The Asia Gold Mining Asset Corporation (AGMAC) Skyper Villa, Taunusanlage 1, 60329 Frankfurt am Main, Germany.

AGMAC Shareholder Declaration Form - 118A/5/13

I, Mister/Miss* ABDULLAH ZIYADI BIN IBRAHIM, a holder of Malaysia Passport/National Identification Card* Number 81072603-5187, date of expiry on ____________ (if applicable) hereby declare that I am the sole beneficiary of all AGMAC shares and options as stated in my online shareholder account number 155518782699. I also declare that, my permanent address is: Address: Address: City: Zip/Post Code: Country: I can be reached at: Mobile Number: Land Line Phone Number: Fax Number: Email Address: I prefer to be reached by: Email Mobile Phone

The best time to reach me is between: ______ and _______ (local time) I declare that all the information provided above is true to my knowledge, and that I will be held accountable should I purposely provide false information.

--------------------------------------Signature ABDULLAH ZIYADI BIN IBRAHIM Date: ____ Day _____ Month _____ Year

* Cross out whichever is not applicable * Fill up in BLOCK LETTERS only