KYC DUE-DILIGENCE

BOARD OF DIRECTORS

*PEP: Person politically exposed

SHAREHOLDERS

DECLARATION OF SOURCE AND ORIGIN OF RESOURCES OF THE TRANSACTION

FINANCIAL PROFILE

DOCUMENTATION REQUIRED

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STATEMENT

"I DECLARE THAT THE INFORMATION CONTAINED IN THIS FORM IS TRUE, COMPLETE AND PROPORTIONATE.
RELIABLE AND UP-TO-DATE INFORMATION ON ALL ASPECTS ON WHICH QUESTIONS HAVE BEEN ASKED."

The applicant declares that:

• Has not been involved in, has not been convicted of or is under investigation anywhere in the world for offences related to the production, trafficking, consumption of drugs or any other offence associated with drugs; or money laundering.
• I (we) confirm that I (we) have and verify the due diligence evidence of all beneficial owners, attorneys, beneficiaries, directors, officers and signatories of the services necessary for ACTIVE-RE; and agree to provide such information and/or documentation requested by ACTIVE-RE.
• I declare under penalty of perjury that this statement has been examined by me and is true, correct and complete to the best of my knowledge and belief.