CLIENT INFORMATION SHEET THIS IS MY CIS FOF SENDER TRANFER TO MY CARD NUMER CODE 4 DIGITS PROTOCOL 101.1 VISA DEBIT CARD DOCUMENTATION ENCLOSED: CLIENT INFORMATION SHEET MASTER CARD CODE MASTER CARD PHOTO PASSPORT COPYUNIONPAY RECERIVER INFORMATION: Name : DY SOEUR Address : No. 12/ Sangkat Chorm Chao, Phonom Penh, Cambodia Passport Number No, NOO837423 Passport issue Date 1 21/MAR/2026 Passport Expired Date ——: 21/ MAR/2016 Passport issue Place CAMBODIA Bank Name 1 ADVANCED BANK OF ASIA LIMITED Bank Address No. 148, Preah Sihanoukblvd., Phnompenh, Cambodia Account Name : Account ! Number Card : Master Card Date Swift Code Declaration: thereby swear under penalty of perjury, that the information provided is both true and accurate. | am the signatory on the aforementioned bank account. All monies engaged in this transaction are derived from non- criminal origin; and, are good, clean and cleared. The origin of funds is in compliance with Anti-Money- Laundering Policies as set forth by the Financial Rules by the corresponding Country. 04/04/2023 SOEUR DY=x BLACK SCREEN cerry THELEE ation Date iz ee Pa UN anata) Pe eke rt erent eee a etea een srs ecto yy PREA era ncr int eens ee nue: teers Ren er Cra ee aera Ute EYL SUCCESSFULLY REDEEMED rs CONNECTED rd Metta) TH COMPLETIONBLUE SCREEN EFERENCE/MALM Ntsc oan TOO eT ne| ooo ay rot) PREAUTH COMPLETION SYSTEM SC * END OF DOCUMENT *