EFTA00085868

# CONFIRMATION OF ENTITLEMENT TO ACT FORM



TO: The Registrar of International Registry of International Interests in Aircraft Equipment

AT: Email: registryofficials@aviareto.aero OR Fax no: +353 1 829 3508



# FORM

**Administrator:** Suzanne Pruitt
**Back-Up Contact:** Rich Munkvold
**Entity:** Industrial Integrity Solutions
**Entity Postal Address:**
**Entity State of Incorporation:** New Mexico

**Relation of Administrator to Entity (select one)**

- □ Employee of
- □ Attorney for
- ✔ Agent of
- □ Natural person acting in own capacity
- □ Other. Please describe: ___

**Entity Type (select one)**

- ✔ A legal entity
- □ Legal entities acting jointly
- □ A natural person
- □ Natural persons acting jointly
- □ Other. Please describe: ___

## DECLARATION

I confirm that the details noted in the Form above are correct and that, when approved by the Registrar, the Administrator has authority to act as administrator for the Entity in accordance with the Regulations and Procedures for the International Registry and to:

(a) effect, amend, discharge, transfer the right to discharge or consent to registrations on the International Registry in which the Entity is a named party or is authorized to act for a named party; and

(b) carry out all other functions of an administrator and assume all of the powers, obligations and responsibilities of an administrator set out in the Regulations and Procedures for the International Registry.

I confirm that the Back-Up Contact noted above is the "back-up contact" as described in the Regulations and Procedures for the International Registry.

I confirm that I have the power to act on behalf of the Entity in confirming the above nominations, authorisations, undertakings and details.

If signing electronically, please acknowledge the following:



I confirm that I am permitted to sign documents using an electronic signature and that I have personally attached my electronic signature to this document, in accordance with the Entity's prevailing policies and guidance.



Signature

(cannot be signed by the Administrator)

Name (Please Print) Richard Munkvold

TITLE (Please Print) Chief Financial Officer

DATE (DD-MMM-YYYY) 5-5-2021