Professional Documents
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CIS Urba
CIS Urba
NAME OF BENEFICIARY
In accordance with Articles 2 and 5 of the due diligence and federal banking commission
circular of December 1999, concerning the prevention of money laundering, and Article 305 of
the Swiss Criminal Code, the following information may be supplied to banks and to financial
institutions for purposes of verification of identity and activities of the investing member, and
the nature and origin of the funds which are to be utilized.
ADDRESS: RUA Antonio Labella Filho, 131 bairro Jd da Rosas – Jaboticabal – Sp – Brasil – cep 14870-000
CLASSIFIED AND CONFIDENTIAL
Initial: Page 1 of 6
Urbano Pereira da Rocha Filho
NAME OF BENEFICIARY
Telephone N/A
Fax N/A
Mobile N/A
Email Address N/A
Commodities/Banking
Instruments/Bonds/Currency Exchange
I hereby swear under penalty of perjury that the information given above is accurate and true.
ADDRESS: RUA Antonio Labella Filho, 131 bairro Jd da Rosas – Jaboticabal – Sp – Brasil – cep 14870-000
CLASSIFIED AND CONFIDENTIAL
Initial: Page 2 of 6
Urbano Pereira da Rocha Filho
NAME OF BENEFICIARY
Country: BRAZIL
ADDRESS: RUA Antonio Labella Filho, 131 bairro Jd da Rosas – Jaboticabal – Sp – Brasil – cep 14870-000
CLASSIFIED AND CONFIDENTIAL
Initial: Page 3 of 6
Urbano Pereira da Rocha Filho
NAME OF BENEFICIARY
COPY OF BENEFICIARY
PASSPORT.
BUSINESS N/A
Please provide description of
the business activity. Where
you are working through the
company as listed above
PROOF OF RESIDENTIAL
ADDRESS (Note that P.O.BOX
is not acceptable)
To validate the home
addresses of all parties,
please provide at least ONE
COPY of the following:
(a) Original and recent bank
statement from a recognized
bank
ADDRESS: RUA Antonio Labella Filho, 131 bairro Jd da Rosas – Jaboticabal – Sp – Brasil – cep 14870-000
CLASSIFIED AND CONFIDENTIAL
Initial: Page 4 of 6
Urbano Pereira da Rocha Filho
NAME OF BENEFICIARY
(b) Original and recent
credit card statement
(c) Letter from your
employer (on headed paper)
confirming your permanent
address
(d) Utility bill
ADDRESS: RUA Antonio Labella Filho, 131 bairro Jd da Rosas – Jaboticabal – Sp – Brasil – cep 14870-000
CLASSIFIED AND CONFIDENTIAL
Initial: Page 5 of 6
Urbano Pereira da Rocha Filho
NAME OF BENEFICIARY
ADDRESS: RUA Antonio Labella Filho, 131 bairro Jd da Rosas – Jaboticabal – Sp – Brasil – cep 14870-000
CLASSIFIED AND CONFIDENTIAL
Initial: Page 6 of 6