CIS FORM - Marilda3

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CLIENT INFORMATION SHEET FOR PAYMASTER SERVICES DATE: July 18, 2018 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 Issue 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

MARILDA RODRIGUES BRAZILIAN FT321449 SR/DPF/RJ 01 JUNHO 2017 31 MAIO 2027 N/A N/A +55 21 96500 7875 [email protected] N/A 02 OUTUBRO 1960 RIO DE JANEIRO/ RJ

Attorney ( if you have one) Address Telephone Fax Mobile Email Address Origin Of Funds re this activity Are Funds Free and Clear Brief Corporate Activity Facilitator and/or Intermediary for transactions between groups and/or Buyers and Sellers of: Commodities/Banking Instruments/Bonds/Currency Exchange

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COPY OF BENEFICIARY PASSPORT.

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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

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