SCHEDULE 5-3 (Annex to Article A. 526-6)

MODEL OF DEED OF WAIVER OF PROTECTION OF THE PERSONAL PROPERTY OF AN INDIVIDUAL ENTREPRENEUR

I.-Identity of the sole trader waiving protection of his personal assets and of the beneficiary of the waiver

1. Identity of the sole trader

Birth name:

Customary name, if any:

Forenames (in order of civil status):

Nationality:

Born on I _ I _ I _ I _ I _ I _ I _ I _ I _ I _ I in (department) (country if abroad)

Home address Home address:

postcode: I _ I _ I _ I _ I _ I commune:

Professional activity(ies) Professional activity(ies) carried out :

Company name (if any):

>Sign (if any) Brand name (if applicable):

> APE/ NAF code (A) APE/ NAF (A) code :

Address of the main establishment or residential premises where the business is based:

Postal code Postcode: I _ I _ I _ I _ I _ I commune:

Unique identification number: I _ I _ I _ I _ I _ I _ I _ I Unique identification number: I _ I _ I _ I _ I _ I _ I _ I _ I _ I _ I _ I or declared date of commencement of activity: I _ I _ I _ I _ I _ I _ I _ I _ I _ I

. 2. Identity of the beneficiary of the waiver who is a natural person

Birth name:

Common name if applicable:

First names (in order of surname) Forenames (in civil status order):

born on I _ I _ I _ I _ I _ I _ I _ I _ I _ I in (department) (country if abroad)

Home address Home address:

postcode:I _ I _ I _ I _ I _ I commune:

(country if abroad)

Professional activity(ies) Professional activity(ies) carried out (if applicable):

If applicable, address of the establishment or residential premises where the company is based:

Postal code postcode: I _ I _ I _ I _ I _ I commune: (country if abroad)

Commercial name (if applicable) Company name (if applicable):

>Sign (if applicable) Brand name (if applicable):

> APE/ NAF code (A) APE/NAF (A) code (if applicable):

Unique identification number (if applicable) Unique identification number (if applicable): I _ I _ I _ I _ I _ I _ I _ I _ I _ I

>. 2 bis. Identity of the beneficiary of the waiver as a legal entity

Company name or corporate name:

Company name and form:

>Address of registered office or place of business Address of the registered office or place of business or premises where the company is established:

Postal code postcode: I _ I _ I _ I _ I _ I commune: (country if abroad)

Unique identification number: I _ I _ I _ I _ I _ I _ I commune: (country if abroad) Unique identification number: I _ I _ I _ I _ I _ I _ I _ I _ I _ I _ I

The beneficiary is a credit institution or finance company within the meaning of Article L. 511-1 of the Financial Monetary Code: yes no

II. II - Undertaking under which the sole trader intends to waive the protection of his personal assets

Date of undertaking: I _ I _ I _ I _ I _ I _ I _ I _ I _ I

Subject of undertaking Purpose of the commitment:

> End date of the commitment Due date of the commitment (this is the contractual date set for the full repayment of the sums due under the commitment, it being specified that this date may be extended either by agreement of the parties or by a court decision): I _ I _ I _ I _ I _ I _ I _ I _ I _ I

Amount of the commitment or factors enabling it to be determined: these factors, once specified in the waiver, definitively set the maximum amount for which the same waiver is valid: (if amount in euros, write it out in full)

Date requested for waiver: I _ I _ I _ I _ I _ I _ I _ I _ I _ I _ I _ I Date of request for waiver: I _ I _ I _ I _ I _ I _ I _ I _ I

III. III -Information for the sole trader on the consequences of the waiver of protection of his personal assets by the beneficiary of the waiver

(the content of the information delivered to the sole trader) (the content of the information provided under III of article D. 526-28 of the French Commercial Code may be appended hereto)

IV. IV -Waiver of the seven-day cooling-off period (where applicable)

Waiver of the seven-day cooling-off period (where applicable)

Waiver of the seven-day cooling-off period (where applicable) If the sole trader and the beneficiary of the waiver wish to reduce the cooling-off period at the end of which the waiver takes effect, under the conditions set out in the second paragraph of Article L. 526-25, the act of renunciation shall bear the following handwritten note by the sole trader: "I hereby declare that I renounce the benefit of the seven-clear-day cooling-off period, set in accordance with provisions of article L. 526-25 of the French Commercial Code. Consequently, this period is reduced to three clear days. "

Done at I _ I _ I _ I _ I _ I _ I _ I _ I _ I