<HTML> <HEAD> <title>040BL 2>?@>A</title> <meta content="http://schemas.microsoft.com/intellisense/ie5" name="vs_targetSchema"> <META http-equiv="Content-Type" content="text/html; charset=unicode"> <META content="Microsoft FrontPage 4.0" name="GENERATOR"> </HEAD> <body bottomMargin="0" bgColor="#003300" topMargin="0"> <form name="QForm" method="post" action="question_form_R.aspx" id="QForm"> <input type="hidden" name="__VIEWSTATE" value="dDw4OTIxMjkwMjE7O2w8Y2hrQ29uZmlybTs+PtaYL8047a6jXDFlJ9FcJLoBCeRZ" /> <TABLE id="Table2" cellSpacing="0" cellPadding="0" width="750" align="center" border="0"> <TR bgColor="#003300"> <TD align="left" width="100%" colSpan="3" rowSpan="1"> <TABLE id="Table1" cellSpacing="0" cellPadding="0" width="100%" bgColor="#003300" border="0"> <TR> <TD width="10%" bgColor="#003300"><IMG height="59" src="../images/Logo.jpg" width="76" border="0"></TD> <TD width="80%" bgColor="#003300"> <P align="center"><FONT face="Arial" size="2">&nbsp;</FONT><IMG height="59" src="../images/welcome_banner_anim_small.gif" width="512" border="0"></P> </TD> </TR> <TR> <TD bgColor="#ccff99" colSpan="2" height="5"><B><FONT face="Arial" size="1"><FONT color="#800000"></FONT></B></FONT></TD> </TR> </TABLE> </TD> </TR> <TR> <TD width="12" bgColor="#ccff99" rowSpan="5">&nbsp; </TD> <TD width="726" bgColor="maroon" height="5"></TD> <TD width="12" bgColor="#ccff99" rowSpan="5">&nbsp; </TD> </TR> <TR> </TR> <TR> <TD width="726" bgColor="#ffcc00"> <P align="center"><STRONG>040BL 2>?@>A</STRONG></P> </TD> </TR> <TR> <TD bgColor="#ffffff"> <TABLE id="Table1" cellSpacing="1" cellPadding="1" width="750" align="center" bgColor="#f1ffe3"> <TR> <TD width="726" colSpan="10" height="10"></TD> </TR> <TR> <TD width="726" bgColor="#c0c0c0" colSpan="10" height="10"> <P align="justify">&nbsp; <span id="Label6"><b><font face="Arial" color="Maroon">5@A>=0;L=K5 40==K5</font></b></span></P> </TD> </TR> <TR> <TD width="12" bgColor="#c0c0c0" height="88" rowSpan="15"></TD> <TD width="198" height="28"> <DIV align="center"><span id="Label5"><b><font face="Arial" color="#112F0F"><O</font></b></span></DIV> </TD> <TD width="450" colSpan="7" height="28"><input name="txtFName" type="text" id="txtFName" title="Joe" />&nbsp;</TD> </TR> <TR> <TD width="198" height="6"> <DIV align="center"><span id="Label4"><b><font face="Arial" color="#112F0F"> $0<8;8O</font></b></span></DIV> </TD> <TD width="450" colSpan="7" height="6"><input name="txtLName" type="text" id="txtLName" title="Doe" />&nbsp;</TD> </TR> <TR> <TD width="198" height="6"> <DIV align="center"><span id="Label3"><b><font face="Arial" color="#112F0F"> 0B0 @>645=8O</font></b></span></DIV> </TD> <TD width="450" colSpan="7" height="6"><input name="txtBirth" type="text" id="txtBirth" />&nbsp;</TD> </TR> <TR> <TD width="198"> <DIV align="center"><span id="Label2"><b><font face="Arial" color="#112F0F">>;</font></b></span></DIV> </TD> <TD width="450" colSpan="7"><table id="rblMF" border="0" bgcolor="#F1FFE3" width="50"> <tr> <td><font face="Arial" color="#112F0F"><b><input id="rblMF_0" type="radio" name="rblMF" value="0" /><label for="rblMF_0">C6A:>9</label></b></font></td><td><font face="Arial" color="#112F0F"><b><input id="rblMF_1" type="radio" name="rblMF" value="1" /><label for="rblMF_1">5=A:89</label></b></font></td> </tr> </table></TD> </TR> <TR> <TD width="212" bgColor="#c0c0c0" colSpan="8"><span id="lblAdress"><b><font face="Arial" color="Maroon">>=B0:B=0O 8=D>@<0F8O</font></b></span></TD> </TR> <TR> <TD align="center" width="198" height="25"><span id="lblEmail"><b><font face="Arial" color="#112F0F"><09; 04@5A</font></b></span></TD> <TD width="450" colSpan="7" height="25"><input name="txtEmail" type="text" id="txtEmail" />&nbsp;</TD> </TR> <TR> <TD width="198"> <DIV align="center"><span id="lblPhone"><b><font face="Arial" color="#112F0F">"5;5D>=</font></b></span></DIV> </TD> <TD width="450" colSpan="7"><input name="txtPhone" type="text" id="txtPhone" />&nbsp;</TD> </TR> <TR> <TD align="center" width="198"><span id="lblAddress"><b><font face="Arial" color="#112F0F">4@5A ?@>6820=8O</font></b></span></TD> <TD width="450" colSpan="7"><textarea name="txtAddress" id="txtAddress"></textarea>&nbsp;</TD> </TR> <TR> <TD width="212" bgColor="#c0c0c0" colSpan="8" height="3"><span id="lblQuestion"><b><font face="Arial" color="Maroon">>?@>A</font></b></span></TD> </TR> <TR> <TD width="198" height="18"> <DIV align="center">!>AB>O=85 D09;0<BR> &nbsp;</DIV> </TD> <TD width="450" colSpan="8" height="18"><table id="rblFile" border="0" width="472"> <tr> <td><font face="Arial" color="#112F0F"><b><input id="rblFile_0" type="radio" name="rblFile" value="yes" /><label for="rblFile_0">/ C65 =0G0; 8<<83@0F8>==K9 ?@>F5AA 8 <8=8AB5@AB2> 8<<83@0F88 @0A?>;>305B <>59 8=D>@<0F859.</label></b></font></td> </tr><tr> <td><font face="Arial" color="#112F0F"><b><input id="rblFile_1" type="radio" name="rblFile" value="no" /><label for="rblFile_1">/ 5I5 =5 =0G0; 8<<83@0F8>==K9 ?@>F5AA</label></b></font></td> </tr> </table></TD> </TR> <TR> <TD width="198" height="146"> <DIV align="center"> <DIV align="center">>?@>A</DIV> &nbsp;</DIV> <TD width="450" colSpan="7" height="146"><textarea name="txtQuestion" id="txtQuestion"></textarea></TD> </TR> <TR> <TD width="100%" colSpan="8"></TD> </TR> <TR> <TD width="100%" colSpan="8" height="68"> <P>&nbsp; <span><b><font face="Arial" color="#112F0F"><input id="chkConfirm" type="checkbox" name="chkConfirm" /><label for="chkConfirm">/ A>3;0A5=,GB> =0 <>9 70?@>A Status Policy Ltd. ?@54>AB028B <=5 @5:><5=40F88 8 2>7<>6=>AB8 @5H5=8O <>8E 2>?@>A>2, 0 B0: 65 AB>8<>ABL A2>8E CA;C3.</label></font></b></span></P> </TD> </TR> <TR> <TD align="center" width="100%" colSpan="8" height="9"> <input type="submit" name="Button1" value="B?@028BL D>@<C" onclick="if (typeof(Page_ClientValidate) == 'function') Page_ClientValidate(); " language="javascript" id="Button1" /></TD> </TR> </TABLE> </TD> </TR> <TR> <TD width="724" bgColor="#ccff99" height="12"></TD> </TR> </TABLE> <DIV align="center"> <TABLE id="Table1" height="3" cellSpacing="0" cellPadding="0" width="750" bgColor="#003300" border="0" align="center"> <TR> <TD width="100%" bgColor="#003300" height="1"> <P align="center"><FONT color="#ffffff"><FONT face="Arial" size="1">Copyright</FONT><FONT face="Arial" size="1"> ©&nbsp; 1993-2003, Status Policy Ltd. / Toronto / Canada.</FONT></FONT></P> </TD> </TR> </TABLE> </DIV> </form> </body> </HTML>