MARLO DAVID JARABA FONTALVO

PASSPORT No.: AT795007

CLIENT INFORMATION SHEET

FOR PAYMASTER SERVICES
DATE: JUNE 19, 2017

In accordance with Articles 2 and 5 of the due diligence and federal banking commission circular of December 1999,
concerning the prevention of money laundering, and Article 305 of the Swiss Criminal Code, the following information
may be supplied to banks and to financial institutions for purposes of verification of identity and activities of the
investing member, and the nature and origin of the funds which are to be utilized.

Client Full Name MARLO DAVID JARABA FONTALVO

Nationality COLOMBIANO
Passport Number AT795007
Issued By COLOMBIA
Issue Date 29/abril/2017
Expiration Date 29/abril/2027
Social Security Number (MEDICARE No.:) if any 85. 455. 009
LICENCES HELD (IF ANY) N/A
Phone No. +(57) 3003778859
E mail address marlojaraba@hotmail.com
Skype address N/A
Date of Birth 07/Agosto/1968
Place of Birth Ariguani , Magdalena , COLOMBIA

Company Name N/A

Registered Office N/A
Registered Number N/A
Business Telephone N/A
Mailing Address N/A
Email Address N/A

Attorney ( if you have one) N/A

Address N/A
Telephone N/A
Fax N/A
Mobile N/A
Email Address N/A

PHONE +(57) 3003778859 EMAIL:. marlojaraba@hotmail.com ADDRESS: MzC,CASA 11 URB VILLA MONICA

CLASSIFIED AND CONFIDENTIAL

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 MARLO DAVID JARABA FONTALVO
PASSPORT No.: AT795007

Origin Of Funds re this activity N/A

Are Funds Free and Clear Si
Brief Corporate Activity

Facilitator and/or Intermediary for transactions between Between Buyer and Seller.
groups and/or Buyers and Sellers of:

Commodities/Banking Instruments/Bonds/Currency
Exchange

I MARLO DAVID JARABA FONTALVO, hereby swear under penalty of perjury that the information given above is
accurate and true.

Any information, work or service conducted hereunder is that of a private placement transaction that is exempt from
the Securities Act and not intended for the public but for Private Use Only.

___________________________________________________
SIGNATURE AND SEAL (electronic signature or original)
Name: MARLO DAVID JARABA FONTALVO
Company: N/A
Title: Mr
Passport: AT 795007
Country: Colombia

PHONE +(57) 3003778859 EMAIL:. marlojaraba@hotmail.com ADDRESS: MzC,CASA 11 URB VILLA MONICA

CLASSIFIED AND CONFIDENTIAL

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 MARLO DAVID JARABA FONTALVO
PASSPORT No.: AT795007

PASSPORT

PEGAR PASAPORTE A COLOR

PHONE +(57) 3003778859 EMAIL:. marlojaraba@hotmail.com ADDRESS: MzC,CASA 11 URB VILLA MONICA

CLASSIFIED AND CONFIDENTIAL

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 MARLO DAVID JARABA FONTALVO
PASSPORT No.: AT795007

PERSONAL ID

PEGAR CEDULA DE CIUDADANIA A

COLOR

PHONE +(57) 3003778859 EMAIL:. marlojaraba@hotmail.com ADDRESS: MzC,CASA 11 URB VILLA MONICA

CLASSIFIED AND CONFIDENTIAL

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 MARLO DAVID JARABA FONTALVO
PASSPORT No.: AT795007

BANKING COORDINATES FOR

INDIVIDUAL (THE BANKING INFO IS FOR RECORD PURPOSES ONLY)
BANK NAME: N/A
BANK ADDRESS: N/A
SWIFT CODE: N/A
BANK OFFICER: N/A
BANK PHONE No: N/A
BANK FAX No: N/A
A/C NUMBER: N/A
BANK ACCOUNT NAME: N/A
EMAIL: N/A
SIGNATURE N/A
Re following, please provide a
copy of a photo id… either
passport or driver license
COPY OF BENEFICIARY N/A
DRIVERS LICENCE
COPY OF BENEFICIARY
PASSPORT
BUSINESS
Please provide description of
Business Consultant
the business activity. Where you
are working through the
company as listed above

PHONE +(57) 3003778859 EMAIL:. marlojaraba@hotmail.com ADDRESS: MzC,CASA 11 URB VILLA MONICA

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 MARLO DAVID JARABA FONTALVO
PASSPORT No.: AT795007

PROOF OF
RESIDENTIAL
ADDRESS (Note that
P.O.BOX is not
acceptable)
To validate the home
addresses of all
parties, please
provide at least ONE
COPY of the following:
(a) Original and
recent bank
statement from a
recognized bank
(b) Original and
recent credit
card statement
(c) Letter from
your employer
(on headed
paper)
confirming your
permanent
address
(d) Utility bill

PHONE +(57) 3003778859 EMAIL:. marlojaraba@hotmail.com ADDRESS: MzC,CASA 11 URB VILLA MONICA

CLASSIFIED AND CONFIDENTIAL

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