ided outside of his/her country of nationality for 5 years or more? Yes I No Profession/Occupation: N/A Tax ID / SSN: Current Employer: N/A Posibon/Tdeffiank: N/A Address of employer: N/A Does the person work as senior executive of a 0B-recognized regulated entity in the financial ndustry? or an entit

of his/her country of nationality for 5 years or more? Yes I No Profession/Occupation: N/A Tax ID / SSN: 048-13-5374 Current Employer: N/A Posibon/Tdeffiank: N/A Address of employer: N/A Does the person work as senior executive of a 0B-recognized regulated entity in the financial industry? or an enti

sided outside of his/her country of nationality for 5 years or more? Yes A No Profession/Occupation: N/A Tax ID / SSN: Current Employer: N/A Posibon/Tdeffiank: N/A Address of employer: N/A Does the person work as senior executive of a 0B-recognized regulated entity in the financial ndustry? or an entit