Declaration of Ultimate Beneficial Ownership

Directors and Managment Information

Principal Names

Account Payable Contact

Bank Name

Please Provide United States Trade References

Company Accreditation Certificate

Declarations and Signature.

The undersigned agrees that:

1. The Company will not ship to any Restricted Country or furnish to any Restricted Person (as such terms defined below) any product obtained from AIR MED AVIATION in any manner, including through sale, lease, exchange, or part-out. “Restricted Country” means any country or nation which engages in armed conflict, declared or otherwise, with the armed forces of the United States and/or United Kingdom, and any other country or nation with which nationals (either individual or corporate) of the United States and/or United Kingdom are prohibited from doing business by law, regulation, order, resolution, or stated policy, including but not limited to Cuba, Iran, Syria, North Korea, or Crimea. General information on United States sanctions can be found at: https://home.treasury.gov/policy-issues/financial-sanctions/sanctions-programs-and-country-information. “Restricted Person” means (a) any person who is a citizen of, or entity that is organized under the laws of or whose principal place of business is located in, any Restricted Country; and (b) any person or entity with which nationals or residents (either individual or corporate) of the United States and/or United Kingdom are prohibited from doing business by law, regulation, order, resolution, or stated policy. The latest Consolidated Screening List of Restricted Persons can be found at: http://export.gov/ecr/eg_main_023148.asp.

2. The Company will abide by all applicable United States, European Union, and United Kingdom export control laws and regulations for any products, software or technology that require any licenses or prior approvals from the United States, European Union, or United Kingdom government prior to export or re-export.

3. All Trade Compliance representations set forth in this KYC Form shall survive the completion, early termination, cancellation or expiration of any applicable purchase order, agreement or contract with AIR MED AVIATION and the Company will cause its subsidiaries and affiliated companies to comply with these terms.

The undersigned compliance officer or other duly empowered officer of the Company hereby certifies that the information furnished above is true and correct to the best of my knowledge and belief, and I agree to inform you immediately of any changes to such information.