Corporate Information
Full Name of Corporation : N/A
Languages / Translator
Languages : N/A
Does the Signatory speak English? : N/A
If No, Name of Translator : N/A
Tel Number : N/A
Email Address : N/A
Legal Advisor
Full Name : N/A
(Please attach copy of the corporate resolution adopted by the Board of Directors appointing and authorizing said
officer(s) below to represent and legally bind the corporation)
(You may duplicate the section above for each Director involved in transaction)
Investment
Are these funds free and clear of all liens, encumbrances and third party interests:
1. I, JUANA CONTRERAS MEJIA, hereby declare as the undersigned, having the full signatory power
to transfer, assign, pledge or reserve upon terms satisfactory to me, with full authority to execute all
documents and agreements relating to the same.
2. I, JUANA CONTRERAS MEJIA, hereby grant permission to contact all parties and institutions named
within this document, including the authorization to verify these disclosures.
3. I, JUANA CONTRERAS MEJIA, Hereby swear under penalty of perjury, that the information
provided herein is accurate and true as of this date: 27 MAY 2019.
Signature:
Name / Title : JUANA CONTRERAS MEJÍA
Passport No : N/A
Date of Issue
Date of Expiry
Country of Issuance
COPY PASSPORT
JUANA CONTRERAS MEJÍA
Cédula de Ciudadanía # 60.311.819
Fecha y lugar de expedición: 04 MAYO DE 1984 Cúcuta. Norte de Santander- Colombia
Address: Avenida 17 # 25-28 Aguas Calientes
Barrio: La Libertad- POSTAL CODE: 540003 Cúcuta-Colombia
Mobile Phone: (+57)-3214286388
E-Mail: juanacontrerasm62@gmail.com
Pág. 5 de 7
COPY ID / C. C.
JUANA CONTRERAS MEJÍA
Cédula de Ciudadanía # 60.311.819
Fecha y lugar de expedición: 04 MAYO DE 1984 Cúcuta. Norte de Santander- Colombia
Address: Avenida 17 # 25-28 Aguas Calientes
Barrio: La Libertad- POSTAL CODE: 540003 Cúcuta-Colombia
Mobile Phone: (+57)-3214286388
E-Mail: juanacontrerasm62@gmail.com
Pág. 6 de 7
➢ Known as CIS, the (Client Information Sheet) is the document that identifies the investor with all its data.
➢ This document will be essential to be able to present the transaction in the office of the trader and thus
initiate a process of "Due Diligence" - DD.