TRACTIS REQUEST OF PROSPECT FORM

Propect's profile

Prospect's company:
- Company name: [Prospect/Company/Name]
- Mail address: [Prospect/Company/mail_address] .
- City: [Prospect/Company/City] .
- State or Province: [Prospect/Company/State] .
- Zip/post code: [Prospect/Company/zip_post code] .
- Phone: [Prospect/Company/Phone] .
- Web site: [Prospect/Company/web_site] .
Prospect's contact person:
- Name: [Prospect/Contact_person/Name] .
- Position: [Prospectl/Contact_person/Position] .
- Phone: [Prospect/Contact_person/Phone] .
- Email: [Cliente_potencial/Persona_de_contacto/Email] .
Legal representative with sufficient faculties and/or power of attorney to act on behalf of the Prospect in regards to the final acceptance:
- Name: [Prospect/Person_with_faculties_to_act_for_final_approval_pursposes/Name] .
- Position: [Prospect/Person_with_faculties_to_act_for_final_approval_purposes//Position] .
Business opportunity: Explain here the type of business opportunitykept in mind for this transaction andwhat you have worked and achieved in regards to this relationship and opportunity:
- [Prospect/Opportunity/Explain_type_of _business_opportunity_and_your_link_with_the_said_opportunity]

REQUEST AND ITS PERTINENT APPROVAL

According to the terms and conditions stated in Section 3.1. of the "TRACTIS Referral Agreement" previously celebrated and executed by both Parties:

[Referring_Party/Legal_Representative/Name] ,acting in the name and on behalf of Referring_Party/Company/Name], and following its express instructions, hereby informs TRACTIS that [Prospect/Company/Name] is willing to become a client of TRACTIS' Solution. Based on that, it istherefore hereby requiredto have this Referral Form duly approved by TRACTIS in order to be deemed as"Referring Party of the Prospect/Company/Name] ", and, as a consequence of the requested approval to be granted by TRACTIS, it shall be entitled to start taking the appropriate measuresto finally getthe above-mentioned client in the benefit of TRACTIS.

Having analyzed the above request, David Blanco Giró,in the name and on behalf of TRACTIS,declares andnotifies to the [Referring_Party/Legal_Representative/Name] about the pertinent approval of this request. In view of this accepted request, it is understood that:

[Prospect/Company/Name] shall be deemed as "AcceptedProspect".
[Referring_Party/Company/Name] shall be considered as"Referring_Party of the [Prospect/Company/Name] ".
Sections 3.3.1. and 4.1. of the "TRACTIS REFERRAL AGREEMENT" executed by the Parties shall be applied and will govern this relationship.

IN WITNESS WHEREOF, the Parties hereto have executed and celebrated this "Request" and pertinent "Approval" document, on the date and place as mentioned below.

REQUESTOR: [Referring_Party/Company/Name]