Semi Annual Report Form

SEMI-ANNUAL REPORT FORM

RECITALS

WHEREAS, Reporting Entity: (the "Reporting Entity") is required to provide a semi-annual report for the period specified below; and

WHEREAS, Recipient: (the "Recipient") shall receive and review the information submitted herein for compliance, oversight, or contractual purposes; and

WHEREAS, the parties acknowledge that this form constitutes a formal submission and certification of facts and figures for the semi-annual reporting period described below.

REPORTING PERIOD

Reporting period start date:    end date:

ENTITY INFORMATION

SUMMARY OF ACTIVITIES

FINANCIAL SUMMARY

Total gross revenue during period: $

Total expenses during period: $

Net income (loss): $

COMPLIANCE CHECKLIST

Payroll taxes remitted on schedule:

Regulatory filings current:

Material contracts updated and executed:

SCOPE OF WORK (IF APPLICABLE)

PAYMENT TERMS (IF APPLICABLE)

Invoice amount due (if any): $

Late payment fee (if unpaid after due date):

TERM AND TERMINATION

Report effective start date:    end date:

Either party may terminate obligations under any associated contract or reporting arrangement upon written notice of days to the other party, except that termination shall not relieve the Reporting Entity of obligations to deliver completed reports and to pay amounts accrued prior to termination.

CONFIDENTIALITY

All non-public information disclosed in this semi-annual report shall be treated as Confidential Information by Recipient. Recipient shall not disclose Confidential Information except to its employees, agents, auditors or advisors who have a need to know and who are bound by confidentiality obligations no less protective than those set forth herein. Confidential Information does not include information that (i) is or becomes publicly available through no fault of Recipient, (ii) was rightfully in Recipient's possession prior to disclosure, or (iii) is independently developed by Recipient without use of the Confidential Information. Breach of this Section shall entitle the disclosing party to injunctive relief in addition to any other remedies available at law or in equity.

GOVERNING LAW

This submission and any dispute arising out of it shall be governed by the laws of the State of , without regard to its conflicts of law principles.

ENTIRE AGREEMENT

This form, together with any attachments, appendices, or referenced exhibits, constitutes the entire agreement between the parties with respect to the subject matter of this semi-annual report and supersedes all prior understandings and agreements, whether written or oral, relating thereto. Any amendment must be in writing and signed by both parties.

ATTACHMENTS

CERTIFICATION

I certify under penalty of perjury that the information contained in this semi-annual report and any accompanying attachments is true, complete, and accurate to the best of my knowledge, and that I am authorized to submit this report on behalf of the Reporting Entity.

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