Client’s Information for IBC Incorporation

C O N F I D E N T I A L

Beneficial owner’s     ______________________________________________________

name & address         ______________________________________________________

1.         3 names in order of preference: ______________________________________

                                                              ________________________________________
                                                               ________________________________________

                                                               ________________________________________

2.         Corporate Capital                     US$5000.00______________________________

            Shares                                        5000____________________________________

            Par value                                   US$1.00_________________________________

3.         Directors (minimum 1)           __________________________________________

4.         Officers (if any):                     __________________________________________

            President                                __________________________________________

            Vice President                        __________________________________________

            Treasurer                               __________________________________________

            Secretary (we provide Secretary of Assistant Secretary) __________________

                                                            __________________________________________

                                                            __________________________________________

                                                            __________________________________________

5.         Are shares to be issued?  Yes  /  No

6.         If yes, shareholder (s)           

                                    ______________________________________________________

                                    ______________________________________________________

                                    ______________________________________________________

                                    ______________________________________________________

7.         Other Services _____________________________________________________

                                    ______________________________________________________

                                    ______________________________________________________

8.         Name and address of sender:   ________________________________________

                                                                ________________________________________
                                                                ________________________________________

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