CIS Nome: 19 DE ABRIL DE 2023

CLIENT INFORMATION SHEET

FOR PAYMASTER SERVICES

DATE: March 23, 2023

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.

Client Full Name

Nationality
Passport Number
Issued By
lssue Date
Expiration Date
Social Security Number (MEDICARE NO:) if any
LICENCES HELD (IF ANY)
Phone no
E mail address
Skype address
Date of Birth
Place of Birth

Attorney (if you have one)

Address
Telephone
Fax
Mobile
Email Address

Origin Of Funds referent this activity Trade

Are Funds Free and Clear Yes
Brief Corporate Activity

Facilitator and/or Intermediary for transactions between

groups and/or Buyers and Sellers of:

Commodities/Banking Instruments/Bonds/Currency
Exchange

PHONE NUMBER: +55 XX XXXX-XXXX e-MAIL:

ADRESS: Rua XXXXXXXX, Bairro XXXXXX, São Paulo, SP, Brazil, ZIP/CEP: XXXXX-XXX
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 CIS Nome: 19 DE ABRIL DE 2023

BANK NAME:
BANK ADDRESS:

IBAN:
SWlFT CODE:
BANK OFFICER:
BANK PHONE No:
BANK FAX No:
A/C NUMBER:
EMAIL:

Or

BANK NAME:
BANK ADDRESS:

IBAN:
SWlFT CODE:
BANK OFFICER:
BANK PHONE No:
BANK FAX No:
A/C NUMBER:
EMAIL:

I hereby swear under penalty of perjury that the information given above is accurate and true.

Any information, work or service conducted hereunder is that of a private placement transaction that is
exempt from the Securities Act and not intended for the general public but for Private Use Only.

SIGNATURE AND SEAL

Passport: *AB123456*

Country: BRASIL

Date: 20 DE AGOSTO DE 2018

PHONE NUMBER: +55 XX XXXX-XXXX e-MAIL:

ADRESS: Rua XXXXXXXX, Bairro XXXXXX, São Paulo, SP, Brazil, ZIP/CEP: XXXXX-XXX
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CIS Nome: 19 DE ABRIL DE 2023

COPY OF BENEFICIARY PASSPORT.

PHONE NUMBER: +55 XX XXXX-XXXX e-MAIL:

ADRESS: Rua XXXXXXXX, Bairro XXXXXX, São Paulo, SP, Brazil, ZIP/CEP: XXXXX-XXX
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 CIS Nome: 19 DE ABRIL DE 2023

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
(b) Original and recent credit card statement
(c) Letter from your employer (on headed paper)
confirming your permanent address.
(d) Utility bill

PHONE NUMBER: +55 XX XXXX-XXXX e-MAIL:

ADRESS: Rua XXXXXXXX, Bairro XXXXXX, São Paulo, SP, Brazil, ZIP/CEP: XXXXX-XXX
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CIS Nome: 19 DE ABRIL DE 2023

COPY OF BENEFICIARY ID CARD

PHONE NUMBER: +55 XX XXXX-XXXX e-MAIL:

ADRESS: Rua XXXXXXXX, Bairro XXXXXX, São Paulo, SP, Brazil, ZIP/CEP: XXXXX-XXX
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