A standard form questionnaire for obtaining information from persons covered by the "bad actor" disqualification provision of Rule 506(d) of Regulation D under the Securities Act. Rule 506(d) disqualifies securities offerings from the safe harbor provided by Rule 506 if any covered person, including the issuer, its directors, and certain officers and stockholders, and any "compensated solicitors" for the offering, was involved in a disqualifying event. This Standard Document assumes that the issuer is not a pooled investment fund.