receiver for your assets or entity(Required)
- Yes
- No
Pending criminal convictions or pleas of nolo contendre to a criminal charge other than traffic offenses or other minor offenses(Required)
- Yes
- No
Any final judgement, order, or decree that you have engaged in unethical or illegal business practices, violated fiduciary duties, or violated securities law(Required)
- Yes
- No
If "Yes," to any of the instances above, include an explanation below to be included in the proxy statement.(Required)
Do you have a family relationship with any director, nominee, or executive officer of the corporation, its subsidiaries, or Goldbelt funded non-profits or trusts? “Family Relationship” shall mean a relationship with any of the following: an individual’s spouse, parents, children, or siblings by blood or adoption.(Required)
- Yes
- No
If "Yes," to any of the instances above, include an explanation below to be included in the proxy statement.(Required)

Goldbelt is required to include my name on its proxy, my biographical information, disclosures, photograph, and management-provided board and committee meeting attendance, I hereby agree to the following
Checking each box indicates that you have read and understand the information being provided.
- I have read and agree to comply with Goldbelt’s Bylaws and Goldbelt’s Election Rules.
- I agree that any decision made by majority vote of the Goldbelt Board of Directors is final.
Electronic Signature(Required)
By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this packet.
Email(Required)
To receive a confirmation of your submission along with a copy of your responses, provide a valid email address below.

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Goldbelt Incorporated is an urban Alaska Native, for‐profit corporation headquartered in Juneau, Alaska.

[email protected]

(907) 790-4990
3025 Clinton Drive
Juneau, AK 99801

(703) 871-2091
13900 Lincoln Park Drive
Suite 140
Herndon, VA 20171

ISO 9001:2015 Registered #GIUS-1067-QC
ISO/IEC 20001-1:2018 Registered #GIUS-1067-IT
ISO/IEC 27001:2013 Registered #GIUS-1067-IC

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