$ (SEE REVERSE FORDETAILS)

1 PRINCIPAL PARTY IN INTEREST (USPPI)(Complete name and address) EIN (IRS) OR ID TO TRANSACTIONR elatedNon-Related2 CONSIGNEE(Complete name and address)3 AGENT(Complete name and address) OF TRANSPORTATION(Specify) AIRPORT OF REFERENCE L DESTINATION CONSIGNEE(Complete name and address) S EIN (IRS) INTERNATIONAL FORWARDING B DESCRIPTION OF COMMODITIES(Use columns 20-22)D/For M(19)PLEASE INDICATE SCHEDULE B NUMBERAND COMMODITY DESCRIPTION(20)QUANTITY -SCHEDULE B UNIT(S)(21)SHIPPING WEIGHT(Kilograms)(22)SHIPPER S LETTER OF INSTRUCTIONWRITTEN AUTHORIZATIONZIP OF EXPORTATIONSHIPPER S REFERENCE VALUE FOR CARRIAGE$_____(SEE REVERSE FOR DETAILS)(If neither is checked, shipment is NOT insured)NOYESAMOUNT $ (STATE) OF ORIGIN OR FTZ OF ULTIMATE IDENTIFICATION REFERENCE BOND EXPORT TRANSACTIONPREPAIDCOLLECTVIA (CARRIER)B/L (SUPPLIER)ABANDONRETURN TO SHIPPERDELIVER TO.

2 VEHICLE INFORMATIONVIN NUMBER / TITLE NUMBER / VEHICLE TYPE(23)DOCUMENTS ACCOMPANYING SHIPMENT(Please Indicate)ATTACHEDPREPARECERTIFICATE OF ORIGINCOMMERCIAL INVOICECONSULAR INVOICEEXPORT INVOICEHAZMAT DECLARATIONLETTER OF CREDITMSDS SHEETNON-HAZMAT DECLARATIONPACKING LISTOTHERVALUE( dollars, omit cents)(selling price or costif not sold)(24)FREIGHTCHARGESPREPAIDCOLLECTYES NOYESNOSHIPPERMUSTINDICATESHIPPERREQUEST SINSURANCEPICK-UP/DELIVERYCHARGESTOCONCO RDIASHIPPER SINSTRUCTIONINCASEOFINABILITYTODELIVERAS CONSIGNEDMANDATORY:Shipper (USPPI)MUST SIGNLINE28 BELOW{ EXCEPTION SYMBOL/ITAR (When Required)The authorizes the Forwarding Agent named above to act as an authorized agent on behalf of the for export and Border Protection, and Census Bureau purposes to transmit export information electronically through the Automated Export -Shipper s Export Declarations (or any successordocument) wherever located, shall be exempt from public disclosureunless the Secretary determines that such exemption would becontrary to the national interest (Title 13, Chapter 6, Section 301 (g)).}

3 I / we certify that all statements made and all information contained herein on this document is true and correct. I / weauthorize Concordia Int'l Forwarding Corp. to act as Forwarding Agent for Export Control, Customs, and Census Bureaupurposes to transmit such export information electronically that may be required by law or regulation in connection with theexportation or transportation of any goods on behalf of said Principal party in Interest. The Principal party in Interestcertifies that necessary and proper documentation to accurately transmit the information electronically is and will be provided tothe said Authorized Agent above. The Principal Party in Interest further understands that civil and criminal penalties may beimposed for making false or fraudulent statements or for the violation of any laws or regulations on exportation and agreesto be bound by all statements of said authorized agent based upon information or documentation provided by the PrincipalParty in Interest to said authorized (When Required)E-mail authorized officer/employee of shipper (USPPI)TitleDateTelephone No.

4 (Include Area Code)SPECIALINSTRUCTIONSAES EEI INFORMATIONS hipper (USPPI) Filed AES YESNOIf Yes Insert AES ITN # _____Export shipments are subject to inspection by Customs Service,Concordia International, and/or Office of Export shipper or his Authorized Agent hereby authorizes Concordia, in his name and on his behalf, to prepare any export documents, to sign and accept any documents relating to said shipment and forward this shipment in accordance with the conditions ofcarriage and the tariffs of the carriers employed. The shipper guarantees payment of all collect charges in the event the consignee refuses payment. The sole responsibility of Concordia is to use reasonable care in the selection of carriers, forwarders, agentsand others to whom it may entrust the :RATE QUOTE NUMBER_____DATE SLI PREPAREDEXPLANATION OF DECLARED VALUE FOR CARRIAGE Shippersmust declare a value for carriage on the air waybill.

5 This declaration may be in any amount or NVD (no valuedeclared). Shipments valued at more than $ per pound/$ per kg., will be assessed a valuation charge of $ $ orpro-rata portion thereof by which the shipper s declared value for carriage exceeds $ per pound, subjectto a minimumcharge of $ OF OFFICESATLANTA,640 Airport South Parkway/Suite 600 (770) 909-0301 FAX: (770) 909-0473 GEORGA Atlanta, GA 30349 PH: (978) 658-8885 FAX: (978) 658-8823101 etiuS ,evirD leweJ 8 BOSTON,M ASSACHUSETTS Wilmington, MA 01887 CHICAGO,1475 E. Thorndale Avenue, Suite F (630) 250-4400 FAX: (630) 250-1528 ILLINOISI tasca, IL 60143 CLEVELAND, 6430 Eastland (440) 243-2244 FAX: (440) 243-4320 OHIOB rookpark, OH 44142 DALLAS,601 Hanover Drive, Suite 500 (817) 481-4560 FAX: (817) 481-6830 TEXASG rapevine, TX 76051 DAYTON,787 Crossroads (937) 890-2438 FAX: (937) 890-1502 OHIOV andalia, OH 45377 HOUSTON,3340-A Greens Road, Suite 100 (281) 449-9862 FAX: (281) 449-9874 TEXASH ouston, TX 77032 LOS ANGELES, 4955 West 145th (310) 219-0400 FAX.

6 (310) 219-4030 CALIFORNIAH awthorne, CA 90250 MIAMI,10913 30th Street, Suite 102 (305) 592-9450 FAX: (305) 592-9648 FLORIDAM iami, FL 33172 MINNEAPOLIS, 1010 Aldrin Drive, Suite (651) 452-2767 FAX: (651) 994-0345 MINNESOTAE agan, MN 55121 NEWARK,604 Progress (908) 289-6300 FAX: (908) 289-3968 NEW JERSEY Elizabeth, NJ 07201 NEW YORK,155-37 145th (718) 723-0900 FAX: (718) 712-1368 NEW YORKJ amaica, NY 11434 PHILADELPHIA, 7 Independence (610) 461-7300 FAX: (610) 461-8364 PENNSYLVANIA Folcroft West Business ParkFolcroft, PA 19032-2111 SAN FRANCISCO, 1172 Cherry (650) 583-1766 FAX: (650) 872-2104 CALIFORNIASan Bruno, CA 94066 SAN JUAN,La Ceramica Industrial (787) 757-6060 FAX: (787) 757-6175 PUERTO RICO Building 1 Carolina, PR 00984 Please visit our website for your