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 understand this investigation is being conducted on a "No Find - No Fee" basis, whereby I will only be charged should the Corpa Group be successful in locating the subject. Subject is defined as "per individual". I understand their fees to be: General Rates: (Your credit card number must be on file with us before we commence) ______________ CAN SEARCH (with SIN) (inclusive of deposit)............$200.00 CAN SEARCH (without SIN) (inclusive of deposit).........$250.00 U.S. SEARCH (with SSN) (inclusive of deposit)...........$250.00 U.S. SEARCH (without SSN) inclusive of deposit).........$300.00 STATUS REPORTS (Affidavits) ............................$ 75.00 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:........................... Law Firm/Insurance Co rates: (We will invoice you if we are successful) ____________________________ CAN SEARCH (NO FIND – NO FEE)...........................$150.00 CAN SEARCH (STANDARD)...................................$200.00 U.S. SEARCH (with SSN) (inclusive of deposit)...........$200.00 U.S. SEARCH (without SSN) inclusive of deposit).........$250.00 STATUS REPORTS (Affidavits) ............................$ 75.00 PLEASE CHECK ONE: If the subject is not found... ( ) I will require a status report $75.00 ( ) I do not require a status report just close your file do not bill me I agree to pay said fees upon receipt of a report and invoice. 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