DECOL Debt Collections L.L.C. - Debt Check Request Form

The undersigned hereby appoint Decol Debt Collections LLC to act on our behalf to prepare a Debt Check on the details as described below.

DEBT CHECK REQUEST FORM

Company Name: Trade License No:

P.O. Box: Address:

Emirate: Telephone:

Fax: Mobile:

Market Sector: Additional Notes:

REQUESTER INFORMATION

Name: Company:

Date: 2010 Credit Bureau No.:

Telephone: Fax:

Email: Delivery Service:

A surcharge of Dhs 35/- is payable for Debt Check Information.

Decol Debt Collections L.L.C.
PO Box 56286, Dubai, United Arab Emirates
Tel: +971 4 333 8188 Fax: +971 4 266 5628
E-mail: uae(@)infocreditgroup(dot)com