KYC - Corporate (1) 20012019-4-Dikonversi

[INSERT APPLICANT LETTERHEAD
IN HEADER SPACE]
DOCUMENTATION ENCLOSED
*** CORPORATE ENTRY ***
DATE: January 9, 2020

TO: Trade Authority / Program Manager
RE: Participation in Structured Private Financial Opportunity
◼ UNDERSTANDING THE RULES OF THE ROAD

◼ AFFIDAVIT REQUESTING INFORMATION
◼ CLIENT INFORMATION SHEET
◼ CORPORATE RESOLUTION
◼ LETTER OF EXCLUSIVITY
◼ LETTER OF INTENT
◼ LETTER OF CEASE & DESIST CONFIRMATION
◼ SOURCE OF FUNDS AFFIDAVIT
◼ LETTER OF NON-SOLICITATION & REQUEST
◼ AUTHORIZATION TO VERIFY FUNDS
◼ CONFIRMATION OF BANK OFFICER
◼ PASSPORT(S)
◼ PROOF OF FUNDS
ATTACHMENTS (IF NEEDED)

◼ LETTER OF LIAISON AND COMMUNICATIONS AUTHORITY
◼ IRREVOCABLE FEE PROTECTION AGREEMENT
E-mail, facsimile copies or photocopies of documents or agreements pertaining to this

subject are declared and regarded as valid and equal to the original, provided they are
represented by proper signatories. Originals may be required upon request.
APPLICANTS INITIALS _______

UNDERSTANDING THE IN HEADER
RULES SPACE]
OF THE ROAD
None of the customary standards and practices that apply to normal, conventional business, investing and finance
applies to private funding programs. It is a "privilege" to be invited to participate in a Private Placement Transaction
Program, not a "right." The trading administrators and managers have a virtually endless supply of financially qualified
applicants. All things considered, the trading administrators and their banks will favor the applicant who provides the
best paperwork. An applicant should never underestimate what the trading entities knowledge about him. Failure to
provide full disclosure will disqualify the disingenuous. Clients must first prove that they are qualified, not the other
way around. Until the client is accepted by Compliance, the Traders, and Trading Banks, no placement can occur. The
U.S. Patriot Act has introduced obligatory compliance procedures. Face‐to‐face interviews with compliance officers and
program management are occasionally required, but generally not necessary. Any arrogant or demanding personality
will be guaranteed to be rejected. Only the principal owner of funds is required as signatory. Corporations must
empower an Officer or Director as sole, exclusive signatory by using a Corporate Resolution. Not only do the funds have
to be on deposit in an acceptable bank; they must also be in an acceptable jurisdiction. It is felony fraud to submit
documents or financial instruments that are forged, altered or counterfeit. Such documents are promptly referred to
the appropriate law enforcement agencies for immediate criminal prosecution. The practices, procedures and rules are
determined by the U.S. Federal Regulatory Authorities, Western European Central Banks program management,
licensed traders and trading banks. It is their decision whom to accept and whom to reject. Contract terms, yield,
schedules, etc., are made to fit their needs and schedules – and not the caprices or demands of the investors. This
marketplace is highly regulated and strictly confidential, and absolute confidentiality by the investor is a key element
of every contract. A client who breaks confidentiality will precipitate instant cancellation. Finally, submission of the
application documents to more than one management group at a time is termed "shopping". If an investor "shops" he
can expect that this fact shall be quickly disseminated and known among the program management groups who
maintain close communication – and will then be accepted by none and rejected by all.
I, (NAME), have read and accepted the above as of this date: January 9, 2020
Signature: ________________________________
Name:
Passport Number:
Country of Issuance:

IN HEADER
AFFIDAVIT REQUESTING SPACE]
INFORMATION

INVESTOR TRANSACTION CODE:
Dear Sir,
I, (NAME), the undersigned, on my own behalf, do hereby affirm that I have requested specific information about
Private Placement Opportunities and or the Participation in Investment Programs. The confidential information
presented, received, and learned is not for the solicitation of funds, nor is it an offering of any kind, but is for my
general knowledge. I confirm that I have requested the information of my own free will and choice, and further
confirm that no party has solicited me in any way. I hereby agree to keep all information received from you strictly
confidential, private, and proprietary, and that I will not disclose it to any other third party.
I, (NAME), further affirm that any funds or assets I decide to place are done so at my own specific initiative, risk,
and authorization with full consideration and without duress. I further affirm that the information received is
intended solely for my PRIVATE & CONFIDENTIAL USE ONLY. I am a sophisticated investor by all definitions of that
classification known to me; I make my own investment decisions and have legally acquired assets available. I, hereby
reaffirm, under penalty of perjury that I have requested information from you and your organization and that you
have not solicited me in any manner.
I, (NAME), understand that the contemplated transaction is strictly one of Private Placement and is in no way relying
upon existing regulations in relation to the United States Securities Act of 1933 as amended, or related regulations,
and does not involve the buy and sell of securities. I further declare that I am not a licensed securities broker or
government employee and understand that neither are you or your organization. I mutually agree that this Private
Placement Transaction is exempt from the securities act.
I, (NAME), understand and agree that the ICC NON-DISCLOSURE and NON-CIRCUMVENTION rules apply to this
affidavit and business relationship, and hereby agree to the current application standards of the International
Chamber of Commerce, Paris, France which rules are made a part hereof by this reference.
I, (NAME), under penalty of perjury, with full corporate and individual responsibility, hereby irrevocably, confirm
that neither myself, nor anyone else associated with my organization, my corporation, or the individual investor are
working for any Agencies of any Government. I further state under penalty of perjury that I am not involved in any
Government entrapment operation.
I, (NAME), under penalty of perjury, with full corporate and individual responsibility, hereby irrevocably, confirm
that neither myself, nor anyone else associated with my organization or corporation have been convicted of a felony,
either within the United States or anywhere in the world where that crime would be considered equal to a US felony.
To the best of my knowledge I am not nor are any of my associates within my organization or

IN HEADER SPACE]
corporation considered to be terrorists or on any watch list with the United States Department of Homeland
Security.
I, (NAME), agree that all email and facsimile transmitted documents shall be treated as original documents. I further
agree that in all cases where plural might apply where singular tense is used it is so applied.
I, (NAME), hereby swear under penalty of perjury, that the information provided herein is accurate and true as of
this date: January 9, 2020
For and on behalf of (NAME OF COMPANY)
Signature: __________________________________ SEAL OF COMPANY

Name / Title:
Company:
Passport Number:
Date of Issue:
Date of Expiry:

IN HEADERSHEET
CLIENT INFORMATION SPACE]
Directions: This document must be completed in full. If a line item does not pertain, then insert the term: “N/A”
(non-applicable).
Corporate Information
Full Name of Corporation:

Date of Incorporation:
Incorporated in (City/State/Country):
Registration Number:
Board of Directors (Name & Title):
Officers (Name & Title):
Shareholders (List all shareholders owning more than 5 % of all outstanding shares of Corporation):
Location of Address: Registered Address (Corporation)

Street Address:
City:
State:
Country:
Postal Code:
Location of Address: Mailing Address (Corporation)

Street Address:
City:
State:
Country:
Postal Code:
Contact Information (Corporation)
Telephone Number:
Fax Number:
Mobile Number:
Email Address:
Financial Information (Corporation)
Annual Income of Corporation:

Liquid Assets of Corporation:
Net Worth of Corporation:

Investment Experience (in years) of Corporation: IN HEADER SPACE]
Languages / Translator
Languages:
Does the Signatory speak English?:
If No, Name of Translator:
Tel Number:
Email Address:
Legal Advisor
Full Name:
Company:
Address:
City:
State:
Country:
Postal Code:
Telephone Number:
Fax Number:
Email Address:
Bank Information (Corporate)

* Please attach copy of account statement from bank
Bank Name (where funds are currently on deposit):

Street Address:
City:
State:
Country:
Postal Code:
Account Name:
Account Number:
Sort Code ABA 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

IN HEADER SPACE]
Bank Name:
Street Address:
City:
State:
Country:
Postal Code:
Account Name:
Account Number:
Sort Code ABA No.:
SWIFT Code:
Bank Officer Name:

Telephone Number:
Fax Number:
Personal Information of Officer(s) of Corporation / Passport Information

(Please attach copy of corporate resolutions adopted by the Board of Directors appointing and authorizing said
officer(s) to represent and legally bind the corporation)
* Duplicate the section below for each Director.
First Name:
Middle Name:
Last Name:
Gender:
Date of Birth:
Social Security Number:
Country of Citizenship:
Languages:
Passport Information of Officers(s) of Corporation

*Please attach copy of photo and signature page of passport
Passport Number:
Date of Issue:
Date of Expiry:
Issuing Authority:
Location of Address: Home-Legal Residence (Officer(s) of Corporation)

(Please attach copy of utility bill)
Full Name of Officer:

Street Address:
City:
State:
Country: IN HEADER SPACE]
Postal Code:
(Below, duplicate the section above for each Director)
Investment
Funds available for this transaction:
Type of currency:
Origin of funds:
Are these funds free and clear of all liens, encumbrances and third party interests?:

Name / Title:
Company:
Passport Number:
Date of Issue:
Date of Expiry:

IN HEADER SPACE]
CORPORATE RESOLUTION
All of the directors of (COMPANY NAME) below listed were in attendance, in person or by telephone conference.
General discussion was then held concerning the issue, and all aspects of the same, were fully explained in detail to
the satisfaction of the board members.
DIRECTOR Name/Title:
Passport No.:
Passport No.:
Passport No.:
SECRETARY Name/Title:
Passport No.:
The Board of Directors of (COMPANY NAME) an International Business Company incorporated on (DATE) in
(LOCATION) in (COUNTRY), with Registered Offices at (ADDRESS) in a meeting held on this the (Day) Day of
(MONTH), (YEAR), adopted the following resolutions.
RESOLUTION 1:
It is resolved that the Board of Directors of (COMPANY NAME) hereby authorizes: (NAME) holder of Passport
Number (NUMBER) issued on (DATE).
As our Managing Member, as the (President-CEO etc) who assigned authority, on our behalf stay and name, to
instruct, negotiate, arrange, monitor, execute, manage and sign any and all agreements and/or necessary contracts
with third parties pertinent to all financial transactions with bank instruments (securities/derivatives)
RESOLUTION 2:
It is resolved that at this meeting of the Board of Directors that our Managing Member and in fact (NAME) acts for
(COMPANY NAME) with regards to the afore said financial investment.
RESOLUTION 3:
It is resolved that (NAME) is hereby authorized to act as our Financial Director for afore said purpose.
RESOLUTION 4:
It is resolved the Board of Directors of (COMPANY NAME) hereby authorized (NAME) to assume all authority,
powers, duties, signatory rights and responsibilities on our behalf.

IN HEADER SPACE]
RESOLUTION 5:
It is resolved that (NAME) is hereby authorized to open a personal, corporate, trading, trust and/or custodial account
in any bank, domestic or foreign and to sign such resolutions as may be required by such bank to accomplish the
objective(s) as stated herein and to give irrevocable instructions to said bank(s) on our behalf.

Name / Title:
Company:
Passport Number:
Date of Issue:
Date of Expiry:
Signature: __________________________________
Name / Title: SECRETARY
Company:
Passport Number:
Date of Issue:
Date of Expiry:

IN HEADER SPACE]
LETTER OF EXCLUSIVITY

Dear Sir,
I, (NAME), bearing (COUNTRY) Passport No. (NUMBER), authorized signatory of the Account No (ACCOUNT
NUMBER) at (NAME OF THE BANK), located at (ADDRESS OF BANK), the undersigned, (hereinafter referred to as
the “INVESTOR”), hereby with full, personal and legal responsibility under penalty of perjury of law, represent,
warrant and attest that:
I, the undersigned, have full legal title, rights, interest, control and authority to commit and invest these funds and
have chosen to do so of their own free will and sole decision without any solicitation or influence from the trade
administrators.
I, the undersigned, principal party involved in this transaction do not have any other party working with or
authorized to work with these funds allocated for above-mentioned reference code, nor have any other parties
been authorized to invest these funds, nor have other funds from myself or the corporation been placed with other
parties for a similar investment. Further I attest that I have sent Cease & Desist Notices to any other intermediaries
or trade groups that have had access to our paperwork in the past.
I, the undersigned, herewith grant Program Manager, full exclusive right as our sole agent for 3 Months and 1 Day
(Three Months and One Day) and/or the period of the contract whichever is later including any proceeds of the
investment if re-invested, from the above date, to enter these funds for me, or the Corporation into the best
available investment
I, the undersigned, understand, and I am fully aware that this transaction will be registered with a major world bank
and/or the Federal Reserve and the submitted private and confidential paperwork will be forwarded for the sole
purpose of establishing necessary dossier due diligence and clearance for this transaction.
I, the undersigned understand and acknowledge that the Program Manger (hereinafter referred to as the “Trade
Coordinator”) will initially base the placement of this transaction on the face value representations and
documentation presented, and that any misrepresentation may be considered criminal bank fraud. I, the
undersigned hereby indemnify the Trade Coordinator against any misrepresentations.
Facsimiles or electronically transmitted documents are deemed as legally binding as delivered originals.

IN HEADER SPACE]

Name / Title:
Company:
Passport Number:
Date of Issue:
Date of Expiry:

LETTER OFININTENT
HEADER SPACE]

Dear Sir,
I, (NAME), the undersigned, hereby confirm under penalty of perjury, my full commitment and agreement to
participate in an investment opportunity, subject to my acceptance of the terms, conditions and procedures that
shall be outlined in the Private Placement Program.
Furthermore, I hereby warrant and represent that I have available for placement into the proposed investment, the
sum of (SPELL AMOUNT) United States Dollars ($_____,000,000.00 USD) of clean, clear funds, free of any levy, liens
or encumbrances and of non-criminal origin, and herewith attach documentary evidence of same. I hereby warrant
and represent that the Rule of Full-disclosure has established these funds were legally obtained from non-criminal
business or actions. I further confirm that I am the beneficial owner of these cash funds, that I have full signatory
authority and control thereof, and that such funds are available for immediate placement at my sole discretion.
I confirm and acknowledge, with full responsibility, that neither your company nor anyone working on your behalf
has solicited me; that the documents that I shall receive shall not be deemed to be a solicitation of funds in
connection with an investment program; and, 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 as required pursuant to the specifics of this program. In
the case of Blocked Funds, it is my understanding the funds will be blocked and or reserved) in the account and they
will remain, at all times, non-callable.
I hereby request information from you covering the terms, condition and procedures of a secured investment and
look forward to commencing the transaction, upon my acceptance of the agreement.
Email, facsimile copies or photocopies of documents or agreements pertaining to this subject are declared and
regarded as valid and equal to the original, provided they are represented by proper signatories. Originals may be
obtained upon request.

IN HEADER SPACE]
Name / Title:
Company:
Passport Number:
Date of Issue:
Date of Expiry:

IN HEADER
LETTER OF CEASE & DESIST SPACE]
CONFIRMATION

Dear Sir,
I, (NAME), bearing (COUNTRY) Passport No. (NUMBER), duly authorized and full legally representative director for
and on behalf of (NAME OF COMPANY), give notice to have Cease and Desist and any/other group previous group
approached in the past regarding our/my files
I, (NAME), make a clear statement and confirm under risk and penalty of perjury not to have any other entities,
associations, financial institutions, affiliates, intermediaries, groups or others with my /our permission nor any
specific authorization to handle nor process any one of my /our documents as from January 9, 2020
And that; All previous entities, associations, financial institutions, affiliates, intermediaries, groups or others have
been notified of such by the correspondent official Cease and Desist Letter communication. This exclusive authority
and engagement shall continue fully effective until cancelled in writing by me.

Name / Title:
Company:
Passport Number:
Date of Issue:
Date of Expiry:

IN HEADER
SOURCE OF FUNDS SPACE]
AFFIDAVIT

Dear Sir,
and on behalf of (NAME OF COMPANY), do solemnly swear/attest the following statements to be true.
I, (NAME), declare under penalty of perjury and with full personal and legal responsibility under the International
Court of Law that I legally hold the sum of (SPELL AMOUNT) United States Dollars ($_____,000,000.00 USD) and it
is deposited in Account No (ACCOUNT NUMBER) at (NAME OF THE BANK), located at (ADDRESS OF BANK).
I further declare these funds are current and valid currency lawfully obtained and constitute clean, cleared funds of
legitimate, non-criminal, commercial origin. There are no liens, contractual obligations or encumbrances of any
kind against these funds.
I have full and complete, legal ownership of, and the unrestricted right and authority to pledge or otherwise utilize
these funds. The funds are ready for transfer or release upon my instruction.
These funds are authentic and verifiable. I am not aware of any matter which could or might cause the non-
validation of these funds and I hereby indemnify the Program Manager and/or assignees, intermediaries, or other
parties involved, against any claims, demands, civil and/or criminal in nature, and liabilities, damages, or expenses
including without limitation any attorney’s fees which may arise, whether in whole or in part, caused by reason of
reliance upon this sworn declaration.
E-mail, facsimile copies or photocopies of documents or agreements pertaining to this subject are declared and
regarded as valid and equal to the original, provided they are represented by proper signatories. Originals may be
obtained upon request.

Name / Title:
Company:
Passport Number: IN HEADER SPACE]
Date of Issue:
Date of Expiry:
(THIS DOCUMENT MUST BE NOTARIZED)
NOTARY:

IN HEADER SPACE]
LETTER OF NON-SOLICITATION & REQUEST

Dear Sir,
I, (NAME), the undersigned, hereby confirm that I have requested of you and your organization specific confidential
information and documentation on behalf of ourselves. I hereby declare that I am fully aware of the information
received from you is in direct response to my request and is not in any way considered or intended to be a
solicitation of funds of any sort, or any type of offering, and is intended for our general knowledge only. I hereby
affirm under penalty of perjury that you have not solicited in any way. I understand that the contemplated
transaction is strictly one of private placement and is in no way relying on or related to the United States Securities
Act of 1933, as amended or related regulations, and does not involve the sale of securities. That affiant makes this
affidavit knowing that the recipients will rely on the contents hereof, and agrees to indemnify and hold-harmless all
recipients and all other parties -- including intermediaries -- 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, governing authority or agency, the Federal Reserve or an official or other insider of any such entity.
Further, I hereby declare we are not licensed brokers or government employees and understand that neither are
you or your organization. We mutually agree that this private placement transaction is exempt from the Securities
Act, and not intended for the general public, and all materials are for private use only.

Name / Title:
Company:
Passport Number:
Date of Issue:
Date of Expiry:

AUTHORIZATION TOIN HEADER
VERIFYSPACE]
FUNDS

RE: Authorization to Verify
Know all men, by these that I, (NAME), at the address shown above, give you clear notice that you have my direct
permission and full authority to do all matters necessary to confirm, verify, and authenticate my beneficially owned
cash funds and/or application asset(s) and its associated good standing account status, in an amount of (SPELL
AMOUNT) United States Dollars ($_____,000,000.00 USD) on a bank to bank basis. The below stated beneficially
owned account is of good, clean, and cleared cash funds obtained via legal means, and is currently available at the
bank coordinates below:
Cash Amount: ($_____,000,000.00 USD)

Bank Name: (NAME OF THE BANK),
Bank Address: (ADDRESS OF BANK)
Account Name: (ACCOUNT NAME)
Account Number: (ACCOUNT NUMBER)
Account Signatory: (ACCOUNT SIGNATORY)
Bank Officer & Title (1): (BANK OFFICER / TITLE)
BANK MAIN SWITCHBOARD TELEPHONE: (BANK MAIN SWITCHBOARD TELEPHONE)
BANK EXTENSION OF CONFIRMING OFFICER: (BANK EXTENSION OF CONFIRMING OFFICER)
BRANCH BANK TELEPHONE NUMBER: (BRANCH BANK TELEPHONE NUMBER)
BANK OFFICER DIRECT BANK TELEPHONE: (BANK OFFICER DIRECT BANK TELEPHONE)
BANK OFFICER BANK FAX NUMBER: (BANK OFFICER BANK FAX NUMBER)
BANK OFFICER BANK EMAIL ADDRESS: (BANK OFFICER BANK EMAIL ADDRESS)
COPY OF THIS AUTHORIZATION WILL BE LODGED AND PRESENTED TO MY BANK OFFICER.
In witness hereof I, (NAME), hereby swear under penalty of perjury, that the information provided herein is accurate
and true as of this date: January 9, 2020

Name / Title:
Company:
Passport Number:
C.C.: (NAME OF BANK AND BANK OFFICER)

IN HEADER SPACE]
LETTER OF CONFIRMATION OF BANK OFFICER

Dear Sir,
and on behalf of (NAME OF COMPANY), do solemnly swear/attest with full legal responsibility, that the following
named person is my actual and personal bank officer at (NAME OF THE BANK), located at (ADDRESS OF BANK), who
will be available to cooperate with the trader for blocking of the following referenced bank account:
Name Bank Officer & Title (1): (BANK OFFICER / TITLE)

BANK MAIN SWITCHBOARD TELEPHONE: (BANK MAIN SWITCHBOARD TELEPHONE)
BANK EXTENSION OF CONFIRMING OFFICER: (BANK EXTENSION OF CONFIRMING OFFICER)
BRANCH BANK TELEPHONE NUMBER: (BRANCH BANK TELEPHONE NUMBER)
BANK OFFICER DIRECT BANK TELEPHONE: (BANK OFFICER DIRECT BANK TELEPHONE)
BANK OFFICER BANK FAX NUMBER: (BANK OFFICER BANK FAX NUMBER)
BANK OFFICER BANK EMAIL ADDRESS: (BANK OFFICER BANK EMAIL ADDRESS)
Account Number: (ACCOUNT NUMBER)
I, (NAME), hereby swear under penalty of perjury, that I AM THE SIGNATORY of the account, that the funds belong
to me, and the information provided herein is accurate and true as of this date: January 9, 2020

Name / Title:
Company:
Passport Number:
Date of Issue:
Date of Expiry:

IN HEADER SPACE]
PASSPORT
PROVIDE COLOR COPY ENLARGED (140%) TO THIS SIZE (8½ X 11 INCHES). PICTURE MUST BE CLEAR AND NOT DARK.
ENLARGE & LIGHTEN (USING PHOTO SETTING). COLOR SCAN THE PASSPORT INTO YOUR COMPUTER AT A HIGH
RESOLUTION IN THE JPEG FORMAT AND INSERT.

PROOF OFINFUNDS
HEADER SPACE]
CURRENT BANK STATEMENT
CURRENT BANK STATEMENT OR RECENT FIVE (5) DAYS TEAR SHEET IS THE REQUESTED ACCEPTABLE PROOF OF
FUNDS. BCL, BANK LETTERS SIGNED BY BANK OFFICER(S), CERTIFICATE OF ACCOUNT OR CONFIRMATION OF FUNDS
MAY BE INCLUDED AS SUPPLEMENTAL BANKING. KINDLY INCLUDE UN‐SANITIZED CURRENT BANK STATEMENT OR
TEAR SHEET WITH YOUR SUBMISSION. TRANSMIT HIGH-QUALITY, COLOR SCANS OF REAL DOCUMENTS. THANK
YOU.

IN HEADER SPACE] AUTHORITY
LETTER OF LIAISON AND COMMUNICATIONS

Dear Sir,
and on behalf of (NAME OF COMPANY), hereby authorize (TRANSLATOR NAME), bearing (COUNTRY) Passport No.
(NUMBER) having the below contact details, to act as my official liaison in such matters to carry out the duty and
responsibility as primary contact to coordinate communication and receive copy of all written and telephonic
communication regarding the above transaction as I do not speak English and he is my official translator. Copy of
corresponding passport has been included.
Name of Translator: (TRANSLATOR NAME)

Telephone Number: (TRANSLATOR TELEPHONE NUMBER)
Email Address: (TRANSLATOR EMAIL)
Address: (TRANSLATOR ADDRESS)
I, (NAME), hereby swear under penalty of perjury that the information provided herein is accurate and true as of

Name / Title:
Company:
Passport Number:
Date of Issue:
Date of Expiry:

IN HEADER SPACE]
This Profit Participation Agreement, Non-Circumvention, Non-Disclosure & Working Agreement

(the "Agreement") is made with effect as of the xxxxxxx, 2018, of (the "Effective Date")
Between
Name:
Passport Number:
Date of Issue:
Date of Expiry:
AND
' '
CONSULTANTS: 10% (Ten Percent) Fee
to be split between
WHEREAS, the undersigned (hereinafter referred to as the "Parties") wish to enter into this Agreement
to define certain parameters of the future legal obligations, are bound by a duty of Confidence with
respect to their sources and contacts. This duty is in accordance with the International Chamber of
Commerce Convention (LC.C. 500). If I.C.C. 500 is found invalid or in existence, the duties will be in
accordance with English Law.
WHEREAS, the Parties desire to enter a working business relationship to the mutual and common
benefit of the parties hereto, including their affiliates, subsidiaries, stockholders, partners, co-ventures,
trading partners, and other associated organizations.
NOW THEREFORE in consideration of the mutual promises, assertions and covenants herein and other
good and valuable considerations, the receipts of which is acknowledged hereby, the parties here to
mutually and voluntarily agree as follows:
Description and Location of Asset/Funds
Bank Information:
Account Name:

IN HEADER SPACE]
TERMS AND CONDITIONS·
1. The Parties of whatsoever nature shall not, in any manner, solicit and/or accept any business from sources that
have been made available by and through the parties hereto, nor in any manner shal1 access, solicit and/or conduct
any transaction with such said sources, without specific permission of the party who made such said sources
available.
The Parties shall maintain complete confidentiality regarding each other's business and / or their affiliates and
shall only disclose knowledge pertaining to these specifically named Panics a: permitted by the concerned
party, unless agreed and granted an expressed written Permission of and by the Party whom made the source
available.
2 The parties shall not in any way what so ever circumvent each other and / or attempt such circumvention of each
other and / or any of the parties involved in any of the transactions the
-parties wish to enter and to the best and proprietary information established are not altered.
3. The parties shall not disclose any contact revealed by either Party to any third Parties as they fully recognized
such information and contact (s) of the respective Party and shall not enter into direct and / or indirect offers,
negotiations and / or transaction with such contacts revealed by the other Party who made the contact (s)
available.
4. In the event of circumvention by any of the undersigned Parties, whether direct and / or indirect, the
circumvented Party shall be entitled to a legal monetary compensation equal to the maximum service it should
realize from such a transaction, plus any and all expenses, including any and all legal fees incurred in lieu of
recovery of such compensation.
5. All considerations, benefits, bonuses, participation, fees, and/or export Profits commissions received as a
result of the contributions of the Parties to this and distributed as mutually agreed between both the Parties
concerned specific arrangements, for each transaction shall be made available and/or submitted to the
recipient on the very day due and payable as per each and every transaction, unless otherwise agreed, and
additionally from the same Paymaster as the Trader and Client.
6. This agreement is valid for five (5) year from the date of signature, for any and all transactions between the
Parties therein, with renewal to be agreed upon between the signatories. It shall become effective immediately
from the date of signing hereof by all parties.

THE PARTIES: IN HEADER SPACE]
7. It is further agreed that any controversy, claims, and / or dispute arising out and / or relating to any
part of the while of this agreement or breach thereof and which is not settled between the
signatories themselves, shall be settled and binding by and through arbitration in accordance with
the rules and through the institution of the International Chamber of Commerce. Any decision and /
or award made by the arbitrators shall be final, conclusive and binding for the parties and
enforceable law in the country of choice and award by the arbitrators. In the event of dispute, the
English language shall prevail. If no agreement has been reached on country of arbitration, the
arbitration shall be conducted in the United States of America Law.
8. This Agreement shall be legally binding upon the Parties hereto their respective heirs, administrators,
executors, their successors and assigns for:
a) The non-circumvention damages, i.e. the total commissions, fees, or profits which, would have been
due,
and;
b) All loss sustained by the non-defaulting party by reason of such breach, and;
c) All expenses incurred in enforcing any legal remedy right s based upon or arising out of this
Agreement.
9. Signature of this agreement shall be deemed to be an executed agreement enforceable and admissible for all
purposes as may be necessary under the terms of this agreement. Signatures on this agreement received by the
way of Facsimile, Mail and/or Email shall be deemed and executed contract.
10. All signatories hereto acknowledge that they have read, and each Party fully understands the terms and
conditions contained in this Agreement and by their initial and signature hereby unconditionally agree to its
terms as of the date noted herein.
11. The purpose of this instrument is to establish an internationally recognized Non-Circumvention Non-
Disclosure and working Agreement between the participating Parties. This and future transactions shall be
conducted under the guidelines of the International Chamber of Commerce.
12. This agreement may be signed in one or more counterparts and the Parties agree that facsimile /email copies of
this Agreement to be considered as a legal original and signatures thereon shall be legal and binding agreement.
13. Terms
This Agreement shall commence and become effective on the date upon which it has been executed by both parties
and shall continue in effect for the Sixty (60) sequential months following the Effective Date. This Agreement may
be extended past the termination date by mutual written agreement of both parties.
14 Notices
All notices, consents and demands under this Agreement shall be in writing and may be delivered personally, sent
by air courier, email, or facsimile or may be forwarded by first class registered or certified mail to the address of
each parties set forth below, or to such address as each party may be from time to time specify by notice.
15 Force Majeure

IN HEADER
This Agreement is subject to the terms and conditions set forthSPACE]
by the International Chamber of Commerce
regarding the Force Majeure and Hardship and popularly known as the ICC Force Majeure Clause 2003 and
ICC Hardship Clause 2003 as they are applied to the International Banking and Financial Transactions.
16 Severability
If any provision of this Agreement , or the application thereof to any person or circumstance, shall for
any reason or to any extent be invalid or unenforceable, such invalidity or unenforceability shall not in
any manner affect or render invalid or unenforceable the remainder of this Agreement and the application
of that provision to other persons or circumstances shall not be affected but, rather, shall be reinforced
to the extent permitted by Law.
· 17. Assigna bility

Neither this Agreement, nor any right or obligations conferred hereunder may be assigned in whole
or in part by either party without obtaining the prior written consent of the other party.
18. Successors
This Agreement shall be extended to and be binding upon the heirs, personal representatives,
successors, and assigns of the parties hereto.
19. Warrantv of Authority

The persons executing and delivering this Agreement on behalf of the parties represent and warrant that each
of them is duly authorized to do so and that the execution is a Lawful and voluntary act of the parties.
20, Modifications
It is agreed by and between the parties hereto that this Agreement may be modified only by written consent
signed by all the parties.
21. Waiver of Breach

The failure of either party to enforce for any time or any period of time any of the provisions of this
Agreement shall not be construed as a waiver of the right of such party thereafter to enforce each and every
provision.
22. Governing Laws

This Agreement, and any disputes here under, shall be governed by the Laws of the United States of America
and the United Kingdom. Any controversy or claim arising out of or in relation to this Agreement, or breach
hereof, shall be settled by arbitration in New York, U.S.A. or in London, U. K.
a. The arbitration shall be conducted before three arbitrators in accordance with the Rules of
Arbitration and Conciliation of the International Chamber of Commerce then in effect
b. The party requesting arbitration shall appoint one arbitrator and the other party or parties in
the position of defendant shall jointly appoint a second arbitrator within thirty (30) days after
receipt of a demand for arbitration. The arbitrators shall be freely selected, and the parties
shall not be limited to any prescribed list. The two arbitrators thus appointed shall, within
thirty (30) days thereafter; appoint a third arbitrator who shall preside over the arbitration
proceedings
23. Costs and Attorney Fees

IN HEADER SPACE]
In the event that either party institutes mediation or Legal action for the enforcement of any right,
obligation, provision, or covenant of this Agreement, the prevailing party shall be entitled to a reasonable
attorney ' s fee in addition to costs of suit.
24. Counterparts
This Agreement may be executed simultaneously in two or more counterparts. all of which together shall
constitute one and the same Agreement and when so signed shall be deemed to bear the date first written
below.
25. Language
This Agreement, because of its International Character, is written in the English language for the counterparts and each
of which shall be deemed of an Original. The English language text of the Agreement will prevail over any translation
thereof and will be the only languages I accepted by all the parties.
26. Confidentiality
Except as required by Law or as reasonably required in order to enable and execute the Transactions
contemplated herein, the parties agree to maintain the confidentiality of all information and data relating to
the business of the parties and each other, including without limitation, economic, financial and/or personal
information, disclosed,
directly or in directly, or disclosed by visual inspection, and shall not disclose such information and data to a
third party without the prior written consent of the other party.
27. Entire Agreement

All of the terms and conditions of this Agreement between the parties are contained herein and no representations
or inducements have been made other than those specifically set forth.
All Fax or E-Mail Signature of this Agreement have been accepted by all parties as Legal and Valid
Documents and shall be considered by law as originals.

[INSERT APPLICANT LETTERHEAD IN THIS HEADER
SPACE]
28. Profit Participation
I, xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx agree to pay Consultants the agreed upon percentage of

10% (TEN PERCENT) of each pay out from Private Placement Profits. Ten Percent of profits derived from
PPP programs include but are not limited to bullet programs and standard forty (40) week transaction
programs or any other programs selected by one of the parties. Funds are to be sent directly to the bank
simultaneously as the trade platform pays out the proceeds from the TRADE PLATFORM and NOT from
the account of xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx This agreement shall remain in effect
for a period of sixty (60) months from the date of execution.
FIRST PARTY:
SIGNATURE:________________________________________________
SIGNED ON:_________________________________________
Signature full Name:
Passport Number:
Date of Issue:
Date if Expiry:
SECOND PARTY:
SIGNATURE:________________________________________________
SIGNED ON:_________________________________________
Signatures full Name:
Passport Number:
Date of Issue:
Date of Expiry:
APPLICANTS INITIALS _____

[INSERT APPLICANT LETTERHEAD IN THIS HEADER
SPACE]
PAYMASTER FOR United Business Alliance, LLC.
Banking Details:
BANK NAME
CORRESPONDING
BANK
BANK ADDRESS
BANK OFFICER NAME
BANK OFFICER E-MAIL
BANK TELEPHONE
BANK A/C NAME
IBAN / A/C NO. (EUR)
BIC / SWIFT CODE

PAYMASTER
INFORMATION
BENEFIARY xxxxxxxxxxxxxxxxx AS PER SUB FEE AGREEMENT to be divided equally with
participating consultants
SPECIAL WIRE PRE-ADVICE MUST BE SENT VIA SWIFT TO BENEFICIARY PRIOR TO WIRE
INSTRUCTIONS TRANSFER OF FUNDS, WITH COPY OF NOTIFICATION BY E-MAIL TO:
___________________, IMMEDIATELY UPON TRANSFER/PAYMENT SETTLEMENT
OF EACH AND EVERY TRANCHE UNDER THE APPLICABLE TRANSACTION
CODES, AS PER THE CONTRACT.
REQUIRED MESSAGE “SAME DAY TRANSFER AND IMMEDIATE CREDIT. REMITTER/CLIENT IS KNOWN
TO US AND IN GOOD STANDING. THIS TRANSFER IS DONE WITH FULL BANK
RESPONSIBILITY AND OUR COMPLIANCE HAS CLEARED/CHECKED THE SOURCE
OF THE FUNDS AND IT COMPLIES FULLY WITH ANTI-MONEY LAUNDERING
RULES AND REGULATIONS.”
End of Document
APPLICANTS INITIALS _____

[INSERT APPLICANT LETTERHEAD IN HEADER SPACE]
APPLICANT INITIALS ___________

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[INSERT APPLICANT LETTERHEAD

*** CORPORATE ENTRY ***

DATE: January 9, 2020

◼ UNDERSTANDING THE RULES OF THE ROAD

ATTACHMENTS (IF NEEDED)

E-mail, facsimile copies or photocopies of documents or agreements pertaining to this

APPLICANTS INITIALS _______

APPLICANTS INITIALS _______

DATE: January 9, 2020

INVESTOR TRANSACTION CODE:

APPLICANTS INITIALS _______

For and on behalf of (NAME OF COMPANY)

Signature: __________________________________ SEAL OF COMPANY

APPLICANTS INITIALS _______

Full Name of Corporation:

Location of Address: Registered Address (Corporation)

Full Name of Corporation:

Location of Address: Mailing Address (Corporation)

Full Name of Corporation:

Contact Information (Corporation)

Financial Information (Corporation)

Annual Income of Corporation:

APPLICANTS INITIALS _______

Bank Information (Corporate)

Bank Name (where funds are currently on deposit):

Bank Officer # 1 Name:

Client Account where Profits to be paid

Bank Officer Name:

Personal Information of Officer(s) of Corporation / Passport Information

Passport Information of Officers(s) of Corporation

Location of Address: Home-Legal Residence (Officer(s) of Corporation)

Full Name of Officer:

(Below, duplicate the section above for each Director)

Funds available for this transaction:

For and on behalf of (NAME OF COMPANY)

Signature: __________________________________ SEAL OF COMPANY

APPLICANTS INITIALS _______

INVESTOR TRANSACTION CODE:

APPLICANTS INITIALS _______

For and on behalf of (NAME OF COMPANY)

Signature: __________________________________ SEAL OF COMPANY

APPLICANTS INITIALS _______

DATE: January 9, 2020

INVESTOR TRANSACTION CODE:

For and on behalf of (NAME OF COMPANY)

APPLICANTS INITIALS _______

Signature: __________________________________ SEAL OF COMPANY

APPLICANTS INITIALS _______

DATE: January 9, 2020

INVESTOR TRANSACTION CODE:

For and on behalf of (NAME OF COMPANY)

APPLICANTS INITIALS _______

APPLICANTS INITIALS _______

DATE: January 9, 2020

INVESTOR TRANSACTION CODE:

For and on behalf of (NAME OF COMPANY)

Signature: __________________________________ SEAL OF COMPANY

APPLICANTS INITIALS _______

DATE: January 9, 2020

INVESTOR TRANSACTION CODE:

For and on behalf of (NAME OF COMPANY)

Signature: __________________________________ SEAL OF COMPANY

* CORPORATE ENTRY *