Trust Instruction Questionnaire

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Name of Bank, Trust Company, or Credit Union	Amount	Actions

There are no Accounts.

Name of Financial Institution	Amount	Actions

There are no Investments.

Name of Financial Institution	Amount	Actions

There are no RRSPs.

Name	Relationship	Actions

There are no Entries.

Item Description	Item Value	Actions

There are no Entries.

I owe $____	Name of creditor	Actions

There are no Entries.

KMK LAW CORPORATION

BARRISTERS & SOLICITORS

PARK PLACE, SUITE 500
666 BURRARD STREET
VANCOUVER, BC, CANADA V6C 2X8
PHONE: 604-990-0995
TOLL FREE: 1-877-394 0999
FAX: 604-990-0993
EMAIL: info@kmklaw.net

WILLS, ESTATES & TRUSTS LAWYERS