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UBO Declaration

I, [Managing Director], confirm that the following Company:

[Company name]

Has many different ultimate beneficial owners and no individual holds directly or
indirectly more than 10% of the shares

Has many different ultimate beneficial owners and KYC documentation of the following
individual(s) holding an interest of more than 10% of the company is attached.

- [Name, private address, Country

We undertake that we will notify you immediately in the event the UBO situation changes
in such a way that would affect the accuracy of this declaration.

[Date, place]

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