ROSALBA MESA DE VIUDA DE GIL

CALLE 23 No 18-66 APTO 102

BOGOTA - COLOMBIA
PASAPORTE: AT341686
CEL: +57 3205889595, Email: ZAGALO1970@HOTMAIL.COM

CLIENT INFORMATION SHEET

Directions This document should be completed in full. If a line tem does not pertain then insert the term: N/A (non
applicable)

Corporate Information

Full Name of Corporation N/A

Date of Incorporation N/A
Incorporated in (city/state/country) N/A
Registration number N/A
Board of directors (Name & Title) N/A
Officers (Name & Title) N/A
Shareholders N/A

Location of address: Registered address (Corporation)

Full Name of Corporation N/A

Street address N/A
City N/A
State N/A
Country N/A
Postal code N/A

Location of address: Mailing address (Corporation)

Full Name of Corporation N/A

Street address N/A
City N/A
State N/A
Country N/A
Postal code N/A

Contact information (Corporation)

Telephone Number N/A

Fax Number N/A
Mobile Number N/A
Email Address N/A

Languages / Traslator

Languages N/A
Does the Signatory speak Englih? N/A
If no, Name or translator N/A
Tel Number N/A
Email address N/A

Legal Advisor

Full Name N/A

Company N/A
Address N/A
City N/A
State N/A
 ROSALBA MESA DE VIUDA DE GIL
CALLE 23 No 18-66 APTO 102
BOGOTA - COLOMBIA
PASAPORTE: AT341686
CEL: +57 3205889595, Email: ZAGALO1970@HOTMAIL.COM

Country N/A
Postal code N/A
Telephone Number N/A
Fax Number N/A
Email address N/A

Bank information (corporate)

Bank Name (where funds are currently on deposit) N/A

Street address N/A
City N/A
State N/A
Country N/A
Postal code N/A

Account Name N/A

Account Number N/A
Sort Code ABA No. N/A
SWIFT Code N/A
Account Signatory (1) N/A
Account Signatory (2) N/A

Bank Officer # 1 Name N/A

Bank Officer # 2 Name N/A
Telephone Number N/A
Fax Number N/A

Client Account where Profits to be paid

Bank Name N/A

Street address N/A
City N/A
State N/A
Country N/A
Postal code N/A

Account Name N/A

Account Number N/A
Sort Code ABA No. N/A
SWIFT Code N/A
Bank Officer N/A
Telephone Number N/A
Fax Number N/A

Personal information of the Transactional Signatory Authorized by Corporation

(Please attach copy of the corporate resolution adopted by the board of Directors oppointing and authorizing said
officer (s) below to represent and legally bind the corporation )

First Name ROSALBA

Middle Name
Last Name MESA VIUDA DE GIL
Gender FEMENINO
Date Of Birth 60- JULIO 1943
Social Security Number N/A
 ROSALBA MESA DE VIUDA DE GIL
CALLE 23 No 18-66 APTO 102
BOGOTA - COLOMBIA
PASAPORTE: AT341686
CEL: +57 3205889595, Email: ZAGALO1970@HOTMAIL.COM

Country of Citizenship COLOMBIA

Languages ESPAOL
Tel +57 32058895954
E-mail Address ZAGALO1970@HOTMAIL.COM

Passport Information of Officer(s) of Corporation

*Please attach copu of photo and signature page passport

Passport number AT341686

Date of issue 21 NOV 2016
Date of Expiry 21 NOV 2026
Issuing Authority BOGOTA CALLE 53

Location of Address: Home Legal Residence (Officer of Corporation)

Full Name officer ROSALBA MESA VIUDA DE GIL

Street address CALLE 23A No 11-66
City BOGOTA
State N/A
Country COLOMBIA
Postal code N/A

(You may duplicate the section above for each Director involved in transaction)

Investment

Funds available for this transaction:

Type of currency:

Origin of funds: Management and intermediation buy

Are these funds free and clear of all liens, encumbrances and third party interests

I ROSALBA MESA VIUDA DE GIL hereby swear under penalty of perjury, that the information provided herein in
accurate and tru as of this date Julio 21 2016

Signature ________________________________________________

Name /Title ROSALBA MESAS VIUDAD DE GIL

Passport Number AT341686
Date of issue 21 NOV 2016
Date of Expiry 21 NOV 2026
Country of Issuance COLOMBIA
 ROSALBA MESA DE VIUDA DE GIL
CALLE 23 No 18-66 APTO 102
BOGOTA - COLOMBIA
PASAPORTE: AT341686
CEL: +57 3205889595, Email: ZAGALO1970@HOTMAIL.COM

Signature ________________ ________________________________

Name /Title ROSALBA MESA VIUDA DE GIL

Passport Number AT341686
Date of issue 21 NOV 2016
Date of Expiry 21 NOV 2026
Country of Issuance COLOMBIA
 CEDULAJUDITH.pdf
ROSALBA MESA DE VIUDA DE GIL
CALLE 23 No 18-66 APTO 102
BOGOTA - COLOMBIA
PASAPORTE: AT341686
CEL: +57 3205889595, Email: ZAGALO1970@HOTMAIL.COM
 ROSALBA MESA DE VIUDA DE GIL
CALLE 23 No 18-66 APTO 102
BOGOTA - COLOMBIA
PASAPORTE: AT341686
CEL: +57 3205889595, Email: ZAGALO1970@HOTMAIL.COM