SPECIAL NOTE: For the sake of our clients' security and safety, we are

mandated to collect from the United States clients the following background
information and also conduct an electronic search on the National Sex
Offender public registry and state public registry (http://www.nsopr.gov/).
This information and search result will be made available to any foreign
national clients designated by the United States client. Please complete the
questionnaire below and sign and date, and return it to us.

FOR USE BY B2C ONLINE SOLUTIONS CORP. ONLY

Date _____/______/______

THE SEARCH RESULT UNDER THE NATIONAL SEX OFFENDER AND

STATE PUBLIC REGISTRY IS:

_____________________________________________________________________

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

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, or an attempt
to commit any such crime.

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: _________________________________________________
 PAGE THREE (3)

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

NO CHILDREN: ________________

YES: _______________

EXPLAIN: _________________________________________________

(vii) All States 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
B2C ONLINE SOLUTIONS CORP. to release and provide this information
in any format to all foreign national clients 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 B2C ONLINE
SOLUTIONS CORP. FROM ANY AND ALL LIABILITES arising from my
release of this information and any use of it.

___________________________________________ Signature

_____/______/______ Date

COPYRIGHT © 2017, B2C ONLINE SOLUTIONS CORP.