A-1 Petroleum Group Ltd

QUESTIONNAIRE FORM

Date of Submission:

1 / REGISTERED COMPANY NAME
2 / CERTIFICATE OF REGISTRATION NO.
3 / DATE & PLACE OF INCORPORATION
4 / NATIONALITY
5 / REGISTERED ADDRESS
TEL. NO / TELEX /FAX NO
6 / BUSINESS ADDRESS
TEL. NO / TELEX /FAX NO
WEBSITE
7 / STATUS OF COMPANY
(Tick the appropriate box) / a. PUBLIC QUOTED/UNQUOTED COMPANIES
b. PRIVATE LTD
c. PARTNERSHIP
d. SOLE PROPRIETORSHIP
e. CO-OPERATIVE SOCIETIES
f. ASSOCIATIONS
8 / NATURE AND LINE OF BUSINESS
9 / NO. OF EMPLOYEES
10 / CONTACT PERSON/ REPRESENTATIVE
E-MAIL
POSITION / MOBILE NO
11 / AUTHORISED CAPITAL
12 / PAID-UP CAPITAL
13 / OVERSEAS OFFICE(S)
14 / SUBSIDIARIES/ AFFILIATES / Portland Aviation Ltd
15 / NO. OF YEARS IN OIL & GAS TRADING / DOMESTIC
INTERNATIONAL
16 / REFINERIES/ MANUFACTURING UNITS
(If Any) / NAME(S)
LOCATION(S)
CAPACITIES
17 / BUSINESS INTEREST (Specify Product) / PURCHASING
SELLING

18. SHAREHOLDERS/ PARTNERS/ SOLE PROPRIETOR

NAME / AMOUNT OF SHARES / PERCENTAGE
OF SHARE

19. MANAGEMENT OF COMPANY

NAME / POSITION / EXPERIENCE IN OIL & GAS INDUSTRY

20. BANKERS

NAME / CONTACT PERSON / PHONE & FAX NUMBERS / ADDRESS


21. AUDITORS

NAME / CONTACT PERSON / PHONE & FAX NUMBERS / ADDRESS

22. ADVOCATES & SOLICITORS

NAME / CONTACT
PERSON / PHONE & FAX NUMBERS / ADDRESS

23. TRADE REFERENCES & CREDIT TERMS

NAME / ADDRESS / PHONE & FAX NO NUMBERS / NATURE OF CREDIT AVAILABLE


24. PHYSICAL TRADE HISTORY

a)  PURCHASE

HOW MANY YEARS TRADING / IN VOLUME (Please specify unit used)
20__ / 20__ / 20__
Term / Spot / Term / Spot / Term / Spot
PETROLEUM PRODUCTS
LPG
GASOLINE
GASOIL s
JET/KERO
FUEL OIL/ LSWR
OTHER SPECIAL PRODUCTS (Pls Specify)
------

b)  SALES

HOW MANY YEARS TRADING / IN VOLUME (Please specify unit used)
20__ / 20__ / 20__
Term / Spot / Term / Spot / Term / Spot
PETROLEUM PRODUCTS
LPG
GASOLINE
GASOIL
JET/KERO
FUEL OIL/ LSWR
OTHER SPECIAL PRODUCTS (Pls Specify)
------

*Purchase/ Sales of crude oil/ petroleum products for intercompany/ group transaction/ own refinery/ own country/market are not to be included in the figures and may be shown separately.

25. SUMMARY FINANCIAL STANDINGS (Please enclosed Audited Financial Statements)

For Year Ended ______ / US Dollar
Exchange rate used: ______= USD 1
1. / Current Assets
2. / Current Liabilities
3. / Total Inventories
4. / Net Profit (Loss) Before Tax
5. / Total Assets
6. / Total Liabilities
7. / Total Net worth
8. / Average collection period
= (Trade Debtor x 365)/ Total Sales / Day


DOCUMENTS NEED TO BE SUBMITTED WITH THIS FORM

1. / Certified Copy of Business Incorporation Certificate / YES/NO
2. / Latest Annual Report / YES/NO
3. / Representative Person/s Verification
a) / Memorandum of Article of Association OR equivalent / YES/NO
OR b) / Notarised Power of Attorney / YES/NO
OR c) / Notarised Corporate Board Resolution / YES/NO
AND d) / Notarised copy of Passport / YES/NO
4. / Financial Capability Verification
a) / Certified copy of audited financial statements (Profit & Loss, Balance Sheet & Cash Flow) for the past 3 years / YES/NO
OR b) / Reference Letters from bankers (inclusive of the estimated credit facilities granted) which can be confirmed by our bankers / YES/NO
5. / Other documents (if any) to support your application
If NO, Please provide details: / YES/NO

Your comments, if any, for our consideration:


DECLARATION

I/We hereby declare to the best of my/our knowledge that the particulars given in this return are true and complete.

FULL NAME
POSITION IN COMPANY
SIGNATURE
DATE / COMPANY STAMP

Kindly note that:

1.  We deal on principal-to-principal basis with the parties who are registered on our approved Counterparts List and NOT through any intermediary/ agents.

2.  Data received either from you or your trade/ bank references would be treated in strict confidence.

3.  The request for registration with A-1 Petroleum Group Ltd as a supplier/ buyer shall be considered, only upon receipt of full documentation required.

4.  Decision of A-1 Petroleum Group Ltds management shall be final and binding with regards to registration.

Please send your application with the documents requested to the following:

A-1 PETROLEUM REG 2205 Page 7