FORM 0C-11 [EMBLEM OF THE DOMINICAN REPUBLIC] 000XXX

DOMINICAN REPUBLIC
CENTRAL ELECTORAL COMMISSION
NATIONAL CIVIL REGISTRY DIRECTORATE
EXTRACT OF CERTIFICATE OF BIRTH
(Article 99, Law No. 659 of 07-17-1944)

I, (Name of Official) An official of the Civil Registry Office of the 4th NATIONAL DISTRICT,
in the Dominican Republic, HEREBY CERTIFY: That in the records before me, there exists a certificate of birth
registered with number 000, Book 000, Folio 00, in the year xxxx. which contains the following details:

That on March 8, 1994, (Name of person appearing, with national ID No. 000-000000-0, appeared and declared,
that on (Month / Date), in the year Xxxx (No. xxx), (Name of person born), son of the declarant, and Mrs (Mothers
name), bearer of National ID Number 00XXX-X,was born in this city.

Notes:

[Signature]
Civil Registry Officer

[SEAL: Civil Registry Office of the 4th NATIONAL DISTRICT]

[stamp: Dominican Republic. Internal taxes..2.00 Two Gold Pesos 2.00 2001