If you answer “YES” to any of the questions below, please provide a DETAILED STATEMENT OF EXPLANATION AND INFORMATION, OR ALTERNATIVELY ANY NECESSARY OPTIONAL DOCUMENTATION. Please use additional pages if necessary for your detailed statement. Please mail, fax or supply by E-Mail or Electronic Attachment, any optional documentation.

CLIENT BACKGROUND INFORMATION UNDER

INTERNATIONAL MARRIAGE BROKER REGULATION ACT OF 2005

FULL NAME: ______

ADDRESS WITH ZIP CODE: ______

TELEPHONE: ______

E-MAIL ADDRESS: ______

DATE OF BIRTH: ______

DO YOU HAVE:

(i) Any temporary or permanent civil protection order or restraining order issued against the United States client.

NO:______

YES:______EXPLAIN:______

(ii) Any Federal, State, or local arrest or conviction of the United States client for homicide, murder, manslaughter, assault, battery, domestic violence, rape, sexual assault, abusive sexual contact, sexual exploitation, incest, child abuse or neglect, torture, trafficking, peonage, holding hostage, involuntary servitude, slave trade, kidnapping, abduction, unlawful criminal restraint, false imprisonment, or stalking.

NO:______

YES:______EXPLAIN:______

PAGE TWO (2)

(iii) Any Federal, State, or local arrest or conviction of the United States client for--

(I) solely, principally, or incidentally engaging in prostitution;

(II) a direct or indirect attempt to procure prostitutes or persons for the purpose of

prostitution; or

(III) receiving, in whole or in part, of the proceeds of prostitution.

NO:______

YES:______EXPLAIN:______

(iv) Any Federal, State, or local arrest or conviction of the United States client for offenses related to controlled substances or alcohol.

NO:______

YES:______EXPLAIN:______

(v) Marital history of the United States client, including whether the client is currently married, whether the client has previously been married and how many times, how previous marriages of the client were terminated and the date of termination, and whether the client has previously sponsored an alien to whom the client was engaged or married.

NONE:______

YES:______EXPLAIN:______

(vi) The ages of any of the United States client's children who are under the age of 18.

NO CHILDREN:______

YES:______EXPLAIN:______

(vii) AllStates and countries in which the United States client has resided since the client was 18 years of age.

NO STATES OR COUNTRIES EXCEPT THE CURRENT:______

YES:______EXPLAIN:______

I ______, CERTIFY AND ATTEST, under penalty of perjury and false statement,that my above CLIENT BACKGROUND INFORMATION IS TRUE AND COMPLETE. I also give my permission to THE INSPIRATIONS COMPANY LLC to release and provide this information in any format to allforeign ladies designated by me. I have provided any necessary additional truthful documentation to all questions answered ‘Yes’ above. I hereby WAIVE ANY PRIVACY RIGHTS FROM RELEASE OF THIS INFORMATION. I ALSO HEREBY RELEASE AND HOLD HARMLESS AND FOREVER DISCHARGE THE INSPIRATIONS COMPANY LLCFROM ANY AND ALL LIABILITES arising from my release of this information and any use of it.

______Signature _____/______/______Date

COPYRIGHT © 2007, THE INSPIRATIONS COMPANY LLC.