Common use of Certification as to Location of Residence or Principal Place of Business Clause in Contracts

Certification as to Location of Residence or Principal Place of Business. The undersigned represents and warrants to the Company that the undersigned is a resident of the location listed in the address of the undersigned set forth below, or, if the undersigned is an entity, that the principal place of business of the undersigned is such address. [Signature Block For Individuals] [Signature Block For Entities] Not applicable (Signature) (Name of Entity) By: _____________________ (Printed Name) Name: _________________ Title: __________________ c/x Xxxxx Xxx Xxxxxxxxxx Xxx Xxx 00-0, Xxxxx 00/00X, (Xxxxxx Address of Residence) (Street Address of Pxxxxxxxx Xxxxxx) Xxxx Xxx Xxxxxxxx 00000 Xxxxx Xxxxxx (City or Town) (State) (Zip Code) (City or Town) (State) (Zip Code) Malaysia (Country) (Country) +0000 000 0000 (Daytime Telephone Number) (Daytime Telephone Number) Date: April __, 2012

Certification as to Location of Residence or Principal Place of Business. The undersigned represents and warrants to the Company that the undersigned is a resident of the location listed in the address of the undersigned set forth below, or, if the undersigned is an entity, that the principal place of business of the undersigned is such address. [Signature Block For Individuals] [Signature Block For Entities] Not applicable (Signature) (Name of Entity) By: _____________________ (Printed Name) Name: _________________ Title: __________________ c/x Xxxxx Xxx Xxxxxxxxxx Xxx Xxx o Union Hub Technology Sdn Bhd 00-0, Xxxxx 00/00X, (Xxxxxx Xxxxxxx xx Xxxxxxxxx) (Xxxxxx Address of Residence) (Street Address of Pxxxxxxxx Xxxxxxxxx Xxxxxx) Xxxx Xxx Xxxxxxxx 00000 Xxxxx Xxxxxx (City or Town) (State) (Zip Code) (City or Town) (State) (Zip Code) Malaysia (Country) (Country) +0000 000 0000 (Daytime Telephone Number) (Daytime Telephone Number) Date: April June __, 2012

Certification as to Location of Residence or Principal Place of Business. The undersigned represents and warrants to the Company that the undersigned is a resident of the location listed in the address of the undersigned set forth below, or, if the undersigned is an entity, that the principal place of business of the undersigned is such address. [Signature Block For Individuals] [Signature Block For Entities] Not applicable (Signature) (Name of Entity) By: _____________________ (Printed Name) Name: _________________ Title: __________________ c/x Xxxxx Xxx Xxxxxxxxxx Xxx Xxx o Union Hub Technology Sdn Bhd 00-0, Xxxxx 00/00X, (Xxxxxx Xxxxxxx xx Xxxxxxxxx) (Xxxxxx Address of Residence) (Street Address of Pxxxxxxxx Xxxxxxxxx Xxxxxx) Xxxx Xxx Xxxxxxxx 00000 Xxxxx Xxxxxx (City or Town) (State) (Zip Code) (City or Town) (State) (Zip Code) Malaysia (Country) (Country) +0000 000 0000 (Daytime Telephone Number) (Daytime Telephone Number) Date: April August __, 2012

Certification as to Location of Residence or Principal Place of Business. The undersigned represents and warrants to the Company that the undersigned is a resident of the location listed in the address of the undersigned set forth below, or, if the undersigned is an entity, that the principal place of business of the undersigned is such address. [Signature Block For Individuals] [Signature Block For Entities] Not applicable (Signature) (Name of Entity) By: _____________________ (Printed Name) Name: _________________ Title: __________________ c/x Xxxxx Xxx Xxxxxxxxxx Xxx Xxx o Union Hub Technology Sdn Bhd 00-0, Xxxxx 00/00X, (Xxxxxx Xxxxxxx xx Xxxxxxxxx) (Xxxxxx Address of Residence) (Street Address of Pxxxxxxxx Xxxxxxxxx Xxxxxx) Xxxx Xxx Xxxxxxxx 00000 Xxxxx Xxxxxx (City or Town) (State) (Zip Code) (City or Town) (State) (Zip Code) Malaysia (Country) (Country) +0000 000 0000 (Daytime Telephone Number) (Daytime Telephone Number) Date: April September __, 2012