Ethics N Conduct

BUSINESS ETHICS AND CONDUCT

DISCLOSURE STATEMENT

Do you understand and support the company’s Code of Ethics?

 Yes  No

Are you aware of any illegal, unethical or improper practices or conduct anywhere within this

Company?

 Yes  No

If the answer to the preceding question is "yes", list here, in full and complete details, all such

practices or conduct. (Use additional pages if necessary.)

………………………………………………………………………………………………………………………………………..

……………………………………………………………………………..

Have any threats or promises been made to you in connection with your answers to the questions

on this form?

 Yes  No

If "yes" please identify them in full and complete detail and notify company management

immediately.

…………………………………………………………………………………………………………………………………………………….

…………………………………………………………………………….

I declare under penalty and perjury, under the laws of the State of …………………………………. that the

above is true and correct.

Signature

Date