dated 2nd August, 2010. THE PROCEEDS OF CRIME LAW, 2008

CAYMAN ISLANDS Supplement No. 4 published with Gazette No. 16 dated 2nd August, 2010. THE PROCEEDS OF CRIME LAW, 2008 (LAW 10 OF 2008) THE PROCEEDS OF CRIME(DISCLOSURE) ORDER, 2010 The Proceeds of Crime (Disclosure) Order, 2010 2 The Proceeds of Crime (Disclosure) Order, 2010 CAYMAN ISLANDS THE PROCEEDS OF CRIME LAW, 2008 (LAW 10 OF 2008) THE PROCEEDS OF CRIME (DISCLOSURE) ORDER, 2010 In exercise of the power conferred by section 143 of the Proceeds of Crime Law, 2008, the Governor in Cabinet makes the following Order - 1. This Order may be cited as the Proceeds of Crime (Disclosure) Order, 2010. Citation 2. A disclosure pursuant to section 136 or 137 of the Law shall be made in the Form of disclosure form prescribed in the Schedule to this Order. Schedule 3. A person who wilfully makes or causes to be made, in the form prescribed Offence in the Schedule to this Order, a declaration which he knows to be false or fraudulent commits an offence and is liable on summary conviction to a fine of five thousand dollars or to imprisonment for a term of two years, or to both. 3 The Proceeds of Crime (Disclosure) Order, 2010 SCHEDULE (Paragraph 2) DISCLOSURE CONFIDENTIAL FINANCIAL REPORTING AUTHORITY Delivery Address: Mailing Address: 80E Shedden Road P.O. Box 1054 3rd Floor, Elizabethan Square, Grand Cayman KY1 - Phase IV 1102 George Town, Grand Cayman Cayman Islands Cayman Islands Te l No. (345) 945-6267 Fa x No. (345) 945-6268 SUSPICIOUS ACTIVITY REPORT Note: This form should preferably be typed using arial 12 point font. Date of this Report: Date of Original Report (if applicable): FRA Case No. (if known): 4 The Proceeds of Crime (Disclosure) Order, 2010 1. REPORTING ENTITY DETAILS: Name of Reporting Entity: Reference of Reporting Entity: Address of Reporting Entity: Name of Money Laundering Reporting Officer: Note: The name of an individual who is authorized to discuss the contents of this report must be provided. Phone number: Fax number: Direct private fax: yes no Do you wish to be contacted prior to faxes being sent to this number: yes no Type of Reporting Entity: (i.e. bank, trust company, mutual fund administrator, insurance manager, real estate agent etc.) Nature of service(s) provided to the individual and / or entity that is the subject of this report: 5 The Proceeds of Crime (Disclosure) Order, 2010 2. SUBJECT(S) OF REPORT (Natural Persons): Note: Please attach additional sheets as necessary. Surname: First Name: Gender: Date of Birth: Place of Birth: Nationality: Occupation/Profession: Address(es): PO Box: Street No. and City/Town Name: State/Province Country Zip/Postal Code: Telephone No: Fax No.: E-Mail: Identification Document Type: (i.e. passport, driver’s license etc.) Identification Document Number: Date of Issue: Place of Issue: Account number(s) if applicable: Other signatories on the account. (Please include relevant KYC details): Other Information: 6 The Proceeds of Crime (Disclosure) Order, 2010 3. SUBJECT(S) OF REPORT (Legal Entities) Note: Please attach additional sheets as necessary. Entity Type (company, trust, partnership, charity, other): Name of Entity: Jurisdiction of Incorporation/Registration: Date of Incorporation/Registration: Purpose of Entity: Registered Office Address (or address of Trustee or General Partner etc.): Business Address (if different from registered office address): NOTE: Please include relevant information for entity type (i.e. settlor and beneficiary information for a trust). For each of the following which is a natural person please provide the information noted in Section 2. Shareholder(s): Name(s): Director(s): Name(s): Ultimate Beneficial Owner (s) if different from above: Name(s): 7 The Proceeds of Crime (Disclosure) Order, 2010 Account number(s) if applicable: Other signatories on the account: (Please include relevant KYC details): Other Information: 4. OTHER FINANCIAL SERVICE PROVIDERS INVOLVED IN ACTIVITY: Name(s): Address(es): Account number(s) if applicable: Other Information: 5. REASON FOR SUSPICION Note: Please include relevant details including date business relationship established/declined, source of funds, value of assets currently held if any and nature of the suspicion. Attach additional sheets as necessary. _________________________________________________ Signature of Money Laundering Reporting Officer Made in Cabinet the 2nd day of March, 2010. Kim Bullings Clerk of the Cabinet. 8