investor relation, SEC reporting, Securities Regulation

1. Director and Officer Proxy statement Questionnaire
All the company’s directors and officers are being asked to respond to this questionnaire. It is
intended to help determine your independence and any related party disclosures required in
accordance with the rules of the Securities and Exchange Commission and any related stock
exchanges regulations. Please complete this questionnaire for full and adequate disclosure. If a
specific question is not applicable, please indicate ‘Not Applicable’ or ‘NA’. If you require
additional space for answering a question, attach extra sheets. Please do not leave any questions
unanswered. Please complete, sign, date and return one copy of this questionnaire to the office of
the Chief securities Counsel and SEC reporting Controller.
1. Please provide the following personal information:[SEC reg S-K, items 401(a) and (b)]
Name: _______________________________________
Address: _____________________________________
__________________________________________
__________________________________________
Date of Birth: ____ / ____ / ____ [SEC reg S-K, item 401(d)
2. Do you have a family member or relative who is also a director or officer of this company?
___ Yes ___ No [SEC reg S-K, items 401(a), (b),(c)]
If Yes, please disclose this relationship:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
3. Describe your present occupation and position:
Job Title / Retired: ____________________________________________________
Employer Name: ______________________________________________________
Principal Business: ____________________________________________________
Number of Years in this Position: ________
4. List prior occupations and positions (during last ten years)
Start Date Stop Date Title Employer
___/___ ___ /___ ______________________ ________________________
___/___ ___ /___ ______________________ ________________________
___/___ ___ /___ ______________________ ________________________
___/___ ___ /___ ______________________ ________________________
___/___ ___ /___ ______________________ ________________________
___/___ ___ /___ ______________________ ________________________
___/___ ___ /___ ______________________ ________________________
5. Describe your proposed position and responsibilities within the company:
Title: _____________________________________
Primary Responsibility: _________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
6. If you are a director or a person chosen or nominated to become a director. Please disclose
the name of ‘other public corporations’ of which you are currently serving as an Officer or
Director:
_____________________________________________________________________
_____________________________________________________________________
Research conducted by Arthur Mboue

2. _____________________________________________________________________
7. List any and all forms and amounts of compensation you have or will receive as an Officer
or Director with our company: [SEC reg S-K, items 402g and 404(a), SEC rule 16b-3(b)(3),
IRS Reg. 1.162-27(c)(3)]
Type of compensation (fees, salary, bonus, property, etc.) _________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Frequency of compensation: ________________________________________
_______________________________________________________________
_______________________________________________________________
Benefits: (use of company property, club memberships, aircraft, etc.)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
8. Will or have you or any family member or relative used company property and assets for
personal use? ____ Yes ____ No [SEC reg S-K, item 404(a)]
If yes, please describe use: __________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
If yes, did you or your family member or relative reimburse the company?
____ Yes ____ No
9. Will the company provide you or any family member or relative with special services, such
as tax return preparation, personal financial planning, legal services, or other services for
your own personal use? ____ Yes ____ No
If yes, please describe: ______________________________________________
_________________________________________________________________
_________________________________________________________________
10. Will or have you or any family member or relative received benefits from suppliers,
customers, or other parties which does business with the company? ___Yes ___No
If yes, please describe benefits (free golf memberships, special discounts, reduced rates,
gifts, and other forms of compensation) and source:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
11. Are you actively working as a “promoter” of the company; i.e. you are directly or indirectly
behind creating and organizing the company ____ Yes ____ No
If yes, did you receive any form of compensation as a promoter? ___ Yes ___ No
What was the form of this compensation? ________________________________
__________________________________________________________________
__________________________________________________________________
12. Please fully disclose your current equity ownership in the company. This would include the
total number of shares you own, date acquired, the amount you paid, if the ownership allows
voting rights, and if the ownership allows you to sell the shares. Also disclose if family
Research conducted by Arthur Mboue

3. members or relatives have an equity interest in the company. [SEC reg. S-K, items 402,
403(b), SEC rule 13d-3, 16a-2, 16a-3]
Number of Shares Date Amount
Owned Acq Paid Voting Power Able to Sell
Your Ownership:
_______ ________ ___________ Yes No Yes No
Spouse:
_______ ________ ___________ Yes No Yes No
Family Member(s):
_______ ________ ___________ Yes No Yes No
Relatives:
_______ ________ ___________ Yes No Yes No
Trust:
_______ ________ ___________ Yes No Yes No
Owned by Company, Partnership or other entity where you are an Officer/Director:
_______ ________ ___________ Yes No Yes No
Beneficial owner table
Title of equity
security
Number of
shares or units
Nature of
beneficial
ownership
Explanations
Shares or Units
included but
issued in
Another’s
name
Shares or Units
Excluded but
issued in Your
name
Table of Rights
Common stock Other
Number of shares or units
as to which you have sole
voting power
Number of shares or units
as to which you have shared
voting power
Number of shares or units
as to which you have sole
investment power
Number of shares or units
as to which you have shared
investment power
Number of shares or units
as to which you have the
‘right to acquire’ beneficial
ownership
Research conducted by Arthur Mboue

4. 13. Please fully disclose any options, rights, or other bonus type arrangements you own with the
company:
Date Amount Exercise
Type of Arrangement Acquired Duration Paid Price
_________________ ________ ________ ________ _________
_________________ ________ ________ ________ _________
14. Has the company adjusted the exercise price of or otherwise repriced any of your options
during the last fiscal year? ____Yes ____No
15. Did you have any transactions, exempt from Form 4 filing, which now need to be reported
on Form 5?___Yes____No
16. Do you plan on having any type of arrangement or agreement with any person or entity that
has or will have an equity ownership interest in the company with respect to first offer,
pledge, or other transfer of stock of the company? [SEC reg S-K, item 403(a)]
____ Yes ____ No
If yes, please describe this arrangement or agreement; disclose the parties involved and number
of shares affected: ________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
17. Are you aware of any arrangement or possible change in the control of the company,
including a pledge of securities? ____ Yes ____ No [Rule 10b5-1]
If yes, please describe the persons involved and the nature of the change:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
18. In the last five years, please indicate if you have filed or anyone has filed against you a
petition under the Bankruptcy Act or any insolvency laws of any state or country.
____ Yes ____ No [SEC Reg. S-K, items 103, 401(f) and 401(g)]
19. In the last ten years, please indicate if you have been convicted in any criminal proceeding,
excluding traffic violations and misdemeanors.
____ Yes ____ No
If yes, indicate the nature of the conviction, name of court, date of conviction, and the penalty or
disposition of the case:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
20. In the last ten years, indicate if you were subject of a court order, judgement, or decree of
any court, the SEC, CFTC, NYSE, American Stock Exchange or NASD which enjoined or
otherwise limited your capacity for acting as an investment advisor, underwriter, broker,
dealer, or affiliated person, director, officer, or employee of any investment company, bank,
insurance company, or any activity connected to the purchase or sale of securities under
federal and state securities laws or commodities laws?
_____ Yes ____ No
If yes, indicate the nature of the restriction, date imposed, and the penalty or disposition of the
restriction:
Research conducted by Arthur Mboue

5. ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
21. Complete the following information if you or any business associate of yours is or has been
indebted to the Company and any of its subsidiaries at anytime since formation of the
Company:
Name of Borrower: ______________________________________
Maximum Amount of Debt: _______________________________
Amount Currently Outstanding: ____________________________
Annual Interest Rate: _________
Terms, Conditions, and Description of Loan: ________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
22. Indicate if you or any business associate is party to a pending lawsuit or legal proceeding
involving the Company or the assets of the Company and any of its subsidiaries?
_____ Yes _____ No
If yes, describe the lawsuit or legal proceeding, the name of the court, the amount claimed, the
parties involved, and date(s) of such proceedings:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
23. To the best of your knowledge, are you aware of any material legal proceeding not before
mentioned in question #20 which could have a substantial effect on the financial condition
of the Company?
_____ Yes _____ No
If yes, describe the pending legal proceeding, the name of the court, the amount claimed, the
parties involved, and date(s) of such proceedings:
___________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
24. Describe any interest you have or any of your business associate has in any legal proceeding
which could be adverse to the Company?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
25. To the best of your knowledge, are you aware of any agreement, trust, or other arrangement
which holds more than 5% of the Company? [SEC reg , item 402(h) and 403(c)]
____ Yes ____ No
If yes, indicate the amount held and the duration of the agreement:
___________________________________________________________________
Research conducted by Arthur Mboue

6. ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
26. To the best of your knowledge, are you aware of any director, officer, or partner who is
insured or indemnified against liability in his or her capacity as a director, officer, or
partner? [SEC reg S-K, item 702]
_____ Yes _____ No
If yes, identify the name(s), position(s), and extent of indemnification if known?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
27. Do you have any relationship with an investment banker, broker, underwriter or other
securities dealer which is more than the usual maintenance of an open account?
_____ Yes _____ No
If yes, describe this relationship(s): ______________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
28. Do you have any material interest, association, affiliation, or relationship with the
Underwriter or Legal staff for the Company?
____ Yes ____ No
If yes, describe the relationship: __________________________________________
_____________________________________________________________________
_____________________________________________________________________
29. Are you aware of any arrangement or agreement which is designed to: a) limit or restrict the
sale of interest in the Company; b) stabilize the marketplace for the stock of the Company
being registered; c) hold underwriters and/or dealers responsible for their participation; or d)
change control of the Company?
_____ Yes _____ No
If yes, describe the details of the arrangements:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
30. Identify the sale of unregistered securities by you or any person, firm or company where you
have a controlling interest or you serve as director, officer or partner for the last three years:
Name of Issuer: ___________________________________
Date of Sale: _____________________________________
Type of Security: _________________________________
Name of Purchaser: _______________________________
Purchase Price: ___________________________________
Total Amount of Transaction: _______________________
Relationship of Purchaser: __________________________
Residence of Purchaser: ____________________________
Research conducted by Arthur Mboue

7. Occupation of Purchaser: ___________________________
NOTE: Attach documentation regarding the sale(s)
31. Have you ever been indemnified by the Company as a result of serving as an officer,
director, partner, agent, or employee of the Company?
_____ Yes _____ No
If yes, describe the indemnification: ______________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
32. Have you ever been disqualified, censored, or reprimanded by a professional organization or
association while practicing as a professional (such as lawyer, doctor, realtor, CPA, etc.)?
____ Yes ____ No
If yes, describe the actions taken and the current disposition:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
33. Are you to be elected pursuant to any arrangements or understanding between yourself and
any other party?
____Yes ____No
34. If yes, please list all the names of such persons or entities and describe the arrangements
__________________________________________________________________________
__________________________________________________________________________
_______________________________________________________________________
35. [SEC reg S-K, item 402j and Schedule 14A, item 7] The company’s records indicate that of
the ___ board meetings held during the last fiscal year, you attended __ of suck meetings,
and that of the ___ meetings of the __________ committee(s) on which you serve, you
attended ___ such meetings. Is this correct?
___ Yes ___No
If no, please provide correct information
36. If you have been nominated to stand for election to the Board of Directors of the Company
at the 2015 Annual Meeting of Stockholders, do you agree to serve if elected?
___Yes ____No
37. Did you, your affiliates or member of your immediate family receive last fiscal year any
compensation for service rendered to the company or its subsidiaries?
___Yes ___No
38. Did you, your affiliates or member of your immediate family receive last fiscal year benefits
from third party due to any relationship with the company?
____Yes ___No, if yes, describe the nature of these transactions
________________________________________________________________
39. Did you, your entity or member of immediate family receive any property or services from
the affiliated group in exchange transaction?
___Yes ___No
40. [IRS reg 1.162-27(c)(3)] Are you, or have you been during the last fiscal year, employed or
self employed by an entity (including any sole proprietorship, trust, estate, partnership,
corporation or other entity) that performed personal services for the Affiliated group?
___Yes ___No
Research conducted by Arthur Mboue

8. 41. Do you now own or have owned, during the company’s last fiscal year, of record or
beneficially, in excess of a 10% equity interest, any firm, corporation, or other business or
professional entity? ____Yes ___No
42. What is the present state of your physical health?
____________________________________________________________________
____________________________________________________________________
43. If you have consented to accept a position or role within the Company (such as director,
advisor, etc.), please describe your role:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
The information provided in this questionnaire is supplied for the purpose of disclosing
certain information to potential investors. If there is any other information not previously
covered in this questionnaire that you believe should be disclosed, then set forth all relevant
information as an attached sheet. In the event that other developments or circumstances make
the information disclosed in this questionnaire misleading, false, incomplete or otherwise
inaccurate, notify the Company or its securities counsel legal staff and SEC reporting staff
immediately by telephone at (___) ____________.
I AGREE TO THE INFORMATION SET FORTH IN THIS QUESTIONNAIRE AND I AGREE
TO NOTIFY THE COMPANY IMMEDIATELY ON BECOMING AWARE OF ANY CHANGES
IN THE FOREGOING INFORMATION AND WILL ENDEAVOR TO DO SO PRIOR TO MY,
AND ANY OF MY AFFILIATES UNDER MY CONTROL DIRECTLY OR INDIRECTLY
ENTERING INTO ANY RELATIONSHIP OR TRANSACTION THAT WOULD REQUIRE
CHANGES IN MY ANSWERS TO ANY QUESTIONS. I AGREE TO CONTACT THE
COMPANY BY TELEPHONE AT (____)_____________ IMMEDIATELY.
I ALSO ACKNOWLEDGE THAT I HAVE REVIEWED THE COMPANY’S CODE OF ETHICS
AND BUSINESS CONDUCT.
______________________________________
(Signature of Director or Officer)
______________________________________
(Print Name)
_____________________
(Date)
Research conducted by Arthur Mboue