1.CONTACT PERSON:

(First name, second name)

2. JURISDICTION:

--- Choose Here --- Panama Palau Delaware Delaware econ. Nevada Bahamas BVI Uk Limited Cyprus Gibraltar Niue Nevis California Belize Isle Of Man Lichtenstein Seychelles Bank in Montenegro

3. INDICATE 3 DESIRABLE NAMES IN ORDER OF  PREFERENCE TO REGISTRATE YOUR NEW COMPANY:

1.  2.  3.

4. CORPORATE OBJECTIVES(OPTIONAL)

In all of the above-mentioned jurisdictions companies may be  incorporated with general, wide-ranging corporate objectives.  If you wish to incoporate the company with a more specific  objective, please describe below - to be indicated in MA & AA

5. I WISH TO USE NOMINEES DIRECTORS:

YES NO

*** IF YES WAS CHOSEN THEN FILL IN FORM 5.1: *** IF NO WAS CHOSEN THEN FILL IN FORM 5.2

5.1 POWER OF ATTORNEY

Please indicate the type of powers(s) of attorney (if needed)

Special  General

ISSUED IN FAVOR OF:

Name:  1.  2.     ID# and type:  1.  2.       Address:  1.  2.

5.2 CORPORATE DIRECTORS AND OFFICERS

Name:    Nationality:  1. 1.  2. 2.  3. 3.     Address:    Position:  1. 1.  2. 2.  3. 3.

6. I WISH TO USE NOMINEES SHAREHOLDERS:

YES NO

*** IF NO WAS CHOSEN THEN FILL IN THIS FORM:

6.1 SHAREHOLDER INFORMATION

Types of shares:      BearerRegistered

No.of Certificate Name of Shareholder (if not bearer):        Address: Number of shares:

7. PLEASE CONTACT ME BY:

Phone: Fax: E-mail:

8.MAILING INSTRUCTIONS:

--- Choose Here --- Registered Mail Courier Mail Personally  Name: Company:    Address: Phone:    Fax:

DETAILS OF INVOICE:

For invoices:

Name: Company:    Address: Phone:

PLEASE SEND INVOICE TO

Fax:  Email:

9. I AM GOING TO PAY THE COMPANY BY:

Payment details Wire transfer  Card authorization form Credit Card (Visa,Master)  How to draw the cheque Cheque

WHERE DID YOU HEAR ABOUT US?