REQUISITOS CUENTAS INDIVIDUAL Fotocopia @ COLOR del PASAPORTE vigente para cada persona Fotocopia @ COLOR de la CEDULA, DNI, etc. vigente para cada persona Fotocopia a COLOR de Ia LICENCIA de CONDUCIR vigente para cada persona Carta de Trabajo o Constancia de Ingreso anual para cada persona si los ingresos son igual o mayor a 100,000.00 Uso Carta Bancaria, Certificacién Bancaria para cada una de las personas. En caso de no poder obtener el certificado bancario, una carta explicando el porqué no pueden obtener el certificado y obtener los ULTIMOS 3 estados de cuenta completos. Sino tenemos la carta explicativa no se aceptaran los estados de cuenta, Si toma mucho tiempo para obtener la carta, favor de.obtener los tiltimos 3 estados de cuenta completos y esperaremos por la carta. Nose detiene el proceso Documento de PRUEBA DE RESIDENCIA para cada persona. Puede ser el ULTIMO recibo de: Agua, Luz, Teléfono, Celular, Gas, Cable, Contrato de Renta o Alquiler, Carta de Familiar mostrando la direccién y su identificacién y copia a COLOR dela misma. No se aceptan ningin tipo de estado de cuenta. En caso de tener distintos apellidos, se necesitaré prueba de cada persona Colocar en pagina 4/7 en REFERENCIA COMERCIAL, obtener el nombre de Banco o Empresa, el ntimero de teléfono de contacto incluyendo el drea y relacién con cuenta habiente. No hace falta documento fisico, Esto aplica a todas las personas Colocar en pagina 4/7 en REFERENCIA PERSONAL, obtener el nombre completo, teléfono de contacto incluyendo el drea y relacién con cuenta habiente. No hace falta documento fisico. Esto aplica a todas las personas. NOTA: La solicitud de los requisitos mencionados en los puntos 4, 5,6,7y 8 no aplican para casos en que todas la firmas autorizadas pertenezcan al mismo grupo familiar y dependan econémicamente del Titular Principal Todos los documentos deben ser Completados en tinta AZUL Todas las paginas tienen que'tener las iniciales de TODOS los participantes en la aplicacién Siempre utilizar el nombre completo de cada persona. 2 nombres y 2 apellidos Todas las fotocopias tienen que tener la inical, firma, fecha y cotejar con FIEL COPIA DEL ORIGINAL, por parte del agente. Como por ejemplo: identificaciones, contratos, recibos, estados de cunetas, etc. En todos nuestros formularios debe de firmar todos los participantes No se aceptan tachaduras, enmiendas y/o correctores Siempre verificar la vigencia de todas las formas a utilizar Rev. 1-Nov-15,Pavisitos oblaystrios STATETRUST “ternational Bank & That LLC New Relationship Checklist Date (MOY): oxlo2 [sor Customer Application Fully completed and signed Customer Profle (Completed by Referral Agent User Passport Copy (cdo &° tiene Devers Liseee /Cédule [o[o[ojo/ofo|oo 1a Coonteans Divers emeatuaua Cong” ojo jo ;oj0 14] Beneficiaries Additonal Information do 48 15| Bonenclaries Copy of Passport iene, Rana 18| Tronater-on-Death Securities Account Agreement 20| Power OF attornoy _ ‘General Terms and Conditions: 22| Cemtined Copy of Artices of Incorporation 23| Comorate Resolution 24| Resolution Granting Signature Authority ‘or Parnorship/Trust Agrooment 25| Corporate Financial Statements 28| Certiteate of Good Standing 27| Certicate of Registered Shareholders SmisT Form 5050 sprodos (a5 ex2MWWS ddloon ewe core hope Row. Nev.t5STATETRUST ‘ernational Bank & Ture EC Portfolio Participants Ne ATS. New O Maintenance Referral Office: 7m Guso evo Ootwer Agent Codes CoA. Bones Pinaivitual O corporate O PHC Goat Centers Cop. (i VEO dee ernto dak cliesie Corindeal ) Rolated Names” cclowr d pomore legph) a) pOmlae de \os Past eantes) se [Reis ewe Funding eve Fong valor ded wm Tigo de foadeo uso © Euro QO other a Fonded Glee Tronster ad Notes 2 esrioge nrnoncicoe aa soeioamte Sere Reinstitin | HaPsRce get Perse {FF er con pot ecto) Yeti accra vie tive Gis fen) Regional Compliance Dates ‘STIBT Form 5039 Krodas las Wuentos daken Wevar aka NOY * Rov, 4HovetsCorporate Office Park, Assertus Building, ‘Suite 107, Carr. 2Km. 22, Guaynabo, Puerto Rico 00966 STATETRUST wre seston Tnternational Bank & Trust LLC Individual Customer Application Individual Customer Application Sections @ |. Account & Relationship Type Zl, Personal Information ) O I, Beneficiary information Cacho shay \e vodhexextos IV. Employment information © V. Financial information Vi. Portfolio Expected Activity @ Vil. Account Funding Information Vill, Internet Banking IK. References @-X. Account Reporting & Communications GX. Banking Objective @ Xi. Banking Services © Xill.. Certifications © XIV. Security Procedures XV. Banking Signature Registry Xvi. Agreement Required Documents ed of valid passport Copy of river's Lleense Copy of National Identity Card ("Cédula") GH Copy of Proof of Resigence, & Copy of signed Form STIBT 0020 Anti-Money Laundering wouce Bank Reference Letter or Statement Reference #1 Reference #2 (Form W8-BEN 5 Form STIBT 0013 TraneerOn-Death osignating eee) | Delivery of Universal Banking Agreement to Client | & othe Pease Markit oppiabic) © Anentorsutstruat? trapoicabie) CSolo EOC RO torr ojos angina Caza ea Re Vag Tartan ( (Ge -Xinpisiovio ) 9 ecciGn 4 S Emaloyer | O°% 1 da Lo emgrSQ gy wy ow ila ka, = nas Quito Vonindra @ S i ceurty | SY} coin 7 burwdor ee vy Proms LOPE WpRaPo = _f 3 = mobi y raat Loss wR IW Selt-employed, please provide tax 1D number Secolawo Wd Moc 3 ¢5Propatank 9 acer Curent | Suto Year otk current] St Yoana Creo [Reddo ae feo | And enla comgpinies| MME 7 See pee cory cs cae tipo de Yadust¥a | Sneor duh negock © Prue | Hore , oo frie | Nomiate dala, compan - reread i Pca ea wee? | Civdor) | Ro _ Yeon Wot ie ve Wa 'STIBT Form 0001 Son ay Rew. t-NovtsTorwen Ok fondeD STATETRUST Individual Customer Application ‘Main Customer Number: Applicant / © Co-Applicant © Co-Applicant/Joint aaa fom anor Oe Annual] Earings Fam employment har reams taeame ey | S00 CCD OFs0 tnepso treome ts) | Seogeem | Segadn.grooienen os Of ages Sauhes | Soures of | Crotossionl Employment Cl ibertance Sourseot | E)Pwhasanal fmpleyman — Clinhertncs Meat | sate ofReal Estate Tinwestnents Wealth | Ci sate of Real Este Di invesinans lower, speaty: Oeciveho de Sepa riamend Dorner, Specity: ae ions Monthy [SECT caret wae & CHICO Expensests) | Gosreseniuales — #O0.C0C Exponsee(8) [fon Jal mony a Prnelpal Sea Principal ‘Own CIRent Etimstea Yoke toe, [Geers cesteredo | Rendeate |W" 9 lowe [asienen vada Networn) | O¢ cian bsmonrs dal Gsen0 Ligue Nat camcquntont a | Ligue net ‘ash Cash Exner a Wort) Inevitable sears ory Excuse Prepal Residence Rios Precey | Copockén gor la Wel Geciore 1 wuentor oo aes = Cd ecount | z, ef ee sage Prorecctén de cop?ted” creo cvenra esisdvad Exists 5 © avenge scooty Manes oma wate ia ae 3 | Pore wees Tes a. B 2000 : OT eel nec eel 3]! [cemcnentenan cana Wire Testers [ | ‘aivonil Grecia Debt Car Trancacons Gages ‘Own Aczoun Porolon Rimes Mathod payable to yoursel endorse tard wrt onthe back For Depost On") Bank namennto | Boson del hana ce Aoode ooviene e\ AraesO Expected Funda] ETys0 amour, PTO Dloter anon S800, ‘Amount ox 0 Main UserID willbe crested and eentby the Bank, To request ado Itemet Banking users please use Form STIBT 2038, User Paseword | ° Bank send now mala UserID and temporary paccword lo main E-Mail adrecs. This paccword must be changed rng the et, Intenat Banking Session. Bela coe VA sere sh Soagasct (eas) eo Gsm a aro, = Dispanble ano / 12, weses = Dreprtdle poe tag ene were, rene: SortaSTATETRUST Individual Customer A, ie cuomrne owe Conger ‘Main Customer Number pplication Customer Soresponsence | El Rexdence Nialing Azeress | Ch wor (rameceretom | Sober: pptcant acres) Applicant / © Co-Applicant © Co-ApplicantiJoint Seen Bane ma tan one it. _| fattenee | “WOON ce), ‘Banco Rance | Golo Se londenel Cus B Geis juss sce 5 Toi ent a Sieh Cienre Onan vont Ratwancat pre Retreat | Hane 31] “Cente "Toaohane Goris “eiephone 2 Fenn wo appear elton he 8 § J [Ravn [oe Tatace | Bane Be iad ~ pe Taerhone ie 3 Feivion te Appicont alston Applicant é ‘Account Oo} Fest Wak Sait sess ed Ti Copies of tast 3 statements included Siemens nn a EMail gggyrenne [Duron can Clune erpirentGatt Clusroner cut Dorks Gage gue Vega I a Ghee Cimiareeas Pretered Mode | ClTekphone CIEMa! ClFax ClPesonalvist (HONRG GOO se cowaUwdO ) of Contact Dspociantructons: (Se Guede SA\SCACINC sistas Oedanes). Vv thal slowed ene inert Fisk Profle Dhow TEioderate EY Rggrastve ow rote cmon. we Want, is pay Fanfare ct x easerons ee iment 5S [Cornemcveno ee (ClpentalPten (Diovan Chm Tnfostment etecioert Crorignec, Cheon jp Ces Tcommoaties — Cl optons Diecsing Years of wv 1010 Yr8 to 15yre © retnan ae Diwsvs Oswror Drowsy Ctstez09 = mereinanz0 5 SSTIBT Form 0004 Page: it Sova Experience tla Rev NotRade lkestoror quar deste os toltierooadaS customer ame: Ong, Loouplett) ‘Main Customer Number: Portatior [1US Dotter cites) [YT Euro wequite Mone = STATETRUST Individual Customer Application (ther Money Market Currencies Dor Ooo Davo er Gow Cotren ‘Requirement - SateTurt iterations! Sank & Trust, LLC, vaqules both a US Dollar and Euro Maney Market accounts. in adion, ‘the Customer can optcnal define other curencies fori Porolo WorldPass and Money Market Account, tier sTIBT Banting Services otintrest eaco. qe sia ad onc CWorePacePontsto Cl Foreign tschange Towers Dinwesment Deewomoney Marte Ci aiiPayments Dine of eat Drontoto Management sweep account Doors Devecte cards rs series Crime Deposts Deter of rest Coenic cars Co reviement Panning Services Diindered co Cieatietions Ce cards a prepais rami Founentons IsiAte any Account Rieter [Bio Ci Yes Woe, please spect: CIU.S.Chizen [1 US. Resident Alen C) _US.orP.R. Resident Nenad cornosio Ree Holders) United see eet | Pease compete reach plat and oplcanl For WA-BEN Net USParonorP>R Person, houfocnd Ut | roms) ween Completed nd netted (cormgusar WP) Political Exposed | Is Are any Account Halder) Polly Exposed Person(s) o lang tobe srir politcal igure)? Persona) Tito Ces, specty which apptcant: | “Senior pial fgure"is a cuent o fxmer senior ficial nthe execute, legislative, acinsatve, mila ojudcalbranches of yore. Wocé® | # forgn government, 2 senor ofical or a major foreign poles pry ora sent execute of 3 foregn goverment cred GC | Corporation. In adton,a“Serior pola gue” cludes ary comperain, business or ether ently that has been fered by. o for ona QoUitss | the bone a sero oka! fore. TsAce or wil Account Holders) be he inmodlatafamiy of conor palticalfgure? no Des, Speaty which appicant: “Immediate family includes the fgure’s parents, ebings, epouse, chidren, and intaws” Is/re or wil Account Holders) be a cose assodate ofa senior polical igure? Ono Ces "Close associate isa person who Is a widely and publicly known to maintain an unusual close relaonship wth the senior foreign poltical igure, and includes a person who i na potion to conduct substanilal domestic and international financial transactions on benalf of he senior foreign potical igure. Benefical Owner (Gidea ist omer) Type Aptana ower ol ese orion? ‘Yes CINo Ht, No please explain: ‘Nota A Banat! OunarsBarea owner fe nds even te leet so enor persons name (a ste uma cuner atthe uns) aa Pa Sutret & 3 Carmsey eS smawes ” S82 ware the Applicani/Go-Appleant related io SlateTast? Uiiene Wlociéa wn em@eado ste Dstatetiust Agent Cl stateTrst Stat yes provide = Offs: CLO __Codes Cason Names DELO Poten: Del nnihiog Ei os Procedure Diclore ‘hen the Customer taremt a payment insucton to te Bank by means of Elecroné Banking, MM, Fax orl, and hat ‘anslerexcesds ine Minimum Secinty Amount Level as Getned fom Unedo-me be the Bank the Bank at ke ow dren troceeds to cakback cont and athcale te paynantineuctonsreceved bythe Bark. Please note hat nevucone may [be erected unl Socurty rocedae a complied a talstay anne foe Bank imum Secuty Amount Level: USD 0.0 (Al transactions may bo subject othe CallBack veriiatlon procedure) Selection of Joao met Mont: OF GO CE RKCEOTOT CAD HCA | eget Securty Feature "AD Phe ic (593) q + wuirero Moddo del sis Foren Poe: 67 Rev. -NOWS Smilaf ) STATETRUST Individual Customer Application Tan cisonertanes Wontge ouDeIO [sin ovioner toric ENaC Lr ene ee tees ae) Signature diidual Type" signers ane Signatur roquted Unies speci instructions ae epactid in writing, i oe 0 ‘Type “B signers two signatures required ‘equal Internet accass wil be granted to all Signer. frre For scuy rants, pase coastal ply oni Boxe a mark he ATS pe Satur Do Signer? | Signature tLe er Pantone Rohe Cogeto a Pare Signer | Sinate CL [= S Wena SPHene Srando Remon Pint Nae Date | Print Name: Signer | Sante Sianers | Sinat Pia Na Pinta ee Barer | Soraure Cole pe Cr Signer ® | Signature ‘Signer 0 Date Signa CL AL A a BANA Date Date Spee | spaerhuctone taena EP ‘Terme ‘By signing this Banking Signature Registry, we authorize StateTrust Intemational Bank & Trust, LLC.(‘STI8T*), to accept instructions: Ponty na exer aan te tprtnenanay acco mut ne nonsmen wee Fen tue ted er opp Wrowih aniregentetaereanet raster seraingrenre Vater Uitior Cia realy pecararancpeiee SSerar nor Sat STBT nay ary bon wen alg ech ree We ster SY orc come esenay Tuners roesione st feet sour bacore an esr uo pose ‘aT Fam ooo! Page: 7/8 Rev.t-Nows Santa(@@ STATETRUST ow Individual Customer Application Main Customer Nem ise plex ‘Main Customer Number: ent/Signature ‘The Customer, under the panales of periuy, hereby cartis that (a) HlShe has reviewed the Infomaten contained inthis Customer Applicaton; (3) AE Infomation ‘snd documectation Runished to the Bank Is tu, correct and. complete In all respects. (<) Customer wil prompiy inform tre Bark of ny ‘anges m such ifematon; (6) Customer acknowledges thatthe terms and condtons in the Banks Universal Barking Agreement regarding accou'ts are ‘Subject fo change c) Funds now or hereer deposed inne Customers accounts) won Pe Bank belany to te Customer (orf te Customer Is ot the Uismate Benes, the Cuetemer coms to clades the Itty ef the ener and relevant eited lYormation to the Bank porto any dopout The (Customer understands tat te unds deponted nis eccount(s) are nc nsured by the Federal Deposit Insurance Corporation any governmental apeney. By signing tis Customer Aoplction. he Custamer acknowecgee receipt of Bank’ Universal Banking Agreement (General tems and conditons) and Understands and agrees to be bound by all he provsione contained in the Unvesal Barking Agreement (General Tams and Condens) regaring Applicant (GSo-Applicantisoint Rena. gh Ccaglicanke en cuso de Wabeivo Stone feomlbose, comnleto 10. For Bank Use only Referral Agent coae ‘comcemer Previous STG (Clv [No E]OontKnow Ronen Fe Camtomer |e ol Mente ene gscduces — supeniaor Code | Bocca cs Tate [OS ER Bcor_/ Spesv’soe caro liasl Ofer Manager ode | CoodigoS Yooxer ‘Date Submited Se = <. ‘Operator ~ — Buro Ofte Name Lédigns anene Referal Agent “Compliance Officer Date 2ADiGoS Horager Ferro. oer Date Man ate ‘xecutve Manager ‘sTIBT Form ooo Page 218 Rev. t-Now-15 SontllayPe oy ATETRUST eric Cart. 2, Km.22 eae Guaynabo, Puerto Rico 00968 ‘International Bank & Trust LLC ery 23-7373 weastatetrustbark.eu UNIVERSAL BANKING AGREEMEN’ (GENERAL BANKING TERMS AND CONDITIONS) Rema Ocente, Go formato de tacrniooS 4 condieones gure Guu d iene Younvtiqun con los Mrmines Crene U iq) “The Engh vesan (is erin) senses the leg bing Yerion and inthe cvent of a ‘eval. The Spanish aniston fr joer information and carvenense oly La wadoce {acd de eotendimiero. Ln versién tingle conmiuye la versénjurdcarerteVnculan yen cio de cualgee conienca con le ‘eadecin al espaol, a veri an inglés ser a ern determine,New Cu STATETRUST “hrmatioel Bask & Ta LE Bdo lo Vera d agente (Resomen dela véstre) stomer Referral Acknowledgement Portfoioname | soln Revre. Portfolio Number individual (©) Joint Cocorporate | international C Premier O Ete 1. Know Your Customer (To be completed by Agent) ‘lation with StateTrust ‘Company or afiiates? How long have you known the | Not Known QlessthanaYear 1 to2 years Customers)? Pleaseexpiain | 2 to 3 years 03 t04 years D4 years or more Do customers) havea business | No OQ donrknow S* & LArerse Vang CUO YrodasckO Yes tes, expan andforhow long: REELS Cae y OMSK Cdo 1s Customer(s) related to any ‘sat of SateTrust Company corafllates? 3 LAE audn coo fa onan Mare: EROS EAD cai SL ENOT Yes w Yes, provide addtional detais: Office: AAEM cone) Oger Position: Relation: Customer(s) refered by? Tae Be Sore a Civica Yo eso (EO ate Where di you vist Custemer(s)? Residence office CO _ sTIBT Reterral Office other, expiain: ode ‘Address Veriieation Visited Home Telephone Directory C2 Not Verified How many times did you visi the Client? Relevant Comments the Relationship ring VAS Que JEWS ad Cente Por que obrela quent BY Ladigos Ogun Seno. Reforal Agent pate aT STIBT Form 0003 ‘Rolerral Agent Name; Referral Agent Code: Céaiigns oggnte. (Bawos acane- ‘county ‘Branch Code: Supervisor Coder Edoe Es COW Kédicos Sogarente © veneer Rev. 1-Nov-15CALL/VISIT REPORT - INDIVIDUAL & PHC STATETRUST ety | Tnternational Bank & Tras LLG. » Nowdclagenre rc = 7 | codes meee Bi ] acentnane | (Cédioos agent —__| fem — [Codiges gene __] careterence: | Agere? wee _ ] [ome [aps Lda Latin | f re ~ | f Customer Name: | ombre del iene | umber: | customer / Prospect: | [7] customer a Lr stattrette 1 onter a Nose! Porta ces Competos deh Curent Purpose: DD Yearly visi Hy Update requested _ SSO [other _ Apertoca. Je cgertox ‘Verification of (Dy nationatity _______ E] Marital status _ Information: [current employer [Zi current position Current income Ccurrentnet worth _ (i currentaddress Location of Visit/call:| [2] Business Li residence 7 Hotel/restaurant other lease confirm f any ofthe flowing has changed in the past year. so, provide documents and detail. ‘Address (any) | CJ ves [No | Telephones Ores no | Emails — — Type of 1D Owe Om ss ‘Account Profile | L] yes [wo | Relation Purpose NOK o era. Ts any of the account signatures or account holders a Politically Exposed Dive EI no Person or planning to be @ senior political figure? ieee isn sgl fom i his is rt Isthe customer or any account holder an American resident or citizen? | Ove Ef no ‘Please be aed that adlvonal vss) withthe agent maybe necessary In order to fill out the appropriate Change Forms and other Gocuments related to the Information len ni Cal Report. ‘The Rear Agent by sping tis form confem the authentic of ents orginal documents LEMAOS AGE feuven cA'GO Hanager Secon ‘Aarot Name at Manager ‘ate Complaee = ‘persons Da STIBT eForm 002 Re. 1-Nov-2015,STATETRUST “ternational Bank & Tract ic Customer/Cliente No. ANTI-MONEY LAUNDERING NOTICE Customer Notice ‘At StateTrust International Bank & Trust, LLC. (the Bank}, we have implemented policies ‘and procedures in compliance with the USA Patriot Act and the United States Bank Secrecy Act thereby adhering to international banking best practices regarding anti- money laundering, terrorist act financing and know your dient. ‘The policies and procedures implemented, makes it necessary to obtain, verify, and record information that identifies each customer who has funds deposited in the Bank. Therefore, the Bank will request information such as your name, street address, date of birth, or any other information that identifies you. In addition, the Bank may require that you submit information regarding your source of wealth, regular sources of income or the execution of certain transactions. The verification process for that information, which must be completed before establishing a relationship with the Bank, may delay the opening of an account. Once an account is opened, the Bank may request corroborating documentation and information to verify the source of funds deposited or the use of funds for payments, on an ongoing basis. Notificacién al Cliente En StateTrust Intemational Bank & Trust, LLC (el Banco), hemos implementado _politicas, y procedimientos de acuerdo con el USA Patriot Act y el Bank Secrecy Act de los Estados Unidos adhiriéndose asi a las mejores précticas bancarias internacionales en materia de lavado de dinero, financiamiento de actos terroristas y de conozca a su. cliente. Las politicas procedimientos implementados, hacen que sea necesario obtener, verificar_y registrar informacién que identifica acada cliente que tiene fondos depositadosen el Banco. Por esta razén, el Banco solicitaré informacién tal como su nombre, direccién, fecha de nacimiento, 0 cualquier otra informacién que le identifique. ‘Ademés, el Banco podré requerir que usted suministre informacién sobre la fuente de su fortuna, fuentes regulares de ingresos 0 la ejecucién de determinadas transacciones. | proceso de verificacién de esta informacién, que debe ser completado antes de establecer una relacién con el Banco, puede retrasar la apertura de una cuenta. Una vez abierta la cuenta, el Banco podré solictar documentacién informacién para verificar el origen de los fondos depositados 0 el uso de fondos para pagos, de manera recurrente. Fier By: Por: “i Name: Nombre: Pome ConQetO Date: Fecha: cane smtFom ono fav Atovss Rae We cnahow vor mesiie_rom W-8BEN Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) (Pr Srey 2817) > For uae by nc. ies must se Form W-8SEN-E, Semmctetasy | SSG tome mewitnaog nent orpoyrDonotsenste be RS (OMB No, 145-1821 ‘DoNOT use Wis form + You ate NOT an navel + You ae a US. zen ortho U.S pron, ining saint an nda bt “Yaawabantcl awa clarng at owe ales anid cot ners in IS (other than personal senices) ee WERE + Ya ra bone ownor voi resvng compensation fr personal sevcespartonmedin the United States... 8233 or Wet 1 You ate aperson acting as anintrmadiary ‘ -WsiMy ete youre dn ATCA pre recon. 8 oda 1 Oh utwdlon wh ec, cana nec oat ay be Proce o your bnecton rei Tdentfication of Beneficial Owner (ee instructions] i Nato of vidal whois the Bane ower 7 County a aa Rormlate comPeNO 3 Parsee aes Se Ao CD, DBT RE Dwreec¥EA + PaeMTO. c1 NAGS See HELO a Tow sate igen ote posal cde wae appa oy Civdesd | re Sis -F Waling address (if alforant fom above) ax or in-care-of accross ‘iy oF Town, ine rownc. clude postal Code wre BPRTOETATE- Cony Some ‘5 US wep Gein namie SSN oF THF roqued fo tons) | € Foreign tax rying ng (oe ratocion] we sisenerd Qr eo, 77 Reference rarer) ee steers) Date of bah @AN-DO-YYYW es rsrtons) w/t (40M de. pucinia gO ‘Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions) '9 carly that be beneficial owner sa resident of tweaty between the United Stats and that county. 10 Special rates and conditions (f eppioable eee instruction): The benafial onmer is claiming the provisions of Atcle and paragraph ‘ofthe treaty identified on ine 9 above to claim ~ win the meaning ofthe income tx [EE _ Certification ‘nce pealies of perry I decors at ave exaied re llornaon en Wis or and the best fy nowedge and belts Won comes, and compat. father erty ore paratos of pry tha: 1+ tam ha nv hat th banal omer am arc ign rth nu tat he Benfll eon of all encore o which Bia fom eto oF ‘smug ws fom to cecuman mye for up «pupeoe, ‘+ Theparzon nomad on in 1 fhe forms not aU. pozen + Theincome to which ie orm elt es (ant etectvaycoonacias wih he cond of ra or buss tha United Saas, (etc connected but nat subject to tax under an apa nce ox Panty er (ete pornar ahve os pater’ lect comected ecme + Thepesen nomad on in 1 ofthis formie a eidet fhe toaty county tad on in 9 oth orm (any win te earing fhe incom ak ey between {he Gone Stas and at our, a ‘+ Forbrkerrarsactns or bara exchanges, te bene our ean exempt een peraon as desire In runs Furtamee,eubotcts fnm be proved to ay wieling agent tat has co recap of custo the seme of which am he banal owner ‘nysitiing ager tt can dbs take payaso tbe ear ef wich a te bere ow agree that wile new fre Wit 30 days any eertileation made on is form Becomes correct sont Son ale ‘Signd “owner (or individual authorized to sign for benafic'al owne’) ~ ‘Ciate MND) North complet Seams coset : owner! Fintrare ot sper Bape rich acing form ot gn by bare me) For Paperwork Reduction Act Nolic, too separate instructions ‘an 80872 Form W-BBEN ex. 2017 eS EN ALLSTAR PS GCE ene.STATETRUST Bank & Trurt LC Tnternat Ross daceo eorivierner (ebhgstoro) D’new individual Internet Banking User 1 Maintenance Mais Cumtonar umber: [ Main Customer Name: 7 ort Inetructions -Pleaee completo all required information felds for each Intarnet User you want to authorize to Vewloperate with your ‘eccountslporfolios. Use separate forms for each Intemat Banking user as needed. Getic Men e See ———S— secant TP Qed = ass Sune UserID & Password | Eonk ners, witbe cate eientby STIT. Porifatios the Intoret Banking User can have accass to ‘Nomber_| Deserion C__| New Tine Deposs G_| Lore & Groat Payments Permtiod Internet Functionality | Veo | No Functionality Yea G_|_C_| Poiteve sitomons D_ | C _| terra transtrs Permied T_ |G _| ererae Accom nctnares Z| _| tars Pay Tense Porta SO [OC | vewweo natvity a © _| Intemational Transfers Permitted [S| 0 _| wow nsneaions Z_|_O__ Prosrrimed Payments Patios ofso 3 a a | ‘An type Customer signature or all account holders must sign ln order to authorize Intemet Banking User(s} under its Customer account. Rae cisieeics By signing this Form We authorize the Intemet Banking User to ave accoss to the selected optionstunconalies of all sccounts under the Selecied Potolos and wil dernlyand hold harmless SiteTrustlnlemational Sank & Trust, LLC, i aftatos and employees trom and against any ‘nd all sims, lables, damages, charges and any expences eusiained or Incurred asa rut of any interme ransactons. © Goodie see (Sap se cme, euorde com ) Name! vombre completO See Name dos Errors ‘STIB1 Form 2030 an Rev. tows KB eercda gerne (1 Gormato) / B Mla cooaile ov coxyorte Qieman los Zen los 2 dormittosSTATETRUST “hirntona Bonk & Pst LE Declaration of Source of Funds Declaracién de Origen de Fondos Fumane: [Humaine eomiptehe Poctetio number: [TTT Account unter: EEE ETT Required Information ntorauton nd ayer eet ro ot "eT Cate” rn of eso va a] ‘ bean Consort nee en eae ee Ta ng Sioned noe patna te pesado Btaer Soo Rae "Sete retanat oscar a or Contam ts acho ‘ti pone anny aaah a ga ‘ayer gn ee Se ech ceo or mo Transaction Type Ty Cheatcnagoe Numbertemero: Fp a Tee [Ej Tansterranetnsit_ © ccoocs du Wyer Transaction Amount [so] NO si LeMlons Seat! Ga ero en EN CoN e eae) Eyres: oo [Worniie del Rance ak AGO oO Aone ES tendo] tence oanemcerers | Nemotonoe TS ERIg ee DUE NG gNON CRIS: soma = Mere rere 2 Explain Source of Funds Explque of arlgen de oe ‘once fades Seems Lion ‘Duress Tiient Cente 2 Name/Nombre: DaFeche Gommpliance Complinionte Daan . Nemeore: See on eee enn cette a STIOT eForm 5040