SOcBc a On AS (EA) Self-Certification Form (Entity) as + Tiss ecentifeation form provided by an acount hod to he Bank for complance wthelevant ox avs an regulations including US Foreign Aecount Tax Compliance et CFATCR'] an tos change financial Account information Theda ted the Bankta eleven tax authorities, inldng US nt Revenue Sere (1RS" and (2) Macou Financia Sens Buren for Wanser tothe tax authori of anather jurisdiction, + An account holder should report al changes his/her tax residency status tothe Bank + Allpas ofthe form must be completed unless not applicable or atherwise specfed space provided is hsuficen.contnue on additonal sheets) Information a + The Bank does not and cannot provide any taxadice you ny questions about howto complet ths form please consult your tx advisor. ae cos The Engin translations forrefeence nly. incas of any discrepancy between the English version and the Chinese version, the Chinese version shal preva Part 1 : Identification of Entity Account Holder (Complete a separate form for each entity account holder.) 8 Legal Name of Entity Branc! ‘ompany Search Number: 218 Centcate of Incorporation / Registration Number: eG ZENO 6219 AFR Juisccton of Incorporation / Organization: ‘RHA Business Address’ ‘RLWAL Correspondence Address: TANG MERMENAORE - TORMARSTOMRES - BREESE 2M AS O SM RRSRIE FATCABSEE FATCA requires the Bank to identity at IRS. In order to as customers, ounts held directly or indirectly by US Persons and to report the relevant account information to the US US or non-US tax status, FATCA requires the Bank to col al information ar documentation from # () GRABER (lis only applicable to the following en 29% Active Business + #8428 Non-profit Organisation Bt) Public Sector Entity + TECG EEE FE Entiles in Li + waEE lquidaton / Reorganisation =9NR Passive Non-Financial Foreign Entities yates SHIRE ERO For ather types of entities, please submit respective US IRS Tax Form, 1 (2022 version)Socsc Bee (RAB Self-Certification Form a ii | FATCA RR Part |: FATCA Status RA TAGES FeO Select one of the following statements that best describe the Etiy. em a FATCA Option Description FATCAStatus * 0 [aman L:-RoKORE OM + ARMAMRAS IS 20% MORAG, Re HB, ESATO) + -ARMNNARS 3 OMT RNA Atv Business Forth precedingcalendar er or ter ppropiote reporting pe 11 Less than oof he Eity/ roe incoe saz income sch ainustment diends intrest eso rote AND + estan Soot east ld ye Ent ae asses that producer rll forthe producto of pase seh: HEA -ROMEARAU TRAINS |e (CIERRA) (He RETIRE: RARMNMNAR (RAMEE R(S2UGHRH IRM KRONE RANALARE) 4 ARORAR ERMAN: ORTRARORRLNKE: RemcRtSenOwNT BEREMERANARREED LRHRATRARRRARARTSAAARN SR Pesce ee grate oon tone at at of ded cartier ayn: ieee reset antes than one dee om eae ond of tad Bsn one at input symphony ret gar slept sea pase mame et as Fm ca ato Comat efron caren hes ene Won fel pal oats sane ene Cah ae We 20 | sane er Non rot Organisation > BaNanProft Orgenaton ma a semehen ‘Active NFFE i IRROFTR (OM «a aRA i RAPER ee ‘aE vo aI RAT vi HRSA Publ eco ny + Baryoreat he ftowng 1 Government ote than couerament MA pots subdwsion of uch government (which includes a tate province county. of ‘munity 3 Apuole boy peroming function of sch government or a altel subdivson thee he Agorenmentofa US. Teton + Aniematenlorpenzatn ‘—nor-.eontal bank sue: oF vii ANErity wot owned ere o moro foreadng a O Fea AORN + RRS FeRAM: + ENGEETAR: RLRMETENRRENERARRSORMOEN mer ies in uldstion Reorganisation 1 tsnota Francia ston ne past ve joa, and + lntneprooess of iquctng ts are, or reorgansng with he tnt to contrus ar tecommence pean in abuses cer hn tha of Fanci stiion (2022 version)Socsc Ey Fk a 9A Ze 18 (BAB) Self-Certification Form (Entity) so euseMmE ABE ROR + ARASH SHS 50% MMB AGO Me. Ble, MeMsssrMOEm ak + AAMBHORAP 5H 00% RALRONAGRE RRARLRMNARE HARE - ee Cam (1) RECA RIENE, Be 2) RRMA SME oXORMEeA + CA (1) RSME ROROMM, Bick (2) MIRE RED OLORM EA WRRA TREE Passive Non Financial Foreign Etities For the preceding calendar year or other appropiate reporting period, + more than 50% of he Enty” s gross income passive income (such 9s vestments, duends, interes, rents or royaties), OR + more than 50% of he assets hes by the Enty are asses that produce or ate hela forthe production of passive Select one only sa 1 doesnot have US Conttling Persons who ultimate owns) orcontos) the Entity, andor] dectyorindvectiy aaaaee ‘v(t east sof the Entity. Passive NFFE 1D has US Contain Person(s) who lintel ows ot cantol he Entity, andor 2 ately or nde als) at leas 10% of the Ey, Please complete Part 2 below, ene MEANS ERMA toRR MAIN RETAM L116) 8): G@) ORAM REINA oMERMRR (HORWTRAN) ©) RMON REGIMEN aE ONKOMNHMRRGR RE: ©) SME EXIM CREED M67 Soro RAMEN NRNAA: ARERR HA TORE Us contin Pesan means ary pct US Pena defn Tatty Seguin Seon 13 hat la) inthe of carprtn on der net. mre than 9 pean fhe stock fu crpration (yo ora) 1B) inthe ese of uteri owns el indeay rte tha 1 peertefthe afin a cap imerestin sh (0 Intmecase ous tested 3s an oar fay porn ofthe at ude scons 6 trough eof Slams Revene Cal; hols decir inet mare thant pret fhe benefit ofthe ta, 60) ea + is one ofthe above. Ba Mi : RMSE A RMI SINC) Part 2 : US Controlling Person(s) (Only lor Passive NFFE) 1 BE Name L oR NE — a9 AS, OREN CHIR 4) He LATIMES » ATRIA» Ifthe Entity have selected AS in (I) Part 1, please provide detals of all (not restricted to four) US Contraling Person(s) who (1) ultimately own(s) oF contro) the Entity, and/or (2) directly or indirectly own(s) atleast 1035 of the Eniy. I space provided i insufficient, continue on adational sheets). SELB US Taxpayer identcaton No (TIN) 2 #4 Name (1) sReetmtsst2RINC « Syst (2) IRSUNTRHEARNEE.> 10 HOARD ARORA » BE SELENE US Taxpayer Ideicaton No (TN) L -2BRIWIRHE US Toxoaye dontfetion No TIN) Loss Lea iiss (AE Residence Adress (8 Rosidonce Adaross u H u 5 3B Nane 4B Name Lesa Lesa iiss (AE Residence Address (tL Residence Adress EWA US Taxpayer tdeiioation No. (TN) (2022 version)Socsc Ey Pea 88 Heth (BAB) Self-Certification Form (Entity) EM} : FATCA HORM Parl 3 : Declarations and Signature for FATCA Status EWE RRA ES (REMI By signing below, \/we (on behalf of the Entity} hereby 1 ke Undertake to promptly LERNER Re MAOH 90 8 ALONE, from the date of change, 1 MEMEO RH ARMOR HR: B ‘of the information provided above: and 2 RH FS, DELETE ASLMARAMAMA A ee ee 1, EME MNRB ME RRR CR RFTIN RIHANNA KEIR 1 9% Sonate ee Rm Name: As perD / Passport sm) sae: ID Passport No Fa RIA A Date: DDMMvY 3 RB Signature ee: ren pm Name: spor ID Passport aoa ames: 1D /Passpor No, Ba BRIA RAR otity the Bankif there is any change in any ofthe information provided above in any event by no later than the date faling 30 calendar days provide tothe Bank such ather information, documents or other evidence which the Bank may requite in connection with such change in any represent, warrant, agree and certity o the Bank that, as a the date of his se-certification form allinformation provded above is true, complete and accurate in all espeets; RAMTEC AARNE ARNT « ‘where any ofthe above certifications are found to be inaccurate and/or where the Bank did not receive the relevant supporting documentations) the Bank has the right and absolute dlscretion in not opening new accounts ar offering additonal products and serices to the Entity A AVES AES IR CR URINAIRE + I IOUT = I/We that oe hae the capacity to sig his pro his se certain form for and on behalf the Etty ant submit Rt the Bonk. (aav.eey2n97 288 IN REDE «Please sign in acordance with he signing arrangement and specimen signature registered with the Bank) 2 8% Sqrawe: eRe Name: As pee 10 Passo ania am: TO rPassporno: AM: BAVA Roe Date: DomMay 4 BB Sgroue: fe: eR a eR Name: As perID Passport arsine: ID Passper No: ME: REUA RE Date: Dany (2022 version)A GERI BE) Self-Certification Form (Entity) matic Exchange of Financial ons ‘RIBAS Part 1 + Entity Type ERECT EAML SWRA « Tick one of the appropriate boxes and provide the relevant information. TD RRR FRAME A aR Custodial Institution, Depository Institution or Specified Insurance Company Francia «| 0 S8RM- OTAEGS-URAMES (Flin: RADAR TR RRNORE) TORRE RE Institution Investment Entity, except an investment entity tha is managed by another financial institution (eg with discretion to manage the entity’ assets) and located in a non-partcipating jurisdiction O Sone ReOmRs YE INFE the stock of which s regularly waded on Which san established secures market Oe TM CI EERSTE) 28 Related entity of. the stock af which is regulary traded on Sento ich isa established securities market Active NEE | cy BUEN « UTA « SPARS Tobe RHR eH NFE is @ governmental erty, an intemational organizaton, a central bank, or an entity wholly owned by one or more of the foregoing entities CO BEM eestor EE ‘Active NFE other than the above 0 GhaSRABTRELES_NeRR SORA ‘es Investment enti investment entity thats managed by another financial institution and located in a nan-participating jurisdiction SMB RE) Rae RM ER Passkenre | 7 NFE thal isnot an active NFE IRE HEA (UCR ARNE IAM» REL) + Part 2 = Controlling Persons (Complete this part ifthe entity account holder isa passive NFE)* MAA INRIA RETIADY RAROE OPTORRRONSR ISA - AEA RAIA RMON Indeate the name of alcontraling person(s ofthe account holder in the table below. 9 atu person exeries control aver anny which sa legal person, the canting ‘person willbe the inialhlding the postion of senior managing official, SRRMAMD IME —HARRARIRCRMA) © ‘Complete So Cenficaon Form (Contating Person) for each contling person, @ o @ @ BSH: SUSAR RETA ASR RR (DLR [BSR MAME! )* Part 3 = Jurisdiction of Residence and Taxpayer Identification Number or its Functional Equivalent ( “TIN" J" BAHFRH 0 (o) BERSAMEREOR TUEPHRAMRMTME (ATIOEEA) & (b) REWEREREEPRSADEMSR PIR CR 3) BPR RA LANGE TARA | AARNE» Ste TR AR «HEARSE RIGA + SRRPHRALACHRATREORSER (0: CANRMERM) RORRRRMMA EITM inane - SRA RUN AA BARS ANERTRREZAOER RMB MET © PARANA «ENE — «RAB a AES R AR = RCE AABARROME ERMA TEM ARBRE ARR RTM © Complete the following table indicating a the jurisdiction of residence rcluding Macau) where the account holder isa resident fr tax purposes and) the account holders TIN ar each jurisdiction indicated. indcateall (nat estrcted to tee) jurisdictions of residence. space provided i insufficent, continue on ‘addtional sheets). ifthe Account Holder has tax obligation inthe Maco SAR, the IN isthe taxpayer number. ifthe account holders nat atax resident in any jurisdiction (eg. Fscally transparent), indcatethejursdiction in which its place of effective managements situated ifaTINis unavailable provide the appropiate reason A, Bor Reason A-The urisiction where the account holders aresident fr tax purposes does notissue Ns tots residents Reason B-The account holder is unable to obtain a TIN. Explain why the account holder is unable to obtain TN ifyau have elected this reason, Reason C-TINs not requited, Select ths reason only ifthe authorities ofthe jurisdiction of residence donot requite the TIN tobe disclosed ao — TEPRERAGE | amas o- BREESE TERS RORMORE MRE idence | ft Bernt Coad | Exam he acount de sunableobtame Nit fino TN isovatable | YoUnave selected Reason B 5 (2022 version)Socse AEE BEB (AE) SOM: APLAR RH LERRSS Part 4: Declarations and Signature for Automatic Exchange of Financial Account Information 1 RAMEROE ATM CEERERRIRAAIS) AIM REO RIER (a) RAGA | ADE Di AMER HR AA ETH MIC ER RHEE (5) IESE HA A ETB 0 AAPL TORR RNOROE © GEMTICAR SHON DIN AMO RIOR» 2. AU MTEMLAR «RAC ARATE ERR RA AO-RARENIR - SLAC ATA MEME RBBRAN A «FOES SE « AR ASERION A ARCO - RMETORE «ARANETA (() EOE IRENA + Bike (i) RT AR IRAN ICAO BERR PATTON RAR + AAR SRICKEUDATATRROIE ARIA RRR ARS + ARSE + SOLAN» ICRA | ARTERY OANA IRE A ASOT + a EMRE 50 A MARGE —HEIRM EA ARMOR > 5. RAIL AAPSOFREE «MR PALL ACE NES SBR TERRA © 1. Lacknowiedge and agre that (2) the information contained in. General Information and i. Automatic Exchange of Financial Account Information of this form iscollected and may be kept by the Bank forthe purpose of automatic exchange of financial account information, and (such infornation and information regarding the account holder and any reportable acount(s} maybe reported bythe Bank to the Financial Services Bureau of the Government ofthe Macau Special Administrative Region and exchanged withthe taxauthortiesofanoth- «er jurisdiction or jurisdictions in which the account holder may be resident for tax purposes pursuant to the legal provisions for exchange of financial account information provided under the Legal Regime forthe Exchange of Tax information 2. declare that have duly notified as required by any applicable laws and regulations, and obtained all necessary consent, authorization and waiver fom, all equity holders and controlling person(s) of the Entity and tir partes relating to this form and whase information may ()) appear inthis elfcertification and any attachments to this form: and/or (i) in ay way be stored, used and disclosed by the Bank pursuant to,orascontemplated inthis sel certification form. 3. certify that am authorized to sign fr the account holder ofall the accounts to which this self-cerification form relates 4, | undertake to advise the Bank of any change in circumstances which affects the tax residency status ofthe entity identified in General Information of this form or causes te information contained herein to become incorrect and to provide the Bank with a suitably updated self.cetfication form within 30 days of such change in circumstances. 5. I declare thatthe information given and statements made in this form are, to the best of my knowledge and belief, true, correct and complete GURERNZRRRE ROR IER) (Please sign in accrdance with the sign atrangement and specimen signature epstered with the Bank) : @) {ERAGE 1D J Passport No, $4: ARSE HA / TEAK Name: As per ID /Passport a8 L 1 L 1 FFP (RRB Capacity (For entity) : 8 (BAY) Date (OD/MAVYYYY) L j L j (is: RAR ORRMAR REA itor or er of company eft) Forbank’s use $8437 GE Na ‘ranch Code CaS Status (2022 version)