To millenniumbcp.pt Área de Operações Tagus Park, Edifício 9, Piso 1 2784-511 Porto Salvo PORTUGAL Dear Sirs, I, _________________________________________________________________________, Here by request you to send to the address of my account with the BIN indicated below, the Multichannel Access Code. BIN: Date______/______/______ ________________________________________________ Signature (signature as per account signature card)