Post Sale Registration Certification By Business Opportunity Seller

POST-SALE REGISTRATION CERTIFICATION BY BUSINESS OPPORTUNITY SELLER The undersigned seller of business opportunities, having applied for post-sale registration under Section 36b-62(g) of the Connecticut Business Opportunity Investment Act, certifies to the Connecticut Banking Commissioner as follows: 1. Each purchaser-investor to whom an unregistered business opportunity was sold has signed the post-sale registration document consisting of an Explanatory Statement and Statement of Non-prejudice; and Included herewith are the signed documents referenced above and their return receipts; and Attached hereto as "Exhibit A" is a list of the names, addresses and telephone numbers of those purchaser-investors to whom business opportunities have been sold without compliance with the registration provisions of sections 36b-60 to 36b-80, inclusive, and the amount of payment furnished by each purchaser-investor for the business opportunity. 2. 3. Print Name of Business Opportunity Seller: Signature of Executive Officer or Authorized Person of Similar Rank: Print Name of Signatory: Date: __________________________ __________________________ __________________________ __________________________ Revised 10/1/2009 American LegalNet, Inc. www.FormsWorkFlow.com