REGISTRATION AND APPLICATION FORM

PENNY STOCK INVESTMENT CLUB (PIC).

(An investment arm of set consulting services Ltd)

DATE…………………………………………………… G S M …………………………………………

NAME (SURNAME):………………………………………………………………………………………

OTHER NAMES:……………………………………………………………………………………………

SEX…………………………………………MARITAL STATUS (SINGLE/MARRIED)

RESID. ADDRESS……………………………………………………………………………………

NATIONALITY……………………………………………………………………………………………

BIRTH DATE………………………………………………………………………………………………

MEMBERS ADDRESS………………………………………………………………………………

E-MAIL ADDRESS………………………………………………………………………………………

POSTER ADDRESS……………………………………………………………………………………

MOTHER MEDIAN NAME……………………………………………………………………………

NEXT OF KIN…………………………………… ADDRESS OF NEX OF KIN……………

GSM OF NEST OF KIN………………………………………………………………………………

OCCUPATION/BUSINESS……………………………………………………………………… QUALIFICATION………...…………………………………………………………………………

BUSINESS ADDRESS………………………………………………………………………………

Would you like to subscribe to our monthly stock report (#7500 for 3 months)

Would you like to subscribe to our magazine (#1000 for 6 months)

How much do you intend to invest monthly ……………………………………………

How did you hear about PIC………………………………………………………………………

Do you wish to join our real estate club……………………………………………………