[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE

]

DOCUMENTATION ENCLOSED (SF-B)

INDIVIDUAL ENTRY
DATE: March 30, 2014
TO:
Trade Authority / Program Manager
RE:
Participation in Structured Private Financial Opportunity
 CLIENT INFORMATION SUMMARY
 LETTER OF INTENT
 LETTER OF CEASE & DESIST CONFIRMATION
 LETTER OF NON-SOLICITATION & REQUEST
 AUTHORIZATION TO VERIFY FUNDS/INSTRUMENT
 SIGNATORY'S 140% PASSPORT SCAN IN ‘PDF’
 PROOF OF FUNDS OR BANK ‘RWA’ RE
INSTRUMENT
 LETTER OF LIAISON AUTHORITY FOR
TRANSLATOR
PLEASE NOTE THE FOLLOWING INSTRUCTIONS:





CLIENT TO ENTER ‘TRANSACTION CODE’ WHERE
REQUESTED
ONLY BLUE ‘WET INK’ SIGN ATURES/INITIALS
ACCEPTED.
ATTAC H FULL PAGE PASSPORT & BANK
STATEMENT SCANS AS SEPAR ATE FILES. SMALL
TYPE & PHOTO MUST BE CLEAR.
PLEASE PROVIDE (150 DPI) 'PDF' SC ANS/FILES
NOT JPG .
DON’T DELETE ANY TEXT. IF NOT APPLICABLE,
ENTER 'N/A'
BANK STATEMENT, PASSPORT, INSTRUMENT
COPIES MUST BE NOTARIZED AS BEING A ‘TRUE
COPY’ OF THE ORIGINAL.

APPLICANT INITIALS ___________

PAGE 1 OF 13

[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE] E-mail. APPLICANT INITIALS ___________ PAGE 2 OF 13 . provided they are represented by the proper signatories. facsimile copies or photocopies of documents or agreements pertaining to this subject are declared and regarded as valid and equal to the original. NOTE: The original signed documents may be requested -.so keep them on file.

: Legal Advisor APPLICANT INITIALS ___________ PAGE 3 OF 13 . then insert the term: “N/A” (not-applicable) -.[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE] CLIENT INFORMATION SUMMARY Directions: This document must be fully completed -. Name of Translator (Complete Page 17): Tel Number: Email Address: Passport No.if a line item does not apply to you.DO NOT DELETE ANY TEXT Personal Information *(Please attach ‘Notarized’ copy of Passport plus 2 Utility Bills) First Name: Middle Name: Last Name: Gender: Date of Birth: Social Security Number: Country of Citizenship: Passport Number: Date of Issue: Date of Expiry: Issuing Authority: Home Street Address: City: State: Country: Postal Code: Telephone Number: Fax Number: Mobile Number: Email Address: Languages / Translator Languages: Do you speak English?: If No.

: SWIFT Code: Account Signatory (1): Account Signatory (2): Bank Officer # 1 Name: Bank Officer # 2 Name: Telephone Number: Fax Number: Client Account where Profits to be paid Bank Name: Street Address: City: State: Country: Postal Code: Account Name: Account Number: APPLICANT INITIALS ___________ PAGE 4 OF 13 .[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE] Full Name: Company: Address: City: State: Country: Postal Code: Telephone Number: Fax Number: Email Address: Bank Information *(Please attach current dated 'Account Statement' from bank) Bank Name (where funds/Instrument are currently on deposit): Street Address: City: State: Country: Postal Code: Account Name: Account Number: Sort Code ABA No.

encumbrances and third party interests?: I.: SWIFT Code: Bank Officer Name: Telephone Number: Fax Number: Investment Funds (amount/currency) available for this transaction?: If Instrument – (describe) issued by (bank name/city/country)?: Origin of Funds/Assets (How Funds/Assets were earned or acquired – give details)?: Are these Funds/Assets free and clear of all liens. that the information provided herein is accurate and true as of this date: March 30. (NAME). 2014 For and on behalf of (NAME OF INDIVIDUAL) Signature: ________________________________ (Blue ‘Wet Ink’ Signature) Name: Passport Number: Date of Issue: Date of Expiry: Country of Issuance: LETTER OF INTENT DATE:March 30. hereby swear under penalty of perjury.[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE] Sort Code ABA No. 2014 TO: Trade Authority / Program Manager RE: Participation in Structured Private Financial Opportunity APPLICANT INITIALS ___________ PAGE 5 OF 13 .

I hereby warrant and represent that I have available for placement into the proposed investment. APPLICANT INITIALS ___________ PAGE 6 OF 13 . I confirm and acknowledge. and herewith attach documentary evidence of same. my full commitment and agreement to participate in an investment opportunity. Furthermore.[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE] INVESTOR TRANSACTION CODE: (client to assign) Dear Sir. liens or encumbrances and of non-criminal origin. I hereby warrant and represent that I have available for placement into the proposed investment.00 USD/Euro) of clean. In the case of Blocked Funds/Assets. conditions and procedures that shall be outlined in the Private Placement Program. it is my understanding the funds/assets will be blocked and or reserved in the account and they will remain. Furthermore. (NAME).00 USD/Euro) backed by clean. hereby confirm under penalty of perjury.000.000. the sum of (SPELL AMOUNT) Euro/United States Dollars ($_____. upon my acceptance of the agreement.000. liens or encumbrances and of non-criminal origin. and herewith attach documentary evidence of same. non-callable. with full responsibility. and. free of any levy. clear funds. at all times. that I am approaching you voluntarily for the purpose of securing participation in a bona fide Secure Private Placement Program. I am prepared to instruct my bank to act upon the funds/assets as required pursuant to the specifics of this program. a (type of instrument) issued by (name of bank/country) with a face value of (SPELL AMOUNT) Euro/United States Dollars ($_____. subject to my acceptance of the terms. and that such funds/assets are available for immediate placement at my sole discretion. that the documents that I shall receive shall not be deemed to be a solicitation of funds/assets in connection with an investment program. I hereby warrant and represent that the Rule of Full-disclosure has established these funds/assets were legally obtained from non-criminal business or actions. I further confirm I am the beneficial owner of these cash funds/assets and that I have full signatory authority and control thereof. clear funds.000. that neither your company nor anyone working on your behalf has solicited me. I. the undersigned. condition and procedures of a secured investment and look forward to commencing the transaction. I hereby request information from you covering the terms. free of any levy.

that the information provided herein is accurate and true as of this date: March 30. facsimile copies or photocopies of documents or agreements pertaining to this subject are declared and regarded as valid and equal to the original. hereby swear under penalty of perjury. (NAME). Originals may be obtained upon request. I. 2014 For and on behalf of (NAME OF INDIVIDUAL) Signature: ________________________________ (Blue ‘Wet Ink’ Signature) Name: Passport Number: Date of Issue: Date of Expiry: Country of Issuance: APPLICANT INITIALS ___________ PAGE 7 OF 13 .[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE] Email. provided they are represented by proper signatories.

intermediaries. duly authorized give notice to have Cease and Desist and any/other group previous group approached in the past regarding our/my files I. 2014 For and on behalf of (NAME OF INDIVIDUAL) Signature: __________________________________ (Blue ‘Wet Ink’ Signature) Name / Title: Company: Passport Number: Date of Issue: Date of Expiry: Country of Issuance: APPLICANT INITIALS ___________ PAGE 8 OF 13 . hereby swear under penalty of perjury.[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE] LETTER OF CEASE & DESIST CONFIRMATION DATE:March 30. 2014 TO: Trade Authority / Program Manager RE: Participation in Structured Private Financial Opportunity INVESTOR TRANSACTION CODE: (client to assign) Dear Sir. affiliates. financial institutions. groups or others with my /our permission nor any specific authorization to handle nor process any one of my /our documents as from March 30. I. 2014 And that. All previous entities. by the correspondent official 'Cease and Desist Letter' communication. intermediaries. (NAME). I. associations. affiliates. This exclusive authority and engagement shall continue fully effective until cancelled in writing by me. (NAME). that the information provided herein is accurate and true as of this date: March 30. (NAME). make a clear statement and confirm under risk and penalty of perjury not to have any other entities. groups or others. bearing (COUNTRY) Passport No. (NUMBER). have been notified of such. financial institutions. associations.

or any type of offering. I hereby declare that I am fully aware of the information received from you is in direct response to my request. hereby confirm that I have requested of you and your organization specific confidential information and documentation on behalf of ourselves. and is not in any way considered or intended to be a solicitation of funds of any sort. and understand that neither are you or your organization. and not intended for the general public.[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE] LETTER OF NON-SOLICITATION & REQUEST DATE:March 30. We mutually agree that this private placement transaction is exempt from the Securities Act. I understand that the contemplated transaction is strictly one of private placement. governing authority or agency. and all materials are for private use only. That affiant makes this affidavit knowing that the recipients will rely on the contents hereof. and is intended for our general knowledge only. Further. (NAME). and is in no way relying on or related to the United States Securities Act of 1933. the Federal Reserve or an official or other insider of any such entity.against any and all claims resulting from any applicant misrepresentation of a material fact or any loss of asset value or any act (legal or not) of a bank or other financial institution. and does not involve the sale of securities. as amended or related regulations. I. 2014 TO: Trade Authority / Program Manager RE: Participation in Structured Private Financial Opportunity INVESTOR TRANSACTION CODE: (client to assign) Dear Sir. and agrees to indemnify and hold-harmless all recipients and all other parties -including intermediaries -. For and on behalf of (NAME OF INDIVIDUAL) Signature: ________________________________ (Blue ‘Wet Ink’ Signature) Name: Passport Number: Date of Issue: Date of Expiry: Country of Issuance: APPLICANT INITIALS ___________ PAGE 9 OF 13 . the undersigned. I hereby affirm under penalty of perjury that you have not solicited in any way. I hereby declare we are not licensed brokers or government employees.

000. and cleared cash funds obtained via legal means. clean. (NAME) at the address shown above.000. and is currently available at the bank coordinates below: Cash/Instrument Amount: ($___.000. hereby swear under penalty of perjury. in an amount of (SPELL AMOUNT) Euro/United States Dollars ($_____. by these present that I. 2014 TO: Trade Authority / Program Manager RE: Authorization to Verify INVESTOR TRANSACTION CODE: (client to assign) Know all men. that the information provided herein is accurate and true as of this date: March 30. give you clear notice that you have my direct permission and full authority to do all matters necessary to confirm. (NAME). 2014 For and on behalf of (NAME OF INDIVIDUAL) Signature: ________________________________ (Blue ‘Wet Ink’ Signature) Name: Passport Number: Country of Issuance: C.[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE] AUTHORIZATION TO VERIFY FUNDS/ASSETS DATE:March 30. The below stated beneficially owned account is of good.00 USD/Euro) Bank Name: (NAME OF THE BANK).C. verify and authenticate my beneficially owned cash funds and/or application asset(s) and its associated good standing account status.: (NAME OF BANK & BANK OFFICER) APPLICANT INITIALS ___________ PAGE 10 OF 13 . Bank Address: (ADDRESS OF BANK) Account Name: (ACCOUNT NAME) Account Number: (ACCOUNT NUMBER) Account Signatory: (ACCOUNT SIGNATORY) Bank Officer on the Account: (OFFICER NAME & TITLE) (A COPY OF THIS AUTHORIZATION WILL BE PRESENTED AND LODGED WITH MY BANK OFFICER) In witness hereof I.000.00 USD/Euro) (OR DESCRIBE INSTRUMENT) on a bank-to-bank basis.

ATTACH THE PASSPORT AS A 'SEPARATE' PDF FILE. ENLARGED TO 140% SO THE PHOTO AND SIGNATURE PAGES FILL AN 8½ X 11 INCH PAGE SIZE IN THE PORTRAIT FORMAT. LEAVE THIS SPACE BLANK APPLICANT INITIALS ___________ PAGE 11 OF 13 .[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE] PASSPORT INSTRUCTIONS PROVIDE A HIGH QUALITY 'PDF' COLOR SCAN. THE PHOTO AND SMALL TYPE MUST BE CLEAR AND EASY TO READ.

FRONT & BACK AS SEPARATE 'PDF' FILES. LEAVE THIS SPACE BLANK LETTER OF LIAISON & COMMUNICATIONS AUTHORITY APPLICANT INITIALS ___________ PAGE 12 OF 13 . MAY ALSO BE INCLUDED.[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE] PROOF OF FUNDS & INSTRUMENT INSTRUCTIONS PLEASE PROVIDE A CURRENT DATED (UNSANITIZED) ‘BANK STATEMENT’ OR ‘TEAR SHEET’. IF SUBMITTING A ‘FINANCIAL INSTRUMENT’ PLEASE ATTACH A HIGH-QUALITY 'PDF' COLOR SCAN OF THE ‘ORIGINAL’ DOCUMENT -. ATTACH BANK STATEMENT / TEAR SHEET AS A 'SEPARATE' PDF FILE. CERTIFICATE OF ACCOUNT OR CONFIRMATION OF FUNDS AS A BANK LETTER. A BANK CAPABILITY LETTER (BCL). SIGNED BY TWO BANK OFFICER(S). NO OLDER THAN FIVE (5) DAYS AS AN ACCEPTABLE PROOF OF FUNDS. BUT ONLY AS 'SUPPLEMENTAL' BANK INFORMATION. PLEASE SCAN IN 'PDF' AND ATTACH AS A SEPARATE FILE.

bearing (COUNTRY) Passport No. A copy of the Translator’s Passport has been attached as a separate PDF file. I. (NUMBER) having the below contact details.) Office/Home Number: (TRANSLATOR PHONE NUMBER) Mobile Number: (TRANSLATOR MOBILE NUMBER) Email Address: (TRANSLATOR EMAIL) Address: (TRANSLATOR ADDRESS) I. duly authorized and full legal representative director for and on behalf of (NAME OF COMPANY). hereby swear under penalty of perjury that the information provided herein is accurate and true as of this date: March 30. Name of Translator: (TRANSLATOR NAME) Passport No.: (TRANSLATOR’S PASSPORT NO. 2014 For and on behalf of (NAME OF COMPANY) Signature: _________________________________ (Blue ‘Wet Ink’ Signature) Name / Title: Company: Passport Number: Date of Issue: Date of Expiry: Country of Issuance: APPLICANT INITIALS ___________ PAGE 13 OF 13 . (NUMBER). to act as my official liaison in such matters to carry out the duty and responsibility as primary contact to coordinate communication and receive copies of all written and telephonic communication regarding the above transaction as I do not speak English and he is my official translator. (NAME). 2014 TO: Trade Authority / Program Manager RE: Participation in Structured Private Financial Opportunity INVESTOR TRANSACTION CODE: (client to assign) Dear Sir.[INSERT APPLICANT LETTERHEAD IN THIS HEADER SPACE] DATE:March 30. bearing (COUNTRY) Passport No. (NAME). hereby authorize (TRANSLATOR NAME).