Notarized Identity Verification

Print Name: Vijesh James

(First, Middle, and Last Name)

augustinevijesh@gmail.com

Email address:

Address: 5920 Hwy 3

City: Salmo
Province: B.C.
Postal Code: V0G 1Z0

I hereby represent that all above information is true and accurate.

Signature:

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For use by Notary:

Address:

City: Province: Postal Code:

I hereby certify that on this day of , 20

personally appeared before me the signer and subject of the above form, who signed or
attested to the same in my presence, and presented the following form of identification as
proof of his or her identity:

( ) Drivers license

( ) Passport

( ) Other:

Notary Public:
(Print Name)

My Commission expires:

Notary Public Signature:

RESERVED FOR NOTARY SEAL