MF LEGAL SERVICES

Ultimate Bene?cial Owner?s Questionnaire (Bearer Shares Custodianship).

 

 

DATE: I  
I. BENEFICIAL owazn

FULL NAME

QB aw: um

PHYS POSTAL ADDRESS

H?rom QLQUQ
TELEPIION E-.

u; . ?1

INIARITAL STATUS
Maui HI seem;
PROFESSIONAL ACTIVITY
-H,n umci 

NATIONA LITY

IS THIS PERSON A POLITICALLY EXPOSED PERSON YES NO

 

IN CASE OF ABSOLI TE ABSENCE OF BENEFICIAL OWNER:
FULL NAME

   
 

pm ALADDRESS
33 Avenue. XS 

Luger; ouLCr
TELEPHON A

L.qu 0 4 (eduqu

POSTAL ADDRESS

MARITAL NATIONALITY

(luff:  

PROFESSIONAL . 
a,ch

IS THIS PERSON A POLITICALLY EXPOSED PERSON YES

    

LII. PERSON WHO (TAN DIRECT 
7 IE

PHYSICAL ADDRESS POSTA 

 MF LEGAL SERVICES
Ultimate Bene?cial Owner?s Questionnaire [Bearer Shares Custodianship).

TELEPHON

MARITAL STATUS NATIONAL 

OFESSIONAL AFT 

IS THIS PERSON A POLITICAL EIPUSED PERSON 

 

 

NAME AND OF THE 
CORPORATION WHOSE SHARES ARE GIVEN IN 

RURAL QERiw?il. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How mo mu HEAR ABOUT [35: 1
I ?l

NAME:
ADDRESS:
NAME:
ADDRESS:
NA ME:
ADDRESS:

DECL RATIO-NS:
declare 11ml llie source of all funds-"assets connected with the for u. ich MF Legal Services is being asked to am as a Bearer Shares Cusludian 
i'rom legitimale sources and are not of criminal mgm. I. the undersigned. retry declare lhal [he above paniculm are true to the best of mg.- knowledgc and
belief.

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