Full Name How much is your annual salary? What is your occupation?

Jimmy Nguyen 182000 Buying and selling cryptocurrencies

What is your full address?

400 Nw 4th st Cape Coral FL 33993

Anticipated volume of How will the cryptocurrency will be Origin of funds used for purchase
purchase (in USD) used?
Sale of business
50-100K Purchasing items online

Gift or inheritance from a third-party?

Yes No

The disposal of a business or other asset? (e.g. Selling of movable or immovable

property)?

Yes No

Any other source of wealth (refer to guidelines below)?

Yes No

Politically Exposed?

I AM NOT a politically exposed person* (PEP) I AM a politically exposed person (PEP) and/or closely

and/or closely related to a PEP as defined by related to a PEP as defined by the Prevention of Money

the Prevention of Money Laundering and Laundering and Financing of Terrorism Regulations.

Financing of Terrorism Regulations.

When answering these questions, has the information been supplied from your own knowledge or have you relied on
information obtained exclusively from third-parties?

Yes No

Confidentiality

Any information given by the investor or their adviser will be used solely by the service provider and the product
providers from whom you buy your policies, in accordance with the Data Protection Act (Chapter 440 of the Laws of
Malta).

Client Declaration

I declare that the information provided on the origin of my wealth is true and complete. I agree to provide the

service provider with any further information or documentary evidence in respect of the funds upon request. I further

agree to the service provider contacting any third party to obtain additional information on the investment, if required.

Date: October 01 2023 - 07:18:AM

 Jimmy Nguyen

Name: Jimmy Nguyen

Date: October 01 2023 - 07:18:AM

Xcoin AML Delivery Jimmy Nguyen

Final Audit Report : October 01 2023 - 07:18:AM

Created By Status

October 01 2023 - 07:18:AM CF Technolgies Ltd. (help@xcoins.com) Signed

"Xcoin AML Delivery Jimmy Nguyen" History "Xcoin AML Delivery Document e-signed by Jimmy
Nguyen"

Document created by CF Technolgies Ltd. (help@xcoins.com) (jimmy419@email.com)

October 01 2023 - 07:18:AM Signature Date :October 01 2023 - 07:18:AM

IP address: 154.6.12.19 Source: server- IP address: 10.0.4.114

Signed document emailed to Jimmy Nguyen

(jimmy419@email.com) and CF Technolgies Ltd. Signature Date :October 01 2023 - 07:18:AM

(help@xcoins.com)