r any and all costs, fees and expenses (including legal fees and disbursements) in connection with any damages resulting from the Investor's or any Beneficial Owner's misrepresentation or misstatement contained herein, or the assertion of the Investor's lack of proper authorization from any Beneficial Owner to en

Beneficial Owner's Information Please complete if owner is NOT an authorized person. Name: OR Entity Name: DOB or Date of Establishment: SSN or TIN: Legal Addre

bile Assets) US COO OX Total Net Worth no coo OX Primary Source of Income raiumoris Tax Status Not Taut,* Beneficial Owners taliaid Net Watt Beneficial Owner's Total Net Woetn Treaty Country No Treaty Benefit Corporate/Partnership Profile : Authorized Contact Authorized Contact User I THETA TRACING. LW

Select one) Limited (1-5 transactions per year) Moderate (6-15 transactions per year) High (Over 15 transactions per year) EFTA01400636 Beneficial Owner's Information Name: DOB or Date of Establishment: Legal Address: City: Country of Citizenship: Employment Status: o Employed Occupation and Posi

Select one) Limited (1-5 transactions per year) Moderate (6-15 transactions per year) High (Over 15 transactions per year) EFTA01467735 Beneficial Owner's Information Name: DOB or Date of Establishment: Legal Address: City: Country of Citizenship: Employment Status: o Employed Occupation and Posi