Datacard Incorporator

DATA CARD (Corporate)

Data concerning legal entity proposed to be incorporator of: [Name of company]

a.         Name of legal entity                                                             :

Official seat                                                                           :

Registration[1]                                                                         :

Office address                                                                      :

Office telephone                                                                   :

Office telefax                                                                         :

b.         List of names, titles and

authority to represent the

legal entity, of all members

of the Management Board,

Board of Directors, Executive

Board or similar internal

body, as the case may be:

c.         Shareholding/group[2]                                           :

d.         This Data Card must be duly

executed[ENDE DER VORSCHAU]