www.ueog.org

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I will make UEOG as Beneficiary in my will. Select Yes or No *

Are you a registered member of UEOG? Select Yes or No *

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I , with my name, address and other personal information as filled in the form above, designate the non profit corporation in Canada: United Earth Organization, Inc., as (Choose Primary or Secondary) beneficiary in my will, and if secondary with (Select %)    % Of my asset ownership being transferred

upon (select upon incident or date)

as of date below, if date is selected above,

                   / /



                            ---------------------------------------------------------------                                                    -------------------------

                                                       Signature                                                                                         Date (dd/mm/yyyy)








Please print this page, sign it, date it and either

   (a)      Electronically scan it and email it to donations@ueog.org


            Or

                                                                     (b)      Mail it to the following Address:

               Or

United Earth Organization, Inc.

P. O. Box xxxxxx

Quebec

Canada

               Or

                                    (c) Fax it to:

(xxx) xxx xxxx

             Or

(d) (Enter the Key of your Digital Electronic Signature in the space below if you have this capability). What is Electronic Signature?

      with the key of my Digital Electronic Signture being entered below,



( Choose the date below, if you are entering Electonic Signature above)

Date (Select Date)        / /