Form Se-1 - Statement Of Claim For The Exemption Of Securities Of A New Generation Processing Entity Page 2

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7. List the states in which the issuer is intending to offer its securities for sale to the public.
8. Has any person received commissions or other remuneration in connection with the offer or sale of securities of the issuer? If yes,
please provide for each person, his name, address, telephone number and description of the commissions or other remuneration.
9. List all promoters, officers and directors of the issuer, including their address, position with the issuer and beginning date with the
issuer.
10. Describe the method by which the securities described above will be sold, including any class of persons to whom offers will be
made and the geographic areas in which sales activities will be conducted.
11. The following documents must be submitted as a part of this statement of claim:
(a) Consent to service of process.
(b) Corporate resolution.
(c) Prospectus or offering document in its latest form.
(d) Bylaws, operating agreement or similar document.
(e) Any advertising materials or any summaries of the offering document to be used in the offer or sale of the securities.
(f) Underwriting or selling agreements.
(g) Subscription agreements.
Date ___________________________________
__________________________________________________
Name of Issuer
By ______________________________________________
Name and Title
FORM SE-1 (01-05)

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