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| Country of Incorporation: |
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| Country of Parent Company(if any): |
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Subsidiaries/Affiliates Engaged in Direct Selling: |
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Personnel: |
Number of Sales People: |
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a. Employees: | |
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b. Independent Distributors: |
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i.e. Door-to-Door, Multi-Level, etc. |
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| Names of Any Trade or Professional Associations where your Organization is a member(if any): |
List of Mnagement Personnel: |
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Name of Nominees who will represent your company at meetings:
Principal Nominee: |
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| Alternative Nominee: |
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