AIG

1 Vendor/Consultant Certification Program Application Please understand that all information requested in this application will be kept CONFIDENTIAL. AIG respects your privacy, and does not intend to compromise your trust and goodwill. DEFINITIONS USED IN THIS APPLICATION Vendor/Business Entity: This is your Company. It may be an incorporated company, or an individual doing business as ( ) a company ( , John Smith, Smith Plumbing of Peoria). Applicant: The person signing this application (an owner, officer, principal partner, etc) who is authorized to engage in this application process.

2 Principal: Any individual holding 5% or greater interest in the Vendor/Business Entity, and who would typically hold a title of owner, general partner, limited partner, officer, or director. Employee/Consultant Subcontractor: Employees, Consultants and Subcontractors are those individuals who do not own significant (5% or more) interest in the Business Entity, and represent the Vendor/Business Entity at AIG. INSTRUCTIONS FOR THE APPLICANT It is the responsibility of the Applicant to complete the Vendor/Business Entity packet, and further to ensure that each Principal and any or all employees/consultants/subcontractors complete his/her packet.

3 In accordance with the note above, All sections in this application need to be completed accurately and legibly, and the FCRA forms must be dated and signed. Additional Principal/Employee/Consultant/Subcontrac tor packets can be downloaded from Be sure to distribute complete packets, including the cover sheet that contains specific instructions for filling out the packet. After all of the packets are returned to you, and you have verified their completeness, mail the packets to: American International Group Inc. ATTN: Security Services Representative CARCO Group, Inc. 70 Pine Street Corporate Security, First Floor New York, NY 10270 FAX: 212-742-8543 If you experience problems filling out this application, please do not hesitate to call CARCO at (800) 773-6506.

4 The Customer Service Department can also be reached by e-mail at: NOTE: After the certification process is completed, you will be contacted regarding your status as an AIG Vendor/Consultant. If approved for certification by AIG, the Vendor/Business Entity s status as an AIG Vendor/Consultant is subject to the terms and conditions of the applicable agreement between AIG and the Vendor/Business Entity A-1 Important Notice If your company is publicly traded on a or foreign exchange, you are required to have those employees, consultants and/or sub-contractors who work with AIG (remotely or at an AIG facility) complete sections C-2 (Principal-Employee-Consultant-subcontra ctor application AND C-3 (The Fair Credit Reporting Act Consumer Disclosure and General Authorization))

5 If your company is privately held, you and your employees, consultants and/or subcontractors, who work with AIG (remotely or at an AIG facility) are required to complete ALL forms contained in this package. AIG APPLICANT WORKSHEET This worksheet has been prepared to assist the Applicant in identifying those Principals, Employees, Consultants and Subcontractors whose information needs to be collected to begin the process of qualifying the Vendor/Business Entity as a Certified AIG Vendor/Consultant. This worksheet will also assist us in maintaining your file s integrity, so be sure to return it with the Certification Program Application.

6 Business Entity Name Please note: All principals who owns 5% or greater interest in the vendor/business entity must complete forms C-2 and C-3 in order for Vendor/Business Entity to be certified. NAME SELECT ONE Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal

7 Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor Principal Employee Consultant Subcontractor A-2 Certification Program Application VENDOR/BUSINESS ENTITY INSTRUCTIONS All sections in this application need to be completed accurately and legibly.

8 It is understood that you may not be able to answer everything asked of you, but please make a sincere effort to furnish the information requested. Incomplete information will result in our contacting you to request this information again. This packet has space for two business addresses (current and two prior). Should this packet prove to have less space than needed for the requested information, please make extra photocopies of the necessary form(s). NOTE: You are strongly encouraged to make a copy of all application materials for your records. B-1 AIG INFORMATION ON VENDOR/BUSINESS ENTITY Vendor/Business Entity Name Fictitious Business Name ( ) Date Company Formed Current Address City County State Country Zip Phone # Fax # E-Mail Dates at this address from to present Parent Business Entity Name Federal Tax ID # of the Vendor/Business Entity SIC Code/Type of Business *AIG Manager Name Phone # *AIG Security Contact *AIG Manager E-mail *AIG Company/Branch/Department Code.

9 _____ # of employees/consultants/subcontractors who represent vendor/business entity at AIG * Required PRIOR to start of background check. Prior Address Information Please record all other addresses for the past seven (7) years, listed from most to least current. The following is a Mailing Address Physical Address Company Address City County State Country Zip Dates at this address from to month/year month/year If you require any additional space.

10 Please make copies of these forms and submit them as an additional page B-2 Certification Program Application PRINCIPAL EMPLOYEE CONSULTANT -SUBCONTRACTOR YOU ARE A PRINCIPAL if you hold 5% or greater interest in the Vendor/Business Entity. Typically, you would have a title of Owner, General Partner, Limited Partner, Officer, or Director. YOU ARE AN EMPLOYEE, CONSULTANT OR A SUBCONTRACTOR if (a) You own less than 5% in the Vendor/Business Entity, and (b) You represent the Vendor/Business Entity at AIG. If you do not fall within one of the above categories, it is not necessary for you to fill out this application packet.