ENHANCED DUE DILIGENCE – Regulation 3(1) of FTRR (No. 1) 2000

PETER D. MAYNARD Counsel and Attorneys

For Individuals

Surname:                                                                                                                                     

First Name                                                                            Middle Initial                                   

Home Address:                                                                     City                                                 

Country                                             Tel: (hm)                     (wk)                                                 

Fax Number                                                                          E-mail                                              

Date of Birth                                      Place                           Nationality                                       

(if self employed, the nature of the self employment):                                                                      

Copy of first four pages of passport or national identity card showing the following details:

Number & Country of Issuance:                                                                   

Issue Date & Expiry Date:                                                    Signature:                                         

Purpose of funds on account:  1. Retainer,   2. Litigation,    3. Government Fees,  4: Real Estate Transaction,

5. Escrow  6. Other (specify)                                                                     

Potential Account Activity:                                                                                                           

Source of Funds on Account:                                                                                                        

My source of Income or Wealth:                                                                                                   

I confirm that all monies held for my credit are beneficially owned only by me: yes/no

If no provide documentary evidence of identity of other beneficial owners:                           

I hereby authorize Peter D. Maynard Counsel and Attorneys to independently verify any of the

information I have provided:

Date:                                                               Clients Signature:                                                     

This information is required in compliance with Regulations to safeguard against money laundering and will

remain confidential unless there is reason to suspect that the named party is involved in illegal activities.