CLIENT INFORMATION SHEET

The following undertaking is provided by the undersigned, as verification of the identity of the undersigned as defined and described in Articles 2 through 5 of the Due Diligence Convention, the Federal Banking Commission circular of December 1991 which deals with the prevention of money laundering, and Article 305 of the Swiss Criminal Code. The nature and origin of the funds owned by the undersigned or a corporate entity under the control of the undersigned are forthrightly and honestly described and defined herein. The prepare of this Summary requests and the recipients of this document will affirm to protect the confidentiality of the information which follows.

The following is to be prepared in English utilizing either printed capital letters or typewritten.

FULL SIGNATORY NAME NATIONALITY PASSPORT NUMBER ISSUANCE DATE DATE OF BIRTH COUNTRY HOME PHONE # HOME FAX # BUSINESS PHONE # BUSINESS FAX # MOBILE PHONE # EMAIL ADDRESS BUSINESS NAME BUSINESS ADDRESS POSITION OF TITLE NATURE OF BUSINESS REGISTERED OFFICE REGISTRATION NUMBER LEGAL ADVISOR LEGAL ADVISOR ADDRESS PREFERRED MAILING ADDRESS

: : : : : : : : : : : : : : : : : : : : :

BANK NAME BANK ADDRESS WHERE INVESTMENT FUNDS RESIDE ACCOUNT HOLDER NAME ACCOUNT NUMBER ACCOUNT SIGNATORY

: : : : :

ORIGIN OF FUNDS TO BE INVESTED:

ARE FUNDS FREE OF ALL LIENS AND ENCUMBRANCES? BRIEF OVERVIEW OF INDIVIDUAL/ CORPORATE ACTIVITY: I hereby swear and attest, under penalty of perjury, that all of the information contained in this Client Information given above is true and accurate. This facsimile copy is as valid and legal as delivered original.

Date : 23/06/2010

___________________________________ (Signature) Name & Title : Passport Number : Issued By : Issue Date : Expiration Date :

Notarization