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.
EURO P’S CODE: app.April.10.2010.50B.USD-EUR.MT103.RHJ.XXX
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usd p’S CODE:
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TRANSACTION CODE: APP.April.10.2010.50B.USD-EUR.MT103.RHJ
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CONTRACT CODE:
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PRIVATE
FOREIGN CURRENCY EXCHANGE
AGREEMENT
EURO (€
EUR) FOR US DOLLAR ($ USD)
Bank-To-Bank SWIFT MT103
This private
foreign exchange transaction
agreement and the
four (4)
attached Annexes
are entered on this XXxx
day of April, 2010 by and
between:
USD PROVIDER:
Company
:
Address
:
Telephone No.
:
Facsimile No.
:
E-Mail
Address
:
Principal
:
Title
:
PASSPORT NO
:
(Hereinafter referred to as USD
Principal or USD-P)
AND
EURO PrOVIDER:
Company
:
Address
:
Telephone No.
:
Facsimile No.
:
E-Mail
Address
:
Principal
:
Title
:
PASSPORT NO
:
(Hereinafter referred to as Euro
Principal or EUR-P)
WHEREAS,
in consideration of the promises
and the mutual covenants,
warranties, terms and conditions
herein contained and for other
good and valuable consideration,
the receipt and sufficiency of
which are hereby acknowledged,
the undersigned parties agree
and state that they wish to
enter into this agreement for
the exchange of United States
Dollars (USD) for Euros (EUR)
under the following terms and
conditions:
This currency
exchange transaction is a bank
to bank transaction, to be
executed via SWIFT
transmittal transfer upon banks
agreement, according to the
following terms, conditions and
agreed Bank to Bank procedure.
EURO
PROVIDER’S CURRENCY:
EURO
USD
PROVIDER’S CURRENCY:
US DOLLAR
1.1
DESCRIPTION OF THE United States
Dollars (USD) CURRENCY:
Currency:
United States Dollars;
LEGAL TENDER OF
USA.
Origin of
Currency:
NON-CRIMINAL ORIGIN.
Year of
Currency Issue:
Current Valid Currency;
IN CIRCULATION, Free from
ANy liens or EncumbranceS,
Freely Tradable in any country
contract
QUANTITY:
50 BILLION USD WITH R & E
FIRST
TRANCHE:
$49.5 MILLION USD
SUBSEQUENT
TRANCHES:
PER TRANCHE AS AGREED
1.2
DESCRIPTION OF THE EURO (EUR)
currency:
Currency:
EUROS, LEGAL TENDER OF E.
U.
Year of
Currency Issue:
Current Valid Currency;
IN CIRCULATION, Free from ANy
liens or EncumbranceS, Freely
Tradable in any country
contract
QUANTITY:
EQUIVALENT AMOUNT OF 50
BILLION USD WITH R & E
FIRST
TRANCHE:
EQUIVALENT AMOUNT OF USD
49,5 MILLION USD
SUBSEQUENT
TRANCHES:
PER TRANCHE AS AGREED
2.
TRANSACTION CONDITIONS:
Transaction
mode:
Bank-to-bank (swift MT103
or AS AGREED)
rate of
exchange:
LONDON MORNING FIXING
INTER-BANK EXCHANGE RATE.
BONUS:
GROSS 15% USD; NET
10% TO THE EURO PRINCIPAL
consultancy
fees:
TOTAL OF 5% ALLOWED
TO BE SPLIT ON 50 / 50 BASIS
uSD PROVIDER
sIDE:
2.50% To USD-P’s Side, TO
BE PAID BY EURO PRINCIPAL
eURO PrOVIDER
sIDE:
2.50% TO eURO-P’S Side,
TO BE PAID BY EURO PRINCIPAL
fee
Transaction Mode:
FROM EURO-P’S BANK
UNCONDITIONALLY TO PAYMASTERS.
USD
MOVES FIRST WITH SWIFT MT103
Per each
$100 USD the Euro Principal
shall pay the equivalent value
in EUROS of $85 USD on the day
of each tranche.
3.
TRANSACTION PROCEDURES:
1)
PARTIES, DIRECTLY OR
THROUGH THEIR AUTHORISED
MANDATED REPRESENTATIVE WOULD
ACCEPT, SIGN, SEAL AND RETURN
THIS CURRENCY EXCHANGE AGREEMENT
ALONG WTH THE FPA BY FAX OR
EMAIL IN PDF-FORMAT (HARD COPIES
TO BE SENT BY COURIER SERVICE IF
REQUIRED).
2)
THIS AGREEMENT ALONG WITH
THE FPA IS TO BE LODGED WITH
EACH PARTY’S BANK.
3)
THE USD PRINCIPAL’S BANK
TRANSFERS USD VIA MT103
CONDITIONAL SWIFT TO THE EURO
PRINCIPAL’S CLOSING BANK
COORDINATES THE FIRST TRANCHE OF
49,5 MILLION USD.
4)
UPON
VERIFICATION, THE EURO
PRINCIPAL’S
CLOSING
BANK
SHALL THEN SEND, ON THE SAME
BANKING DAY AS ABOVE, VIA SWIFT
MT103 UNCONDITIONALLY THE EURO
TO THE USD PRINCIPAL’S
RETURN
BANK IN
ACCORDANCE WITH THE BANKING
INSTRUCTIONS WITHIN THIS
AGREEMENT.
5)
FURTHER
TRANCHES ARE TO BE CONTINUED AS
PER THE ABOVE PROCEDURE UNTIL
THE USD IS EXHAUSTED OR THE
AMOUNT OF AGREEMENT IS COMPLETED.
BANKING
COORDINATES OF EURO PRINCIPAL
AND USD PRINCIPAL AS PER ANNEX
“A”
The Parties must
follow the guidelines provided
by the rules of the banks on the
Anti-Terrorism Act and the
Patriot Act I and II. The Buyer
will not be held responsible for
any harmful money laundering.
4.
BANKING COORDINATES AND
INSTRUCTIONS FOR USD-P AND
EUR-P:
The respective bank
account details are listed in
ANNEX “A” attached and cannot be
changed for the life of this
agreement without written notice
given to all beneficiaries of
consulting fees and commissions
five days prior to any change.
5.
CONSULTANCY FEES:
The PAYOR OF
THE CONSULTING FEES AND
COMMISSIONS AS WELL AS THE EURO
PRINCIPAL AND USD PRINCIPAL AS
PRINCIPALS, irrevocably commit
themselves to transfer, upon
settlement of each tranche
exchanged, including all rolls
and extensions, the consultancy
fees as follows:
A.
CONSULTANCY FEES TO
EURO-PRINCIPAL’S SIDE:
To
be paid by the EURO Principal
to the bank accounts designated
by the PAYMASTERS in ANNEX D”
ATTACHED.
B.
CONSULTANCY FEES TO
USD-PRINCIPAL’S SIDE:
To
be paid by the EURO Principal
to the bank accounts designated
by the PAYMASTER in ANNEX “D”
ATTACHED.
6.
CONSULTANCY FEES BANKING
INSTRUCTIONS AND INFORMATION:
THE EURO
PRINCIPAL shall release and
otherwise transfer funds in the
form of USD for payment of The
PAY ORDERS – Fee Agreement-
attached herewith to the EUR and
USD FACILITATORS &
BENEFICIARIES, to the nominated
bank accounts indicated in the
Pay Orders, by SWIFT WIRE
TRANSFER. All payments to
facilitators wire transfers
shall state the FOLLOWING
instruction:
“FOR
IMMEDIATE CREDIT- instant cash
payment - same day value”
7.
OTHER TERMS AND
CONDITIONS:
-
EXCHANGE RATE:
The exchange
rate is agreed
as the official
inter-bank
exchange rate
fixed in the
morning as of
the date of
exchange. The
day when the
EUROS funds are
deposited in the
USD Account for
the transaction
is considered as
Exchange date.
-
TERM OF
AGREEMENT:
This
contractual
Agreement is a
full recourse
commercial
commitment
enforceable
under the laws
of the
jurisdiction of
USA,
UK, Switzerland
or any European
Union country as
it applies. And
said law shall
govern the
interpretation,
enforceability,
performance,
execution,
validity and any
other such
matters
regarding this
Contract.
And, it is in full force
and effect until completion of
the transaction and it is
legally binding upon the
Parties signatories,
their heirs, successors and
assigns, agents, principals,
attorneys and all
associated
Parties involved in this
contract transaction.
-
CODES OF
IDENTIFICATION:
The Parties to
this contract
agree that all
documents
related to this
transaction
shall indicate
the codes as
indicated
herein. And, the
codes shall not
be changed
during the term
of this
transaction
contract,
including all
rollovers,
renewals,
extensions and
all additions.
UNAUTHORIZED BANK
COMMUNICATION:
Neither Party is allowed to
contact the Bank of the
other Party without the
authorization of the Party whose
Bank is to be contacted.
Any unauthorized
contact act is breach of
this contract.
-
TAXES,
INSTITUTIONAL
COSTS:
Both Parties
hereto
individually and
separately
accept liability
of taxes,
imposts, levies,
duties or
charges that may
be applicable in
the execution of
their
respective roles
in this
transaction.
-
PENALTY CLAUSE
FOR
NON-PERFORMANCE:
Should any of
the Parties
herein fail to
perform as
required by this
contract,
once signed, and
after the Term
of Validity
thereof had
expired, then,
the
failing Party
shall indemnify
the other Party
for an amount of
the 2% of the
total quantity
of
the transaction;
and one percent
of said two [2%]
percent shall be
paid and equally
distributed,
to each
of the
facilitators
that made the
introduction of
the signatories
possible, if the
non-defaulting
signatory to the
contract files a
default claim,
if not, then,
the two [2%]
percent shall be
paid to the
facilitators
only. The
facilitators
have the right
to make a legal
claim for such
amount of two
[2%] percent as
it applies, of
the total amount
contracted, in
any court of
jurisdiction
against the
party failing to
perform.
-
LAW AND
ARBITRATION:
This contract is
a full recourse
commercial
commitment
enforceable
under the laws
of jurisdiction
of the countries
where this
transaction is
effectuated, and
any dispute is
to be resolved
under the ICC
rules for
arbitration,
unless the
aggrieved party
takes legal
action in a
court of
jurisdiction.
The Swiss,
British or any
European Union
Country Law
shall be the
applicable law,
as the aggrieved
Party may
choose, and
shall govern the
interpretation,
construction,
enforceability,
performance,
execution,
validity and any
other such
matters
regarding this
contractual
agreement. The
Parties hereto
acknowledge and
agree that any
discrepancy
and/or dispute
in application
of this
Agreement will
be solved
amicably, but if
this is not
possible, the
arbitration
procedure is to
be followed.
-
This contract is
intended to be
performed in
accordance with,
and only to the
extent permitted
by all
applicable laws
of jurisdiction,
ordinances,
rules and
regulations. If
any provision of
this contract be
considered
invalid or
unenforceable,
then, the
reminder of this
contract shall
not be affected
and shall be
enforced to the
greatest extend
permitted by
law.
-
NON-DISCLOSURE
AND
NON-CIRCUMVENTION:
Both Parties are
to be bound and
to abide by the
Non-Circumvention
Non-Disclosure
rules of all
issues by the
ICC, PARIS /
FRANCE, last
edition of which
shall apply to
this transaction
for a period of
five (5) years,
no matter
whether direct
or indirect.
-
EDT- ELECTRONIC
DOCUMENT
TRANSMITTAL &
COUNTERPARTS:
This
contract may be
executed in
multiple copies
at different
times and
places, each
being considered
an original and
binding. All
facsimile /
electronic
transmittal/
communications
relating to this
transaction and
which are
mutually
accepted by the
Parties, shall
be deemed
legally binding
and enforceable
documents for
the duration of
the transaction.
-
force Majeure:
The “FORCE
MAJEURE”
exception clause
of the
International
Chamber of
Commerce (ICC
Publication No.
421) is hereby
incorporated and
made an integral
part of this
agreement. A
party cannot be
held in default
if the reason is
caused by force
Majeure. Case
may be, when
executed by both
PARTIES.
IN WITNESS
WHEREOF,
The undersigned have read this
document and had advise of its
legality and after understanding
the content of this contract
written in the English language,
by knowledge of the language or
by professional translation to
the party’s language and legal
advise, and initialed all the
pages of this contract and,
fully understand and agree that
its execution constitutes an
acceptance of all of its
mutually protective covenants,
terms and conditions, and is
lawfully binding upon the
“Parties”, and their legal
heirs, successors,
representatives and assignees.
BY THE USD
PRINCIPAL / AUTHORIZED
SIGNATORY:
I hereby
swear under the International
Laws of Perjury and Fraud that
the information provided by me
herein is accurate and true and
that I have read and understood
the full contract. Signed and
sealed on the date indicated
below by signature:
Signature:
DATE:
___ XXxx, 2010
NAME:
PASSPORT NO:
Country of
ISSUE:
Issuance /
Validity:
AGREED AND
ACCEPTED THIS CONTRACT
BY THE EURO
PRINCIPAL / AUTHORIZED SIGNATORY
(MANDATE):
I hereby
swear under the International
Laws of Perjury and Fraud that
the information provided by me
herein is accurate and true and
that I have read and understood
the full contract. Signed and
sealed on the date indicated
below by signature:
Signature:
DATE:
____ XXxx,
2010
NAME:
PASSPORT NO:
Country of
ISSUE:
Issuance /
Validity:
AGREED AND
ACCEPTED THIS CONTRACT
annex “A”
ADDENDUM
1
usd
Provider’S Banking COORDINATES:
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BANK NAME
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BANK ADDRESS
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:
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ACCOUNT NAME
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ACCOUNT N°
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:
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IBAN CODE
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:
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SWIFT / bic CODE
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:
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BANK OFFICER
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:
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TELEPHONE N°.
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:
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FACSIMILE N°
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:
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E-MAIL BANK
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:
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ADDENDUM 2
EUR-PR’S BANK
BANKING COORDINATES
WIRE TRANSFER
US DOLLAR INSTRUCTION
FUNDS BEING
TRANSFERRED FROM FOREIGN
COUNTRIES :
ALL TRANSFERS
MUST INDICATE THAT ARE:
FOR FURTHER
CREDIT TO:
AT ACCOUNT
NUMBER:
ROUTING
NUMBER (ABA):
SWIFT CODE:
APPLICABLE
AT:
BANK OFFICER:
TEL:
FAX:
annex “B”
THE SCHEDULE
OF TRANCHES
The total
amount of the Contract shall be
equal to Fifty BILLION UNITED
STATES DOLLARS
($50,000,000,000.00 USD) with
extensions and rollovers as per
mutual agreement. Any changes
hereto must be agreed upon
mutually in writing and lodged
with the banks and the
Intermediaries’ Paymasters at
least five (5) banking days in
advance of the proposed date of
exchange.
The entire
quantity will be exchanged as
mutually agreed by the Parties.
The First Tranche in the amount
of $49,500,000.00 should be
completed by the USD-PR not
later than fifteen Banking days
from the date of execution of
this Contract.
The First
Tranche should be completed by
the USD-PR on the….. day
of May , 2010.
Additional
tranche amounts and dates are to
be mutually agreed.
If a tranche
day is a National
Holiday, the
exchange is to be executed the
next subsequent Banking day. All
other terms and conditions will
be in accordance with this
Contract.
Tranche
Schedule (all amounts in USD)
DAY AMOUNT
TOTAL PER DAY AGGREGATE TOTAL
1ST
49.500,000
49,500,000
49,500,000
2nd
100,000,000
100,000,000
149.500,000
3rd
500,000,000
500,000,000
649.500,000
4th
500,000,000
500,000,000
1,149.500,000
5th
500,000,000
500,000,000
1,649.500,000
FURTHER
TRANCHES to be agreed
SUBSEQUENT TRANCHES TO BE AGREED
UPON BY THE BANKS
IF A
TRANCHE DAY IS A NATIONAL
HOLIDAY, THE EXCHANGE IS TO BE
EXECUTED IN THE NEXT SUBSEQUENT
OR IN THE PRIOR BANKING DAY. ALL
OTHER TERMS AND CONDITIONS WILL
BE IN ACCORDANCE WITH THIS
CONTRACT.
annex “C”
IRREVOCABLE
FEE AGREEMENT / pay ORDER TO
facilitators
for the
transaction of the
PRIVATE FOREIGN CURRENCY
EXCHANGE AGREEMENT
TO BE
SIGNED BY EURO PRINCIPAL, TO THE
BENEFICIARIES OF THIS FEE
AGREEMENT:
USD
PRINCIPAL SIDE: 2.50 % (PAID BY
THE EURO PRINCIPAL) (CLOSED)
EUR
PRINCIPAL SIDE: 2.50 % (PAID BY
THE EURO PRINCIPAL)
ON THE
MATTERS OF THE TRANSACTION CODE
INDICATED HEREIN FOR THE
EXCHANGE OF US DOLLARS AGAINST
EUROS IN THE TOTAL CONTRAT
AMOUNT OF 50B USD WITH
ROLLS AND EXTENSIONS AND A TOTAL
BONUS OF 5% TO BE PAID IN FEES.
I,
MR. ERIC
IRENEUSZ IZDEBSKI,
AS THE
EURO
PRINCIPAL PAYING FEES,
irrevocably and with full legal
Authority, and corporate
responsibility, hereby agree and
guarantee to protect, and
immediately cause to pay,
through THE paymaster to the
banking coordinates provided by
the beneficiaries, THE FEE
AMOUNT OF 5.00% (FIVE
PERCENT) in US Dollars
OR
EUROS
PER each tranche delivered of
the total contract amount to be
paid and divided as agreed
herein and, to be paid to each
of the facilitators/ mediators/
intermediaries and agents OF THE
euro Principal’S SIDE involved
in this transaction and, the
disbursement of consulting fees
and commissions are to be made
immediately upon closing of each
and every transaction tranche
delivered, without restrictions,
imposts or taxes imposed, or
impediment, delays of any kind
or nature whatsoever of All
quantities / tranches scheduled
to be delivered and paid by the
payor/Guarantor of the
consulting fees/commissions to
the designated Paymasters.
Furthermore, the delivery of
these funds is guaranteed with
full Corporate Authority and
responsibility as good, clean,
clear funds of non-criminal
origin.
WE, the
undersigned, agree that this
payment is irrevocable, and
unconditional, and shall be made
immediately by a freely
negotiable bank draft, or cash
swift wire transfer in United
States Dollars OR EUROS per
tranche transacted of principal
sums, These consulting fees and
or commissions will be paid
regardless whether the banks or
transactions codes are changed.
The same property rights of
introduction of sources and of
business connection will be
upheld and honored as per
contract.
FEES PAID BY
THE EURO PRINCIPAL TO THE US
DOLLAR SIDE AND EURO SIDE
PAYMASTERS:
A) EURO SIDE:
2.50% BUYER SIDE COMMISSION OF
THE CONTRACT TOTAL AMOUNT
B) USD SIDE:
2.50% SELLER SIDE
COMMISSION OF THE CONTRACT TOTAL
AMOUNT
A-1-2-3)
EURO
SIDE
COMMISSIONS: 1,25%, (ONE Point
TWO Five
percent) of the total contract
value
a-1
PAYMASTER:
MR. __________________
Passport-n°:
__________________
EURO MANDATE:
0,62 % OF TOTAL CONTRACT VALUE
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Paymaster/Beneficiary:
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______________
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Bank Name:
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______________
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Bank Address:
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______________
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Account Name:
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________
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Account Number:
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_________
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IBAN Number:
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__________
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SWIFT Code:
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__________
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Bank Officer:
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__________
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Bank Telephone:
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___________
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a-2
PAYMASTER: Mr. ______________
Passport-n°:
________________________
EURO
PAYMASTER and INTERMEDIARIES:
0,63% OF TOTAL CONTRACT VALUE
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Paymaster:
Beneficiaries:
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___________
“_____ Group” 0,21% OF TOTAL CONTRACT VALUE
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Bank Name:
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___________________
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Bank Address:
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___________________
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Account Name:
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______________
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Account Number:
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_______________
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IBAN Number:
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_______________
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SWIFT Code:
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_______________
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Bank Officer:
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______________
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Bank Telephone:
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_______________
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Beneficiaries:
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__________ 0,21% OF TOTAL CONTRACT VALUE
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Bank Name:
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__________
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Bank Address:
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__________________
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Account Name:
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__________________
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Account Number:
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__________________
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IBAN Number:
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__________________
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SWIFT Code:
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__________________
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Bank Officer:
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___________________
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Bank Telephone:
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__________________
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Beneficiaries:
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____________ 0,21% OF TOTAL CONTRACT VALUE
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Address :
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_____________
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Bank Name:
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____________
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Bank Address:
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____________
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Account Name:
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____________
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Account Number:
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__________________
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Swift Code:
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_____________
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Intermediary Bank :
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_____________
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Bank Address:
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_____________
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Account Number:
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_____________
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Swift Code:
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_____________
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Bank Officer:
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_____________
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Bank Telephone:
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_____________
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A-3
COMMISSIONS: 1,25%, (ONE Point
TWO Five
percent) of the total contract
value
PAYMASTER:
Passport-n°:
USD SIDE:
1,25% OF TOTAL CONTRACT VALUE
(CLOSED)
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Paymaster/Beneficiary:
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_____% OF TOTAL CONTRACT VALUE
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Passport
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Bank Name:
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Bank Address:
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Account Name:
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Account Number:
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IBAN Number:
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SWIFT Code:
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Bank Officer:
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Bank Telephone:
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Paymaster/Beneficiary: _________________
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_____% OF TOTAL CONTRACT VALUE
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Passport ______________________
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Bank Name: _________
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Bank Address: _________
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Account Name: __________
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Account Number: ________
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IBAN Number: ___________
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SWIFT Code: _____________
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Bank Officer: _______________
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Bank Telephone: __________
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B1)
usd
SIDE
COMMISSIONS: 2.5%, (TWO Point
Five ZERO percent) of the
total contract value
PAYMASTER:
Passport-n°:
USD SIDE:
2,5% OF TOTAL CONTRACT VALUE
(CLOSED)
|
Paymaster/Beneficiary:
|
_____% OF TOTAL CONTRACT VALUE
|
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Passport
|
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Bank Name:
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Bank Address:
|
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Account Name:
|
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Account Number:
|
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IBAN Number:
|
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SWIFT Code:
|
|
|
Bank Officer:
|
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Bank Telephone:
|
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|
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Paymaster/Beneficiary:
|
_____% OF TOTAL CONTRACT VALUE
|
|
Passport
|
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Bank Name:
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Bank Address:
|
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Account Name:
|
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Account Number:
|
|
|
IBAN Number:
|
|
|
SWIFT Code:
|
|
|
Bank Officer:
|
|
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Bank Telephone:
|
|
|
|
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Paymaster/Beneficiary:
|
_____% OF TOTAL CONTRACT VALUE
|
|
Passport
|
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Bank Name:
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Bank Address:
|
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Account Name:
|
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Account Number:
|
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IBAN Number:
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SWIFT Code:
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Bank Officer:
|
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Bank Telephone:
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BY THE EURO
PRINCIPAL / AUTHORIZED SIGNATORY
(MANDATE):
I hereby
swear under the International
Laws of Perjury and Fraud that
the information provided by me
herein is accurate and true and
that I have read and understood
the full contract. Signed and
sealed on the date indicated
below by signature:
Signature:
DATE:
May XXxx, 2009
NAME:
_______
PASSPORT NO:
________
Country of
ISSUE:
________
Issuance /
Validity:
_________
AGREED AND
ACCEPTED THIS CONTRACT
BY THE USD
PRINCIPAL / AUTHORIZED
SIGNATORY:
I hereby
swear under the International
Laws of Perjury and Fraud that
the information provided by me
herein is accurate and true and
that I have read and understood
the full contract. Signed and
sealed on the date indicated
below by signature:
Signature:
DATE:
May XXxx, 2009
NAME:
PASSPORT NO:
Country of
ISSUE:
Issuance /
Validity:
AGREED AND
ACCEPTED THIS CONTRACT
THIS
SPACE INTENTIONALLY BLANK
annex “D”
The USD
Provider and the EURO P presents
the legal tender United States
Dollars (USD) and EUROS
available in a bank and warrants
under penalty of perjury laws of
jurisdiction as it
applies, that the US DOLLAR and
EURO funds are totally derived
from legal sources and not from
any illegal drug traffic or
money laundering activities,
terrorist group or association
and neither from any other
criminal activity, and confirms
that the funds are good, clean,
clear, of non-criminal origin,
free from any liens and taxes,
freely transferable to be
exchanged for Euros (EURO) and
USD.
The
parties must follow the
guidelines provided by the rules
of the banks on the
Anti-Terrorism Act and the
U.S.A. Patriot Act I and II. The
USD-PR and EURO-PR will not be
held responsible for any harmful
money laundering.
Each Party,
individually and separately,
accepts liabilities on taxes,
import, levies, duties or
charges that may be applicable
while in the execution of their
institutional role.
BY THE EURO
PRINCIPAL / FINAL APPROVAL:
Signature:
DATE:
May XXxx, 2010
NAME:
__________
PASSPORT NO:
__________
Country of
ISSUE:
__________
Issuance /
Validity:
__________
AGREED AND
ACCEPTED THIS CONTRACT
BY THE USD
PRINCIPAL / AUTHORIZED
SIGNATORY:
Signature:
DATE:
May XXxx, 2010
NAME:
PASSPORT NO:
Country of
ISSUE:
Issuance /
Validity:
AGREED AND
ACCEPTED THIS CONTRACT
END OF
DOCUMENT
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