Legal Annual Financial Statement

LEGAL ANNUAL FINANCIAL STATEMENT

This Legal Annual Financial Statement (the "Statement") is made as of by and between Company Name: (the "Company") and Reporting Party: (the "Reporting Party").

RECITALS

WHEREAS, the Company maintains financial records and prepares annual financial statements for the fiscal year and the Reporting Party requires a legally certified annual statement for regulatory and contractual purposes;

WHEREAS, the Company represents that the financial information presented herein fairly reflects the financial position and results of operations of the Company for the fiscal year described below in accordance with the accounting basis selected by the Company; and

WHEREAS, the parties each desire to set forth their certifications, representations and remedies with respect to the attached financial information.

NOW, THEREFORE

In consideration of the mutual covenants and agreements contained herein, the parties agree as follows:

1. FISCAL YEAR AND IDENTIFYING INFORMATION

1.1 Fiscal Year Covered. This Statement covers the fiscal year commencing on and ending on .

1.2 Company Details. Principal place of business: ; Tax/EIN or Business ID: .

2. ACCOUNTING BASIS

The financial statements included with this Statement have been prepared on the following basis (check one):

Generally Accepted Accounting Principles (GAAP) International Financial Reporting Standards (IFRS) Other (describe):

3. SUMMARY FINANCIAL DATA

The Company hereby certifies that the summarized amounts below fairly present the aggregate balances of the Company as of the fiscal year end:

4. ATTACHED STATEMENTS AND NOTES

The following documents are attached and form an integral part of this Statement: statement of financial position, statement of comprehensive income, statement of cash flows, and notes to the financial statements. Describe any significant accounting policies, contingencies, subsequent events, or exceptions below:

5. REPRESENTATIONS AND WARRANTIES

5.1 The Company represents and warrants that, to the best of its knowledge, the attached financial statements were prepared in accordance with the accounting basis selected above and present fairly, in all material respects, the financial position of the Company as of the fiscal year end and the results of its operations and cash flows for the fiscal year then ended.

5.2 The Company further represents that no material adverse change in the financial condition or prospects of the Company has occurred since the fiscal year end except as fully disclosed in the notes to the financial statements.

5.3 The Company shall promptly notify the Reporting Party in writing of any material misstatement discovered in the attached financial statements and shall cooperate in any corrective filings or restatements as required by applicable law or agreement.

6. AUDIT OR REVIEW

Has the financial information been audited or reviewed by an independent licensed accountant?

Audited Reviewed Neither audited nor reviewed

7. CERTIFICATION

The undersigned, being duly authorized officers of their respective parties, certify under penalty of perjury and pursuant to applicable law that the attached financial statements and the information provided in this Statement are true, complete and correct to the best of their knowledge and belief, and that this Statement does not omit any material fact necessary to make the statements contained herein not misleading.

8. COMPLIANCE, REMEDIES AND COVENANTS

The Company covenants to maintain accounting records and internal controls sufficient to support the financial statements. In the event of material misrepresentation or omission, the Reporting Party may seek all remedies available at law or in equity, including requiring prompt corrective action and recovery of damages.

9. NOTICES

All notices required or permitted under this Statement shall be in writing and delivered to the addresses set forth below or such other address as a party may designate by notice in accordance with this section.

10. MISCELLANEOUS

Governing Law: This Statement shall be governed by and construed in accordance with the laws of the state or jurisdiction identified by the Company:

Entire Agreement: This Statement, together with the attached financial statements and notes, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior understandings and agreements, whether written or oral.

Severability: If any provision of this Statement is held invalid or unenforceable, the remaining provisions shall continue in full force and effect.

Amendments and Waiver: No amendment or waiver of any provision of this Statement shall be effective unless in a writing signed by both parties.

Counterparts: This Statement may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument.

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