ORDER FORM Incorporation of an International Business Company: Date of Application Name of Applicant Person to whom correspondence should be sent: Email Address: Telephone Number: Name of Company If the company has not already been reserved, please provide three alternative names below: Names of Proposed Shareholders (Antiguan Laws require a minimum of one shareholder) NAME NO. OF SHARES Names and Addresses of all beneficial owners of bearer shares (if any). [Unless this section is completed and signed by the beneficial owners we will assume the shareholders to be the beneficial owners. This will be reflected on our records]: Name Address Name Address If other beneficial owners of bearer shares, please give details below or on a separate piece of paper attached. Activities (a) Standard provisions: The standard Articles of Incorporation and By-Laws are very widely drawn and suitable for most types of business activity. Do you require these standard provisions? YesNo (b) Non standard provisions: If no, please provide details of your specific requirements below or on a separate sheet of paper attached: Capital (a) Standard provisions: Unless instructed to the contrary, the company will be incorporated with an authorized share capital of US$10,000 with one class of shares of US$1.00 each issuable in registered or bearer form. Do you require these standard provisions? YesNo (b) Non standard provisions: If the answer is no, please complete the following: Authorized share capital Amount [in figures] Classes of shares: If more than one class is needed, please give full particulars below or on a separate sheet of paper attached, including dividend,voting and capital repayment rights. Class Rights Denomination of shares: Denomination may be in any unit of US dollars. In addition, no par value shares are permissible. Please state below the denomination for each class of share. Class Denomination Registered or bearer shares: The standard provisions allow the company to issue shares in registered or bearer form. Please provide details of any restriction you wish to place on the shares: Registered Office/Agent The company is required to have a Registered Office/Agent in Antigua. Please tick whether you require the Registered Office/Agent to be maintained by Antigua Offshore Inc. [AOI]: YesNo If no, please give details below: Directors and Secretaries (a)Name of proposed secretary Please tick whether you require AOI to be secretary on your behalf. YesNo (b)List director(s) below with current mailing address. (Antigua lawrequires that there be at least one director). Director Address Director Address If other directors, please give details below or on a separate piece of paper attached. Proposed Bank Account(s) Please indicate whether you require AOI to open a bank account on behalf of the company. YesNo Name of Bank [Unless instructed we will use the services of our current bankers] Signatories to the Account Special Work Required Books of Account Other Please Note: With regard to any special services requested of us, we claim no expertise in the laws of any country other than Antigua. Person[s] authorized to give instructions We hereby instruct AOI to provide the above services and to continue to supply them until otherwise instructed by us in writing. In consideration of AOI Inc. carrying out my/our instructions and providing services, I/we hereby agree to indemnify AOI Inc, its directors, officers, employees and agents in respect of any liability incurred by them as a result of their carrying out my/our instructions or those of our agents. I/We further understand thatI/we will be expected to pay the fees chargeable in respect of the services I/we require and that such fees will be paid promptly. We further agree that any liability created by this agreement is both joint and several. Fees Please enclose a cheque payable to "Antigua Offshore Inc." to cover the services required or contact us for wire instructions. Incorporation Fees (a) Incorporation fees $ Annual Fees (b) Registered Office/Registered Agent fee to 31st December 19___ $ (c) Other Fees (if required) $ Total $ Signature of Applicant __________________________________________________

Please fax or mail a signed copy of this application with your payment to the address below.