MOSSACK . 



Declaration Form

Source of Funds/Source of Wealth

 

Pursuant to Section Anti-money Laundering and Terrorist Financing Code,2008
NAME OF THE COMPANY (APPLICANT FOR BUSINESS): SOUTH EUROPE CAPITAL Inc.

 

SPECIFIC ACTIVITIES CARRIED OUT BY THE COMPANY: Capital investments, shares, bonds,..

 

 

MAIN COUNTRY (IES) WHERE THE ACTIVITIES ARE CONDUCTED: Bosna and Herzegovina, Croatia, Slovenia

 

 

 

ESTIMATED VALUE OF THE TRANSACTIONS THAT WILL BE CARRIED OUT BY THE COMPANY (if it is a recurring

transaction, the value on an annual basis): 10 mil. 

 

 

 

1. Source of Funds: the origin of the monies being used by the Applicant for Business to execute the specific

transaction/activity

Cl Personal Savings.

Please indicate the specific activities that originate
your personal
savings:

Proceeds of Inheritance/Trust Fund.

Please enclose the applicable inheritance or trust

.docu mentation:

 

 

 

Please indicate the estimated amount of your savings:

 

Borrowing/Loans.

Please indicate the purpose of the loans and which
institutions were

involved: POLE-73.09 .

 

io?c.

 

Please indicate the estimated amount of the
loan: 23 M4 ?5

 

Proceeds from Business Trade.

(3) Please indicate the specific trading activities, such as

Please indicate the estimated value of the assets
inherited/held in
trust:

 

Proceed from Financial Investments.

Please indicate the specific financial investment

activities carried out and the involved ?nancial 
institutions. 9 HAILES FONA

3990,17,, p/mToai/Ue BERT game/v14?

 

 

Please indicate the source of funds initially invested:
741w am 

 

Please indicate the estimated amount of the profits
received: 0,3 4M: 1 [Lu 7.0 riJ

 

Proceeds from Contractual Obligations.

Please indicate the specific contractual obligations and

 

what products and/or services are offered in your parties
trading involved:
activities:

 

 

 

Please indicate the amount subject to contractual
Please indicate the estimated turnover/net obligation:

 

profit:

 

2. Source of Wealth: the business, transactions or activities which generated the total net worth of the Applicant for

Business. Please provide a detailed description:

to ow" ,to yiarHLS WE, EAR/org) Cr?inT/lt. err/mag (N Bog/um? 


$999399 WE IN 


 

 

 

Please indicate the estimated value of the net worth: 2 

 

l/We declare that the source of all funds/assets connected with the services for which MOSSFON provides,
derives from legitimate sources and are not of criminal origin. I also confirm that the above information is true
and accurate, and that you are authorized to provide any or all of such information for due diligence purposes to
the Regulators if so requested by them. We also undertake to notify you of any future changes to the above
information.

4: 9717 42 . '2 or 

Authorized Signa7bry Date 

gale/I?; 

Print Name

 

Director/ Shareholder/ Beneficial Owner (circle one)