Lops Asia Pte. Ltd.

1 Scotts Road, #26-07A, Shaw Centre, Singapore 228208

Tel. +65-6235 4002 Fax.+65 6235 4003

Date: ________________

Company Name and Website: ___________________________________________________________________

Alternative Name / Trading Name / DBA: __________________________________________________________

Type of entity (e.g. corporation, partnership, private, state or gov’t entity)? ________________________________

Legal Registration Number / Tax ID: _____________________________ DUNS Number: ______________________

Registered Address: ______________________________________________________________________________

Country: ____________________ State_____________ City_________________ Zip / Area Code: ________________

*Please note that name and address should be of the entity that will be invoiced or invoice is being received from.

Physical Address: _________________________________________________________________________________

Country: ____________________ State_____________ City_________________ Zip / Area Code: ________________

Does this company belong to a larger group / company? Please name: ______________________________________

If the company or group is publicly traded, please provide the stock ticker and exchange: _______________________

Ownership and management information

Who are the major shareholders of the company? Please list each individual and/or entity with holding in excess of 10%:

Shareholder Name*: Percent Ownership:

*Please include copy of valid passport, if applicable. If additional rows are needed, please provide on a separate list.

There are no other stakeholders with holdings in excess of 10%: ___________________________________________

Signature
 Lops Asia Pte. Ltd.
1 Scotts Road, #26-07A, Shaw Centre, Singapore 228208
Tel. +65-6235 4002 Fax.+65 6235 4003

List of directors / officers:

Name: Title:

Please provide following information along with this credit request form:

i. Articles of Incorporation / Company Registration Document (or similar form)

ii. For companies requesting open terms for sale, please provide 3 years audited financials
iii. For companies not requesting open terms for sale or sellers, please provide the most recent audited financial.
iv. A summary of the company’s main operations

If Supplier or Vendor, please fill below Bank Account Detail:

Beneficiary Name: ___________________________________________________________________________________

Beneficiary Bank Name: _______________________________________________________________________________

Beneficiary Bank Swift Code: ___________________________________________________________________________

Beneficiary Account Number: ___________________________________________________________________________

Correspondent Bank/Intermediary Bank Name: ____________________________________________________________

Correspondent Bank/Intermediary Bank Swift Code: ________________________________________________________

If Buyer, please provide list of banks issuing Letter of Credit or cash payment:
Bank Name: Bank Swift Code:

Counterparty Contacts:
Accounts Payable/Receivable Contact:
Name: _____________________________________Phone: ___________________________________________
Email: _____________________________________Address: __________________________________________
Logistics Operation Contact:
Name: _____________________________________Phone: ___________________________________________
Email: _____________________________________Address: __________________________________________
Commercial Contact:
Name: _____________________________________Phone: ___________________________________________
Email: _____________________________________Address: __________________________________________

Thank you for your attentions.