PPP Client docs





Investor Name: XXXX XXXXX

Company Name:         XXXXX XXXXX

Available Funds:         XXXXXXX USD

Submission Date:       January 24, 2011


Mobile Tel No:

Email Address: xxxxxx@xxxxx.xxx







Date: XXth day of XXXXXXXX, 2009

1)        Client Name (Signatory):

2)        Nationality:

3)        Passport Number:

4)        Passport Issue Data:

5)        Date and Place of Birth:

6)        Home Address:

7)        Home Fax Number:

8)        Home Tel. Number:

9)        Cellular Phone Number:

10)      Email Address:

11)      Business Name:

12)      Business Address:

13)      Registered Office:

14)      Registration Number:

15)      Business Fax Number:

16)      Business Telephone Number:

17)      Legal Advisor (Name & Law Firm):

18)      Legal Advisor Mail Address:

19)      Legal Advisor Courier Address:

20)      Bank:

21)      Branch and Branch Address:

22)      Bank Officer’s Name:

            Phone Number:

            Fax Number:

23)      Account Name:

24)      Account Number:                                        

25)      Account Signatory:
26)      Funds available for this transaction:

            Funds available in words:                Hundred Million Dollars USD



Initials:_____                                      Client Information Sheet                                   Page 1 of 2


Date: XXth day of XXXXXXXX, 2009

27)      Origin of funds:                       Earnings from

28)      Are funds free and clear?   Yes:       X                 No: ________

29)      Brief Overview of Corporate Activity:

It is agreed that facsimile copies of this Client Information Sheet, or any other associated documents to this transaction, are as valid and legal as delivered originals.

I Hereby Swear, under penalty of perjury, the information given above is accurate and true.

For and on behalf of:



Name & Title

Passport Number:

Issued by:

Issue date:

Expiry date:

Initials:_____                                      Client Information Sheet                                   Page 2 of 2



Date: XXth day of XXXXXXXX, 2009

To:                  Program Manager

RE:                 PRIVATE PLACEMENT

Please answer the following questions:

1) What is the origin of the funds?  Please describe giving specific details.


2) Have funds been on deposit for at least three (3) years at the bank from which the Proof of Funds is issued?

3) If not, please provide a history of the previous banking information and describe the form in which the assets were deposited and/or transferred.

Previous Bank:


Bank Officer:

Telephone Number:

Account Holder’s Name:

Reason for Transfer:

Transfer Date:

4) Do you have full discretion to invest the subject funds upon satisfactory terms?

5) Do you have discretionary power to transfer or reserve and / or block the funds?  If not, please accurately describe your responsibility to those funds?

6) Have you placed, or have you tried to place these assets elsewhere?  If yes, where, when, and with whom?  Has a Cease and Desist been issued?  If yes, when and to whom?

Initials_____                            Funds History Affidavit                               Page 1 of 2

FUNDS HISTORY (continued)

It is agreed that facsimile copies of this Funds History Statement, or any other associated documents to this transaction, are as valid and legal as delivered originals.

All statements made herein are under penalty of perjury.

Information prepared this XXth day of XXXXXXXX, 2009.



Name & Title                                                                        Date:

Company Name

Passport Number:

Initials_____                  Funds History Affidavit                                              Page 2 of 2



Date:                          XXth day of XXXXXXXX, 2009

Attention:                   Program manager

Re:                             Private placement

Transaction code:    (Allocated by Client)

I, (NAME OF CLIENT) authorized signatory (COMPANY NAME) and holder of (COUNTRY) Passport Number:  (NUMBER), hereby, with full corporate, personal and legal responsibility, under penalty of perjury of law, represent, warrant, and attest as follows:

1.      We currently have available under my/our control (AMOUNT IN WORDS)  Hundred Million United States Dollars $ XX 00,000,000.00)USD (herein referred to as ‘funds’) that are on deposit at (NAME OF BANK) Bank in account number: (ACCOUNT NUMBER) under the account name: (COMPANY NAME) with (NAME OF SIGNATORY) being the authorized signatory.

2.    We warrant and attest that the funds are good, clean and cleared United States Dollars that have been legitimately earned and are of non-criminal origin.

3.    We warrant and attest that the funds are completely free and clear of any liens or encumbrances of any kind or any rights of third-party interests.

4.      We warrant and attest that the funds are not involved in any breach of money laundering regulations whatsoever, as defined in the jurisdiction of origin, or internationally.

5.      We warrant and attest, with full responsibility that (NAME OF SIGNATORY) has bank acknowledged signatory control and (COMPANY NAME) has full legal title and authority over the herein described funds.

6.    We warrant and attest that (Signatory Name) by the power granted in the corporate resolution of the board of directors of (Company Name) dated the XXth day of XXXXX, 2009 that (SIGNATORY NAME) is the authorized signatory over the funds and duly empowered to sign all documents related to this transaction.

7.    We warrant and attest that the funds are freely transferable and may be reserved and / or blocked.

Initials:_______                   Sworn Statement Funds History                 Page 1 of 3


8.      We warrant and attest that we are willing and able to place the funds for participation in a reserved and / or blocked funds private placement.

9.    We warrant and attest that the Board Of Directors of (COMPANY NAME) have unanimously resolved to participate in a reserved and / or blocked funds private placement and have appointed (SIGNATORY NAME) as our sole authorized signatory to enter funds into such a program.

10.  We understand and acknowledge that THE TRANSACTING PRINCIPALS and the trading bank will initially base placement of this transaction on the face value representations and documentation of (COMPANY NAME) and that any misrepresentations of (COMPANY NAME) may be considered criminal bank fraud.

11.   We hereby agree to indemnify THE TRANSACTING PRINCIPALS against any misrepresentations of (COMPANY).

12.   We hereby grant THE TRANSACTING PRINCIPALS full permission and authority to verify, confirm, and reconfirm said funds on a bank to bank basis or by phone and / or fax and conduct standard background checks of (COMPANY NAME), the funds, and the entity owning the funds if the signatory is representing a corporate entity.

13.      We warrant and attest that I/we have not authorized any other party to place these funds into a Private Placement or Buy / Sell Contract.

14.  We herewith grant the trade group full exclusive rights to provide (Company Name) with the best available reserved and / or blocked funds private placement and to facilitate this private placement.

15.    We warrant and attest that we have full legal title, rights, interest, control, and authority to commit and invest these funds and have chosen to do so of my/our own free will and sole decision without any solicitation or influence from the transacting principals or the trade group.

Initials:_______                   Sworn Statement Funds History                 Page 2 of 3


16.    It is agreed that facsimile copies of this Sworn Statement and Funds Affidavit, or any other associated documents to this transaction, are as valid and legal as delivered originals.


All statements herein are made under penalty of perjury.


Name of Signatory & Title                                                  Date

Name of Company

Passport number:

Issued by:

Initials:_______                   Sworn Statement Funds History                 Page 3 of 3



To:                  Program Manager

Re                   PRIVATE PLACEMENT

From:             Company Name – Name of Signatory


Telephone (hm):

Telephone (wk):



I, as authorized signatory, do hereby confirm that I have requested of you and your organization, specific confidential information and documentation on behalf of myself regarding currently available Private Placement Programs to serve only my interest, education, and not for further distribution.

I am hereby agreeing that all information received form you is in direct response to my request, and is not in any way considered or intended to be a solicitation of any sort, or any type of offering, and for my general knowledge only.  I hereby affirm under penalty of perjury, that I have requested this information from you and your organization of my choice and free will and further, and that you have not solicited me in any way.

I hereby represent that I am not an informant, nor am I associated with any government agency of the United States of America, or any other country, such as the Secret Service, Internal Revenue Service, Federal Bureau of Investigation, Central Intelligence Agency, Securities and Exchange Commission, Banking Commission, or any agency whose purpose is to gather information regarding such offerings. I understand that the contemplated transaction is strictly one of private placement, and is in no way

relying upon, or relating to, the United States Securities Act of 1933, as amended, or related regulations, and does not involve the sale of securities.  Further, I hereby declare that you, the Program Manager, have disclosed that you are not a licensed Security trader, attorney, bank officer, certified public accountant or financial planner.  Any information, work or service conducted hereunder is that of a private individual and that this is a private placement transaction that is exempt from the Securities Act and not intended for the general public but Private Use only.

Initials:_____                                          Non-Solicitation Statement                page 1 of 2


The facsimile transmission of this document shall be considered a binding and enforceable instrument, treated as original copy.  Original may be obtained upon request.