CUSTOMER REGISTRATION FORM

In accordance with applicable laws, including but not limited those related to money laundering and terrorism
financing prevention, Kuehne + Nagel S.A. ("KN" hereinafter)
request yourcollaboration filling this form with your data, attaching the documentation below required.

General Information

Please provide the following documentation: (i) Company registration certificate issued by the compe-tent
authority of your country of incorporation; (ii) Tax ID certificate (if applies); (iii) Copy of the ID cards for the
legal representatives of the Company.

Corporate Name: AUTOMOTORES Y ANEXOS S.A AYASA

Commercial Registration Number and/or TAX ID 1790014797001
Number:
Corporate Addresss: PICHINCHA / QUITO / IÑAQUITO / AV. ORELLANA E2-30 Y AV. 10 DE AGOSTO

Corporate Purpose/Economic Activity: Importación, distribución y comercialización de vehículos, repuestos y accesorios, entre otras actividades automotrices.

Legal Representative Data

Full Name: HERNANDO CHIRIBOGA DÁVALOS
ID Card number: 1704945573
Address: PICHINCHA / QUITO / IÑAQUITO / AV. ORELLANA E2-30 Y AV. 10 DE AGOSTO
If there is more than 1 legal representative, please fill the respective information in the Additional Page

Owners/Shareholders Data:
(Please indicate the final beneficiaries of the company; if your company is listed in the stock exchange market, please provide details)
Full Name:
Nationality:
ID Card number:
Address:

Board of Directors Data (if apply):

Full Name:
ID Card number:
Address:
If there are more Board members, please fill the respective information in the Additional Page
Treasury and Invoicing Data:
Full Name:
Address:
Phone number:
Treasury Email*:
Email for electronic
invoicing reception**:

* If there are various emails, please separate them with semicolon (;)
** If there are various emails, please separate them with semicolon (;). Email here requested is equivalent to the judicial and legal address for invoicing notification purposes.
Foreign Trade Data:
Full Name:
ID Card number:
Address:
Phone number:
Email*

Credit

Do you require credit? Yes No

In afirmative case, please attach: (i) Bank certification (issued within last 30 days); (ii) Financial State-
ments for the previous fiscal period.

Banking Information
Please provide details of your Bank and your bank account.
Bank
Kind of account bank
Account number

Commercial References

Corporate Name: Corporate Name:

Full Name: Full Name:
Email: Email:
Phone number: Phone number:

Funds origin statement

I declare that funds and economic resources that the company manages: (i) do not have origin on illegal
activities and, (ii) come from the following sources:
Please detail the business and main economic activity of the company. Please do not use generic descriptions, e.g. commerce.

Politically exposed Persons (PEP) and Public Officers:

Please indicate if any of your employees, managers, members of the board of directors and/or shareholder is considered a PEP) and/or if any of
such persons is a Public Officer or has been in the last 3 years, in affirmative case please provide the name and identification of the person:

PEP: individuals, who are or have been appointed as civil servants with the power to decide on public expenditure, or entrusted with prominent public
functions in any country, for example Heads of State or of government, members of parliament (congressmen), senior government, judicial or militar officials,
senior executives of state owned corporations, important political party officials. Family members of PEPs.
y

* If there are various emails, please separate them with semicolon (;)
** If apply (Circular 170)
 Personal Data Authorization:

I hereby authorize KN, its related companies and representatives to collect, file, use, manage and distribute the personal data provided (or
to be provided in the future) in accordance with: (i) the Data Protection Policies of KN (document to be provided by KN if requested) and
(ii) the applicable laws.

Yes ✓
Prevention of corruption, money laundering and terrorism financing:

I hereby declare that the company which I represent, its employees, managers and shareholders: (i) do not belong to any criminal/terrorist
group/organization, are not listed/reported in international and local lists related to corruption, money laundering and terrorism
financing, including but not limited to OFAC and UN Security Council; if any of those situations change, I oblige to inform such change
within 2 next days after the date in which I take knowledge of the change.

I hereby declare that information here provided is true and currently valid, I oblige to update such information, when necessary and at
least once per year; I will indemnify Kuehne + Nagel for any claim if the information here provided is false or invalid.

I hereby declare that the company here represented has taken all needed measures and due diligence in order to know its counterparties
and its final beneficiaries, updating such information periodically

Yes

The information provided above is, to the best of my knowledge and belief, accurate, current and complete. I agree to notify promptly
of any material changes to the information provided herein.
IN WITNESS WHEREOF, this document is executed on this day, , 20 in Quito .

HERNANDO CHIRIBOGA DÁVALOS

Full name of the Legal Representative:

ID Card number:

Signature:

For KN filling exclusively

Level 1: Customer ID creation

Level 2: Customer ID creation + Debtor code Customer

Level 3: ID creation + Debtor code + credit

 ADDITIONAL PAGE
Fill and print this Additional Page, only if requiered.

Additional Legal Representative Data:

Full Name:
ID Card number:
Address:

Additional Legal Representative Data:

Full Name:
ID Card number:
Address:

Additional Owners/Shareholders Data:

(Please indicate the final beneficiaries of the company; if your company is listed in the stock exchange market, please provide details)
Full Name:
Nacionalidad
ID Card number:
Address:

Additional Owners/Shareholders Data:

(Please indicate the final beneficiaries of the company; if your company is listed in the stock exchange market, please provide details)
Full Name:
Nacionalidad
ID Card number:
Address:

Additional Board of Directors Data (if apply):

Full Name:
ID Card number:
Address:

Additional Board of Directors Data (if apply):

Full Name:
ID Card number:
Address: