Dinar and Dong to Be Sent to Hong Kong

BOND ORDER PLACEMENT FORM DATE: FedEx No:______

Please fill out for each transaction. Team Leader will place ALL bond placement orders. If you have the bond(s) in your possession, then follow the procedures of the program. If further information is needed, please refer to the person who invited you into this program.

BOND PURCHASER/ OWNER INFORMATION: NAME OF OWNERS, ADDRESS, PHONE, & EMAIL DESCRIPTION OF BOND BOND QTY. NAME: Example: 1954 Chinese Construction 1 ADDRESS: Loan Bond 10,000.

PHONE: EMAIL:

TRANSACTION DIRECT INTERMEDIARIES: List of Intermediaries pertaining to this transaction (Referrals will be paid by each INTERMEDIARY or in mutual agreement, list in groups or in one line).

NAME & PHONE NO. NATIONALITY EMAIL ADDRESS

Chad E. Washington American cwashington@coralislandgroup. 412-853-7237 com Ivanhoe N. Smith American [email protected] 215-232-8000

1. PLEASE EMAIL COPY OF THIS COMPLETED FORM DIRECTLY TO:

2. IF YOU ARE SENDING IN BOND(S) THAT ARE IN YOUR POSSESSION, THEN FOLLOW THE PROGRAM PROCEDURES AND EMAIL THIS COMPLETED FORM AND COURIER TRACKING NUMBER TO: . IF YOU ARE SENDING IN YOUR OWN BONDS, PLEASE INCLUDE Proof of Purchase (POP) or Proof of Ownership (POO).

Proof of Ownership Statement

of 2 I, , confirm under the risk and penalty of perjury that the proposed purchase of my Historical Documents which are free and clear of any liens or encumbrances and have been originated from a legal source. The source derivation is by personal savings.

I further confirm that the documents have for a period of (XX) (XXXX) years been in my possession. Facsimiles of this document and any other associated documents are as valid as the original. Hard copies shall be delivered if requested.

I hereby affirm under penalty of perjury, that I am able to sell these documents and that the documents are legally held by me. The information provided herein is accurate and true.

Client Wet Signature: ______Name : Passport No : Date of Issue : Date of Expiry : Country of Issue :