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SGM OPERATIC BHD 785 Gang Road Singapore 389673 Tel : 6743 9595 Fax : 6743 9559 Website: www.sgm.com.sg DANA KETCHIKAN BERGAMO DEATH OF MEMBER 1. PARTICULARS OF NOMINEE Name ERIC No Address Postal
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Statement of other member who witnessed death of member : (Please attach copies of documents) 4. Death certificate : (Please attach copy of death certificate) 3. Statement of other member who witnessed death of member : (Please attach copies of documents) Letter of Oath : 1. Name — ERIC NAME, Member 2. NAME OF OTHER MEMBERS OF SGM, Date and Place of Birth — EDUCATION, Age. 5. EDUCATIONAL STATUS, Class of Education, Certificate of Course completion/Major Course in Education etc. (Not for General Certificates) 6. MEMBERSHIP IN THE SGM, Name, Email address, date, Place of residence etc., (not for general Certificates) 7. MEMBERSHIP IN THE COSMOLOGY CLUB, Name, Email address, Date, Place of residence etc. (Not for General Certificates) 8. LOVELACE STATEMENT, (Copy or scan of photo) 9. CERTIFICATE OF INTERNATIONAL CERTIFICATE (i) NATIONAL CERTIFICATE, (ii) INTERNATIONAL CERTIFICATE, (iii) REGISTRATION DOCUMENT, 10. COPYRIGHT STATEMENT AND (iv) COPYRIGHT AUTHORIZATION CARD. 11. SGM MEMBERSHIP IN THE SOCIETY OF LIVING MEMBERS, (ii) MEMBER STATUS, (iii) REGISTRATION DOCUMENT, (iv) PASSPORT NO. of Country (Please see section “Citizen” under “I.P.O. below) 12. REGISTRATION OF PERSONAL PROPERTY (i) IN THE ENCROACHMENT AND CONFISCATION ACT OF 1986 — PROPERTY OF A PERSON WHO HAS BEEN CONFIRMED FROM THE ESTABLISHMENT (PROPERTY OF A PERSON WHO HAS BEEN CONFIRMED FROM THE ESTABLISHMENT) — IN THE CASE OF DETAINEES ONLY, THE S.N.S. DELETED FROM THE CITIZEN'S PROPERTY UNDER THE CONFISCATION ACT OF 1984 AND THE A.N.S.P.C. DELETED FROM THE PROPERTY UNDER THE LAW OF THE INTERNATIONAL SOCIETY OF HOSPITALS AND NURSING TABLES.

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