CLIENT LETTERHEAD FULL ADDRESS TEL. FAX.

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CLIENT INFORMATION SHEET

In accordance with Articles two (2) through five (5) of the Due Diligence Convention and the Federal Banking Commission Circular of December 1998, concerning the prevention of money laundering, and Article 305 of the Swiss Criminal Code, the following information may be supplied to banks and/or other financial institutions for the purpose of verification of identity and activities of the investing Member, and the nature and origin of the funds that are to be utilized. All parties have an obligation to respect professional secrecy and to take all appropriate precautions to protect the confidentiality of the information each holds in respect of the others activities. This legal obligation shall remain in full force and effect at all times.

1. Project Name : Form Filling ( USD$ 1.00 Per Form) 2. Monthly Slot : 25000 Forms Monthly (22 days) 3. Contract Period : 3 Years 4. Amount Of consultancy : USD$1200 (Rs.49,000/-) 5. Consultant Name : B.S.BHANDARI 6. Consultant Bank : Slandered Chartered Bank 7. A/C Name : B.S.BHANDARI 8. A/C No. : 243-1-022145-8 9. Branch : Lokhandwala-Mumbai 10. Name of The Company : 11. Client Name (Signatory) : 12. Country of Residence : 13. Date and Place of Birth : 14. Home Address : 15. Home Telephone Number : 16. Home Fax Number : 17. Mobile Tel Number : 18. Clients Email Address : 19. Do you speak English? : 20. Business Name : 21. Business Address :
Client Information Sheet January 15, 2013 Initials: __

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CLIENT LETTERHEAD FULL ADDRESS TEL. FAX. EMAIL

22. No.Of Computer : 23. No.Of Employee : 24. Registered Office Domicile : 25. Business Tax ID Number : 26. Years in Business : 27. Registration Number : 28. Country / State of Incorporation: 29. Business Telephone Number : 30. Business Fax Number : 31. Address for Mail Delivery : 32. Address for Courier Delivery : 33. Bank Name : Branch: : Bank Address: : Account Number : Account Name : Account Signatory (1) : Account Signatory (2) : Clients Account where payment are to be Paid Name of Bank : Address : Account No. : Account Name : SWIFT CODE : Bank Telex : Bank Fax : Declaration: I/we swear under penalty of perjury, the information given above is both true and accurate. I am the signatory on the aforementioned bank account. All monies engaged in this transaction are derived from non-criminal origin: and are good cleared. The origin of funds is in compliance with Anti-Money-Laundering Policies as set forth by the Financial Action Task Force (FATF) 6/01. In Faith:
Client Information Sheet January 15, 2013 Initials: __

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CLIENT LETTERHEAD FULL ADDRESS TEL. FAX. EMAIL

DATE: Month: ___________ Day:____, 20___ _________________ Name: Passport No.: Country of Issue:
Sworn to and subscribed before me this _____ day of_________________ 20__. (SEAL)

Client Information Sheet January 15, 2013 Initials: __

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