THE CORPA GROUP INC. RUSH ( ) NON_RUSH ( ) 2000 Appleby Line Suite 494 Burlington, Ontario CanadaL7L 7H7 (877)-331-1333 Tel (905) 331-1333 Fax (905) 331-0234 E-Mail: corpa@corpa.com HOW TO USE THIS QUESTIONNAIRE This questionnaire is a guide to assist you with some of the information we will require. You have the option of using this form and faxing it back to us, or you may use this as a guide to assist you when you send your letter of instructions to us. Please feel free to contact us by telephone, should you wish to speak to an investigator directly. Complete this form based on the information you have available. We don't expect this form to be completed in full. The minimum information we require is the subject's FIRST and LAST NAME and the LAST KNOWN ADDRESS. Correct spelling of the subject's FIRST and LAST NAME is of the utmost importance. CLIENT INFORMATION NAME OF FIRM: TELEPHONE NO.: YOUR NAME: FAX NO.: E-MAIL: ADDRESS: PROVINCE/STATE: POSTAL/ZIP CODE: NAME OF SECRETARY OR ASSISTANT: YOUR MATTER NAME: YOUR FILE NO.: RETAINER AGREEMENT I hereby authorize the Corpa Group Inc., to conduct the enclosed investigation on our behalf. I confirm I will be charged $75.00 for a full report if they are unsuccessful. If they are successful in locating the subject I understand their fees to be: I understand their fees to be: PLEASE CHECK WHICH TRACE YOU REQUIRE: _________GENERAL SKIP TRACE: .....................................$150.00 _________RUSH SKIP TRACE:.........................................$175.00 _________GENERAL PUBLIC TRACE:....................................$200.00 Law firms and Insurance Companies are not require to provide credit cards numbers or retainers. Just complete this form. We will invoice you upon completion of the matter. Payment Details via Credit Card for General Public. If you are paying by credit card fax or mail the form and we will call you. I am paying by __Visa __Amex ___MC ___Discover Card No: Exp Date: Authorized Signature:...................................Date:........................... SUBJECT INFORMATION SUBJECT'S FIRST SUBJECT'S & MIDDLE NAME: LAST NAME: DATE OF BIRTH: SOCIAL (Approximate Age) INSURANCE NUMBER: LAST ADDRESS: PROVINCE/ POSTAL/ (unit or apt. No.) STATE: ZIP CODE: DATE LAST AT PHONE NUMBERS: (List all numbers in THIS ADDRESS service, home, business, car, fax, etc.) LAST EMPLOYER & EMPLOYER EMPLOYER NAME: ADDRESS: PROVINCE/ POSTAL/ LAST EMPLOYER STATE: ZIP CODE: PHONE NO: POSITION AT SUBJECT'S TRADE LAST EMPLOYER: OR PROFESSION: SUBJECT'S DRIVER'S LICENCE PLATE NUMBERS LICENCE NUMBER: OR ANY VEHICLES: DESCRIPTION OF ANY VEHICLES: SUBJECT'S SPOUSE SUBJECT'S SPOUSE: ( ) Married ( ) Common-law ( ) Divorced ( ) Separated SPOUSE'S FIRST SPOUSES & MIDDLE NAME: LAST NAMES: DATE OF BIRTH: SOCIAL (Approximate Age) INSURANCE NUMBER: SPOUSE'S ADDRESS: ( ) Same as spouse ( ) Different than above SPOUSE'S PROVINCE/ POSTAL/ LAST ADDRESS: STATE: ZIP CODE: DATE LAST AT PHONE NUMBERS (List all numbers in THIS ADDRESS: service, home, business, car, fax,etc.) SPOUSE'S LAST EMPLOYER & LAST EMPLOYER EMPLOYER NAME: ADDRESS: PROVINCE/ POSTAL/ LAST EMPLOYER STATE: ZIP CODE: PHONE NO: POSITION AT SPOUSE'S TRADE LAST EMPLOYER: OR PROFESSION: SPOUSE'S DRIVER'S LICENCE PLATE NUMBERS LICENCE NUMBER: OR ANY VEHICLES (past or present): DESCRIPTION OF ANY VEHICLES: GENERAL INFORMATION NAMES AND ADDRESSES OF FRIENDS OR RELATIVES WHO MIGHT BE ABLE TO PROVIDE INFORMATION: (PLEASE PROVIDE TELEPHONE NUMBERS) BUSINESS OR CREDIT REFERENCES: IF YOU HAVE ANY OF THE FOLLOWING DOCUMENTATIONS, PLEASE PLACE AN (X), AND MAIL A PHOTOCOPY TO OUR OFFICE. (Please do not mail any original documentations as we will not be returning them to you). ( ) Application (credit, employment, lease, loan, rental, stock, tenancy, etc.) ( ) Articles of Incorporation (Last page showing the subject as a director) ( ) Motor Vehicle Accident Report ( ) Bill or Invoice Outstanding ( ) Police Report or Offence Notices ( ) Credit or Financial Info ( ) P.P.S.A. or U.C.C. ( ) N.S.F. Cheque ( ) Vehicle Registration Info DO YOU HAVE JUDGEMENT AGAINST THE SUBJECT? ( ) YES ( ) NO IF YES, PLEASE STATE AMOUNT AND WHEN WAS JUDGEMENT OBTAINED: Has the subject ever signed a consent giving authorization for you or your client to conduct a financial investigation? (ie. as is usually found in loan, lease or credit application): ( ) YES ( ) NO Please explain: WE ARE A LICENSED AGENCY BY LAW WE MUST BE CONVINCED THAT THIS TRACE IS BEING CONDUCTED FOR A LAWFUL PURPOSE. ARE THERE ANY COURT ORDERS PROHIBITING YOU (OR ANYONE ASSOCIATED WITH YOU FROM CONTACTING THIS PERSON OR BEING NEAR THIS PERSON? ( ) YES ( ) NO YOU "MUST " GIVE A FULL EXPLANATION WHY THIS TRACE IS REQUIRED. WE WILL NOT BE ABLE TO CONDUCT THIS TRACE UNLESS WE ARE COMPLETELY CONVINCED THAT YOU WILL NOT VIOLATE ANY LAW ONCE WE FIND THE PERSON FOR YOU. ------------------------------------------------------------------------- 5