IGNACIO

MIGUEL QUINTANA
ÁNGEL MOSCARDA
ADDRESS: Ruta Nº 7 Km 181- CAAGUAZÙ- PARAGUAY
E-mail:
nacho.quintana49@gmail.com
Phone: +595 992886005

CIS - CLIENT INFORMATION SHEET

In accordance with Articles 2 through 5 of the Due Diligence Convention and the Federal Banking
Commission Circular of December 1998, and under the US Patriot Act of 2002, as amended in February
2003 concerning the prevention of money laundering and 305 of the Swiss Criminal Code, the following
information may be supplied to banks and/or other financial institutions for purposes of verification of
identity and activities of the Client described before, and the nature and origin of the funds which are to
be utilized. The foregoing is subject to agreement by all parties to whom this information is provided
that they are obligated to respect the privacy rights of the Client and all individuals described herein, as
well as the generally accepted professional standards relating to the maintenance of confidential
information, and to take all appropriate precautions to protect the confidentiality of the information
contained herein. This legal obligation shall remain in full force indefinitely without restriction.

Name IGNACIO QUINTANA

ID / Passport AAE936912 - ARGENTINIAN PASSPORT
Issues Date May, 2015
Expiry Date May, 2030
Authority REGISTRO NACIONAL DE LAS PERSONAS ARGENTINA
Date of Birth: February 01st, 1949
Address Ruta Nº 7 Km 181- Caaguazú - Paraguay
Telephone +595 992886005
Cellular +595 992886005 Whatsapp
E*Mail nacho.quintana49@gmail.com
Bank Name
Bank Address
Account Name
Bank Officer Name
Correspondent Bank
SWIFT Code
Fedwire
Beneficiary Bank
Swift Code
Account Number
Bank Officer
BankOfficer phone:
THE ABOVE INFORMATION WAS PREPARED THIS 28 DAY THE MONTH OF JANUARY 2021 YEAR AND I HEREBY
ATTEST AND CONFIRM UNDER PENALTY OF PERJURY LAWS OF JURISDICTION AND UNDER EACH OF THE
EUROPEAN UNION COUNTRIES, U.S.A. LAWS, AND IN THE COUNTRY OF ABOVE OF THE SIGNATORY, THAT THE
INFORMATION GIVEN ABOVE IS CORRECT, ACCURATE AND TRUE, AND UNDER PENALTY OF PERJURY LAWS OF
JURISDICTION, I SET MY SIGNATURE AND SEAL HEREIN BELOW: m.a.m.asociados@gmail.com
Seal & Signature
 IGNACIO
MIGUEL QUINTANA
ÁNGEL MOSCARDA

Declaration: I swear under penalty of perjury, the information given above is both true
and accurate. I am the signatory on the aforementioned bank account. All assets
engaged in this transaction are legal, whom shall justify the non-criminal origin of them,
as well as the assets are good cleared, and the origin of funds is in compliance with Anti-
Money-Laundering Policies as set forth by the Financial Action Task Force (FATF) 6/01.

In Faith:
DATE: Abril 16th, 2021

SIGNED BY: IGNACIO QUINTANA

Passport N°: AAE936912
Country of Issue: ARGENTINA