CO. NAME -------------------------------------------------------

CAPITAL:   $------------ DIVIDED INTO----------SHARES OF $------EACH

     ___/REGISTERED                                  ___/OTHER

                           TYPE OF COMPANY

     TRADING              ___/REGULAR          INVESTMENTS

S H A R E H O L D E R S

1.   -------------------------------

2.   -------------------------------

3.   -------------------------------

4.   -------------------------------

5.   -------------------------------

     DIRECTORS                            &          OFFICERS

     1.------------------                       --------------------

     2.--------------------                     --------------------

     3.--------------------                     --------------------

     4.--------------------                     --------------------

EXCHANGE CONTROL REQUIRED?  ___/YES     ___/NO

If so who (is/are) Beneficial owner(s):----------------------------

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Nationality:-------------------------------------------------------

Address:   ---------------------------------------------------------

           ---------------------------------PHONE NO.---------------

           ---------------------------------FAX NO.-----------------

Incorporation fees paid ___/day    ___/mth.   199       AMT.-------

Date to form company:----------------------------------------------

Contact for Billings & Information --------------------------------

           Address:   ----------------------------------------------

                     ----------------------------------------------

CLIENT’S OF (LAWYER)-----------------------------------------------