Urbano Pereira da Rocha Filho

NAME OF BENEFICIARY

CLIENT INFORMATION SHEET

FOR PAYMASTER SERVICES
DATE: July 5, 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 Urbano Pereira da Rocha Filho

Nationality BRASILIAN
Passport Number CS804798
Issued By FEDERAL POLICY BRAZIL
Issue Date 04/02/2004
Expiration Date 05/01/2006
Social Security Number (MEDICARE NO:) if N/A
any
LICENCES HELD(IF ANY) N/A
Phone no +55 16 98259-6771 (vivo – WHATSAPP)
E mail address Infourbagp@gmail.com
Skype address N/A
Date of Birth 02/07/1962
Place of Birth Sao Paulo – SP - BRAZIL

Company Name N/A

Registered Office N/A
Registered Number N/A
Business Telephone N/A
Mailing Address N/A
Email Address N/A

Attorney ( if you have one) N/A

Address N/A

ADDRESS: RUA Antonio Labella Filho, 131 bairro Jd da Rosas – Jaboticabal – Sp – Brasil – cep 14870-000
CLASSIFIED AND CONFIDENTIAL

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 Urbano Pereira da Rocha Filho
NAME OF BENEFICIARY
Telephone N/A
Fax N/A
Mobile N/A
Email Address N/A

Origin Of Funds re this activity N/A

Are Funds Free and Clear N/A
Brief Corporate Activity N/A

Facilitator and/or Intermediary for

transactions between groups and/or Buyers
and Sellers of:

Commodities/Banking
Instruments/Bonds/Currency Exchange

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 ( electronic signature or original)

Signatory: WILSON BATISTA
Company:
Title: Individual
Passport: FN003841

ADDRESS: RUA Antonio Labella Filho, 131 bairro Jd da Rosas – Jaboticabal – Sp – Brasil – cep 14870-000
CLASSIFIED AND CONFIDENTIAL

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 Urbano Pereira da Rocha Filho
NAME OF BENEFICIARY
Country: BRAZIL

DATE: July 5, 2018

BANKING COORDINATES FOR

INDIVIDUAL ( THE BANKING INFO IS FOR RECORD PURPOSES ONLY)
BANK NAME: N/A
BANK ADDRESS: N/A

SWIFT CODE: N/A

BANK OFFICER: N/A
BANK PHONE No: N/A
BANK FAX No: N/A
A/C NUMBER: N/A
BANK ACCOUNT NAME: N/A
EMAIL: N/A
SIGNATURE N/A
Re following, please provide N/A
a copy of a photo id… either
passport or driver licence

COPY OF BENEFICIARY N/A

DRIVERS LICENCE

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

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 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