demand deposit account application (dda) -...

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DEMAND DEPOSIT ACCOUNT APPLICATION (DDA) Formulário de Solicitação de Conta para Pessoas Físicas

NEW ACCOUNT DDA Conta Corrente

FTD (Time Deposit) Deposito à prazo

Type of Account / T ipo de Conta

Individual Joint w/ Rights of survivorship Conjunta com direitos por sobrevivência

Reason for opening the Account / Razão para abertura da conta

ACCOUNT HOLDER INFORMATION / Informações sobre o Titular da conta

Personal Information / Informações Pessoais

Name Last Name

Nome

Middle Name (s) Nomes Intermediários

Sobrenome

Father’s Full Name Nome Completo do Pai

Mother’s Full Name Nome Completo da Mãe

Place of Birth Date of Birth Data de Nascimento

Mês/Dia/Ano

Naturalidade

CPF Nationality

Sex F M

Nacionalidade

Sexo

Issue Date Issued by Passport / ID Number Passaporte / No. documento

Data de Emissão Emitido por

Addresses & Telephones / Endereos e Telefones

Home Address City

Endereço Residencial Cidade

State Zip Code Country

Phone Number

Estado Código Postal País

Telefone

Cellphone Fax

E-mail 1:

Celular

Married Single Widow/er Divorced Other Casado(a) Solteiro(a) Viúvo(a) Divorciado(a) Outro

EXISTING ACCOUNT Conta nova Conta existente

Individual

Month / Day / Year

Month / Day / Year Mês/Dia/Ano

Civil Status / Estado Civil

E-mail 2:

2

Professional Information / Dados Profissionais

Employer

Occupation

EmpregadorDate of Hiring Data de Admissao

Profissão

City Business Address Endereço Comercial Cidade

Origem

Monthly Income US$ Salário Mensal

Other Income US$ Outros Rendimentos Origem

Mailing Instructions / Correspondência

Statements: Ordinarily, statements of accounts will be made available to you, electronically only, utilizing BB- USA Electronic Address, www.bb.com.br/miami. Paper statements will not be delivered to you unless you specifically request this service by checking the appropriate box below:

Extratos: Geralmente, os extratos de conta serão disponibilizados e entregues a você somente em forma eletrônica, através do BB Internet Banking. Você não receberá extratos impressos, exceto se solicitar especificamente esse serviço, marcando a caixa abaixo:

I will check my statements online at BB Internet Banking.(www.bb.com.br/miami)

Home

Other Outros

Residencial

Business Comercial

Your Initial Favor rubricar

Please deliver paper statements to the general mail instructions below:Por favor entregar os extratos impressos no endereço de correspondência abaixo especificado:

Month / Day / Year Mês/Dia/Ano

State Zip Code Country

Phone Number

Estado Código Postal País

Telefone

Fax

E-mail :

Month / Year Mês/Ano

3

Liquidity Requirements / Requisistos de Liquidez

Do you have specific needs for cash from this account at some point in the near future? V.Sa. efetuará retiradas especifícas desta conta em algum dado momento em futuro próximo?

YesSim

Expected Activity / Movimentação Esperada

Deposits Year Month Depósitos

Number of Transactions No. de transações Ano Mês

Withdrawals Year Month Saques Ano Mês

Wire Transfers Year Month Transferências Ano Mês

Checks Year Month Cheques Ano Mês

NoNão

MinimalMínima

ModerateModerada

SignificantSignificativa

Initial Deposit / Deposito Inicial

Initial Deposit Amount US$

Wire transfer from Banco do Brasil

Wire transfer from another bank

By check Other

Number of Transactions No. de transações



4

Acknowledgements / Confirmações

All Account Holders must sign. Todos os titulares da Conta devem assinar.

By signing below, you confirm that you have received and agree to the terms and conditions set forth in this Account Application, the General Terms and Conditions for accounts, the Bank’s Current Fee Schedule and you and each Authorized Person signing below consents to the taping or other recording by or on behalf of the Bank of any or all telephone communications that you or such Authorized Person may have with representatives of the Bank and waives any notice other than this paragraph that such telephone conversations may be recorded at any time.

Ao firmar abaixo, V.Sa.(s) confirma (m) haver recebido e concorda(m) com os termos e condições estipulados neste Formulário de Solicitação de Conta, com os Termos e Condições Gerais para Contas, com a Atual Tabela de Encargos do Banco e também, V.Sa. e cada signatário autorizado deste documento, consentem na gravação em fita ou em outro meios, que o Banco, ou alguém em nome dele, realize de todas e qualquer de suas comunicações telefônicas com representantes do Banco renunciando expressamente a qualquer outra notificação, que não este paragráfo, de que tais conversações telefônicas possam ser gravadas a qualquer tempo.

DEPOSITS MAINTAINED WITH BANCO DO BRASIL, ARE NOT INSURED BY THE FDIC. DEPÓSITOS COM O BANCO DO BRASIL NÃO ESTÃO SEGURADOS PELO FDIC.

First Account Holder Name (Please Print) Nome do primeiro titular (Favor usar letra de imprensa)

Second Account Holder Name (Please Print) Nome do segundo titular (Favor usar letra de imprensa)

Signature Assinatura

For Bank Use Only / Para uso exclusive do Banco

Identified and signature verified by Identidade e assinatura conferida por:

Management Signature Assinatura da Gerencia


First Account Holder Name (Please Print) Nome do primeiro titular (Favor usar letra de imprensa)

Second Account Holder Name (Please Print) Nome do segundo titular (Favor usar letra de imprensa)



Rev. Dec /2017

Date (MM/DD/YYYY) Data (Mês/dia/Ano)

SIGNATURE CARD Cartão de Assinaturas

Account Opening Date: Account Number: Data de Abertura da Conta Número da Conta

Individual Joint with Rights of Survivorship Customer Number Individual Conjunta com direitos por sobrevivência Número de Cliente

DEPOSITS MAINTAINED WITH BANCO DO BRASIL ARE NOT INSURED BY FDIC Depósitos com o Banco do Brasil não estão segurados pelo FDIC

Name / Nome (Letra de Forma) Title / Cargo (Letra de Forma)

(A) Signature / Assinatura

(B) Signature / Assinatura

(C) Signature / Assinatura

(D) Signature / Assinatura

Special Signature Instructions / Instruções Especiais sobre a Assinatura

Authenticated by: Autenticado por

Date: Data

(mm/dd/yyyy)

Internal Use / Para uso Interno

(mm/dd/yyyy)

Número da Conta

FUNDS TRANSFER AGREEMENTContrato de Transferência de Fundos

ACKNOWLEDGEMENTDeclaraçãoThe undersigned (“Customer”) hereby acknowledges receiving, reading and agreeing to all the provisions and disclosures contained in the General Terms and Conditions governing Customer’s demand deposit account bearing the number specified above (the “Account”) and any other agreements governing the Account, which is maintained with Banco do Brasil (the “Bank”)’s Miami Branch or New York Branch. Customer also acknowledges and agrees that, effective the date of Customer’s signature below, this Funds Transfer Agreement (this “Agreement”) replaces any previous Funds Transfer Agreement or Funds Transfer Acknowledgement governing the Account.

O signatário (“Cliente”) declara que recebeu, leu e concorda com todos os dispositivos e revelações contidas nestes Termos e CondiçõesGerais que regulam a conta corrente do Cliente (a “Conta”), cujo número encontra-se especificado acima, e quaisquer outros contratosque regulem a Conta mantida nas agências do Banco do Brasil em Miami ou Nova Iorque (o “Banco”). O Cliente declara e concorda aindaque, a partir da data de sua assinatura neste documento, este Contrato de Transferência de Fundos (o “Contrato) passará a substituirqualquer outro Contrato de Transferência de Fundos ou Declaração de Transferência de Fundos anterior que regule esta Conta.

SECURITY PROCEDURESProcedimentos de SegurançaCustomer hereby agrees to use only the security procedure(s) selected hereunder to authenticate, or to requestcancellation of, any wire transfer instruction or payment order requested by Customer with regard to the Account (an“Order”). Customer hereby agrees that any Order purporting to be sent by Customer shall, when received by the Bank, beeffective as Customer’s Order, whether or not actually authorized by Customer and regardless of the actual identity of thetransmitter thereof, if such Order is accepted by the Bank in good faith and in accordance with the security procedure(s)selected hereunder.

O Cliente concorda em usar somente o(s) procedimento(s) de segurança aqui descrito(s) para autenticar, ou requisitar o cancelamento dequalquer instrução de transferência ou ordem de pagamento que o Cliente venha a requisitar em conexão com sua Conta (uma “Ordem”).O Cliente concorda que qualquer Ordem que aparente ter sido enviada pelo Cliente, ao ser recebida pelo Banco, seja consideradaefetivamente uma Ordem do Cliente, tendo sido ou não autorizada de fato pelo Cliente e independente da identidade real de quem a tiverenviado, se tal Ordem for aceita pelo Banco em boa fé e de acordo com o(s) procedimento(s) de segurança aqui selecionado(s).

THE FOLLOWING TYPES OF ORDERS ARE AUTHORIZED UNLESS YOU INDICATE THAT YOU DO NOT AUTHORIZESUCH ORDERS (Please utilize appropriate boxes):

OS TIPOS DE ORDENS ABAIXO LISTADOS SÃO AUTORIZADOS, EXCETO SE VOCÊ INDICAR QUE NÃO AUTORIZA TAIS ORDENS(favor marcar as caixas apropriadas):

(1) Original Written Orders. Original written Orders shall be delivered to the Bank by hand or by mail, signed by

you. / Ordens Originais por Escrito. Ordens originais por escrito e assinadas por você deverão ser entregues em mãos noBanco, ou enviadas pelo correio.

Check here if you do not authorize such Orders/ Marque aqui se você não autoriza tais Ordens

(2) Facsimile Orders. Facsimile Orders shall be sent to the Bank by facsimile transmission, signed by you. / Ordenspor Fax: ordens por fax deverão ser enviadas ao Banco via fac-símile e assinadas por você.

Check here if you do not authorize such Orders/ Marque aqui se você não autoriza tais Ordens.

(3) Electronic Funds Transfers. Such Orders shall be sent by you to the Bank by electronic transmission, utilizingBB USA Internet Banking services, in accordance with the Electronic Banking Services Agreement. Any dailylimits (dollar limitations), and any special requirements regarding the registration of beneficiaries of such

Orders, will apply accordingly./ Transferências Eletrônicas de Fundos. Tais Ordens deverão ser enviadas por vocêeletronicamente ao Banco, utilizando os serviços BB USA Internet Banking, de acordo com o Contrato de Serviços deElectronic Banking. Quaisquer limites diários (em dólares) e requisitos especiais com relação ao registro de beneficiários detais Ordens serão aplicáveis, conforme apropriado.

Check here if you do not authorize such Orders/ Marque aqui se você não autoriza tais Ordens

CALLBACK PROCEDUREPROCEDIMENTO DE CHAMADA DE CONFIRMAÇÃO

Customer understands and agrees that the Bank reserves the right to confirm each Order at its own discretion and inaccordance to Bank’s internal procedures, by telephone callback to you (at the telephone number informed by you availablein the Bank’s records) or to any authorized person identified below (at the telephone number specified forhim or her below). This callback procedure may not apply if (a) Customer is also the beneficiary of such Order or (b) thebeneficiary of such Order is a Registered Beneficiary pursuant to standing payment instructions that are duly recorded andaccepted by the Bank in accordance with the requirements of the BB USA Internet Banking services.

O Cliente reconhece e concorda que o Banco tem o direito de confirmar cada ordem, conforme julgado necessário e de acordo com seusprocedimentos internos, através de chamada telefônica à você (para o número informado por você constante dos registros do Banco) ou aqualquer pessoa autorizada, identificada abaixo (através do número de telefone especificado pela pessoa abaixo autorizada). Esteprocedimento de chamada de confirmação não se aplicará caso (a) o Cliente for também o beneficiário de tal Ordem; ou (b) o beneficiário daOrdem for um Beneficiário Registrado, conforme as instruções de pagamento devidamente gravadas e aceitas pelo Banco, de acordo comas exigências dos serviços de Internet Banking do BB.

If you wish, you may use the space below to designate other persons authorized to receive such telephone callbacks:/ Casodesejar, você poderá utilizar o espaço abaixo para designar outras pessoas autorizadas a receber tais ligações telefônicas de confirmação:

Name/ Nome: Phone No./ Telefone: Signature of Authorized Person /Assinatura da pessoa autorizada

BY SIGNING ABOVE, EACH SUCH PERSON AUTHORIZED TO RECEIVE TELEPHONE CALLBACKS (I) CONSENTS ONA CONTINUING BASIS TO THE BANK’S TAPE RECORDING OF SUCH CALLBACKS, AND (II) WAIVES ANY NOTICE(OTHER THAN THIS SENTENCE) THAT SUCH CALLBACKS SHALL OR MAY BE RECORDED.

AO ASSINAR ACIMA, CADA PESSOA AUTORIZADA A RECEBER LIGAÇÕES TELEFÔNICAS DE CONFIRMAÇÃO DECLARA QUE (I) CONSENTEQUE O BANCO GRAVE, EM BASES REGULARES, TAIS LIGAÇÕES TELEFÔNICAS E (II) RENUNCIA AO DIREITO DE RECEBER NOTIFICAÇÃO(ALÉM DA CONTIDA NESTE PARÁGRAFO) DE QUE TAIS LIGAÇÕES DE CONFIRMAÇÃO SERÃO OU PODERÃO SER GRAVADAS.

Important Notes: In addition to the types of Orders mentioned above, on a case by case basis, the Bank may permitOrders initiated by Customer by telephone (confirmed by callbacks), and may permit tested Orderstransmitted utilizing test keys. Moreover, with regard to any telephonic Orders and with regard to allfacsimile Orders, the Bank will, if Customer so elects, confirm each Order by a callback and, as afurther security procedure, require that each such Order also contain a code word agreed upon byCustomer and the Bank. Customer must contact the Bank for details regarding requirements andnecessary arrangements for such services.

Notas Importantes: Além dos tipos de Ordens acima mencionados, dependendo do caso, o Banco poderá permitir Ordens iniciadas peloCliente através de ligação telefônica (confirmadas por ligação de confirmação), e poderá ainda permitir Ordenstestadas, transmitidas utilizando números chave. E ainda, com relação a qualquer Ordem telefônica e a todas asOrdens por fax, o Banco confirmará, caso o Cliente assim escolher, cada Ordem através de ligação telefônica e, comoprocedimento de segurança, exigirá que cada Ordem contenha ainda uma palavra-código aprovada pelo Cliente epelo Banco. Para obter maiores detalhes sobre os requisitos e arranjos necessários para o provimento de taisserviços, o Cliente deverá entrar em contato com o Banco.

LIMITATION OF BANK’S LIABILITY AND INDEMNIFICATIONCustomer understands and agrees that, in addition to any limitation of Bank’s liability, and any indemnification, set forth in theGeneral Terms and Conditions or in any other agreement, Customer specifically and unconditionally discharges the Bankfrom any and all responsibility for any consequences that may result from Orders or from any non-action or action on theBank’s part in connection therewith, including but not limited to any payment that the Bank may make pursuant to thisAgreement or any payment not made due to inadvertence or circumstances beyond the Bank’s control. Customer agrees topay fees for services hereunder, if the Bank elects to charge such fees; such fees may change from time to time. In addition,Customer agrees to indemnify the Bank for and to pay any and all charges and costs, direct or indirect and including withoutlimitation attorney’s fees, which the Bank may at any time or times incur in connection with the services provided by the Bankhereunder.

LIMITAÇÃO DE RESPONSABILIDADE E INDENIZAÇÃO AO BANCOO Cliente reconhece e concorda que, além de qualquer limitação de responsabilidade do Banco, bem como qualquer indenização estabelecida nosTermos e Condições Gerais, ou em qualquer outro instrumento contratual, o Cliente libera específica e incondicionalmente o Banco de qualquerresponsabilidade pelas conseqüências que venham a resultar de Ordens, ou de qualquer ação ou omissão da parte do Banco em conexão a taisOrdens, inclusive, mas não limitado a, qualquer pagamento que o Banco venha a fazer, sob a égide deste Contrato, ou qualquer pagamento não feitodevido a desatenção ou a circunstâncias fora do controle do Banco. O Cliente concorda em pagar os encargos pelos serviços aqui descritos e que taisencargos possam vir a mudar de tempos em tempos. O Cliente concorda ainda em indenizar o Banco por, e pagar todo e qualquer encargo ou custo,direto ou indireto, incluindo, mas não limitado a, honorários advocatícios, os quais o Banco possa vir a incorrer, de tempos em tempos, em conexãocom os serviços prestados pelo Banco de acordo com este instrumento.

Agreed on/ De acordo: Data ___________________________________ (please insert date/ favor inserir a data)

Account Holder Name:/ Nome do titular da conta Signature/ Assinatura::


Verification done by: / Verificação feita por: Date(DD/MM/YYYY):/Data(dia/mês/ano)

Approved by: / Aprovado por

(For joint accounts all holders should sign in this same agreement or in a separated funds transfer agreement.) (Para contas conjuntas todos os titulares devem assinar no mesmo acordo ou em acordo separado)

(mm/dd/yyyy)

Debit Card Application Form Formulário para solicitação de Cartão de Débito

Checking Account Number Número da Conta Corrente:

Individual Account(Conta Individual)

Joint Account(Conta Conjunta)

Please Print Clearly (Preencher com letra de forma):

Full Name (Nome Completo):

Please inform the numbers of the documents below (Favor informar os números dos documentos abaixo):

1. CPF Number (Número do CPF):

2. Social Security Number (Número do Seguro Social Americano):

3. Country ID Number (Número do Documento de Identidade do País):

Mother's Maiden Name (Sobrenome de solteira da mãe - Informe apenas 1 sobrenome):

E-mail Address: (Endereço de e-mail):

Date of Birth(Data de Nascimento):

ADDITIONAL CARDS (Only for account holders)Cartões adicionais (somente para pessoas que fazem parte da conta)

I (We) acknowledge the receipt of the Visa Debit Card Terms and Conditions, the Electronic Funds Transfer Disclosures and the Fee Schedule. By signing below, I (We) hereby acknowledge, understand and agree to the Debit Card Terms and Conditions, which include in Section 5.G., a waiver of the “parties” right to a trial by jury in the event of a dispute arising under the Debit Card Terms and Conditions.

Eu (Nós) confirmo(amos) o recebimento dos Termos e Condições do Cartão de Débito, das informações sobre Transferências Eletrônicas de Fundos e da Tabela de Tarifas. Assinando abaixo eu (nós), confirmo(amos) que, compreendo(emos) e concordo(amos) com os Termos e Condições do Cartão de Débito, o qual inclui na Seção 5.G., uma dispensa pelas “partes” do direito de julgamento por juri no caso de disputa sob os Termos e Condições do Cartão de Débito.

Signature:Assinatura:

Date:Data:

Month / Mês Day / Dia Year / Ano

SHIPPING INFORMATION (Informação sobre o Envio)

For your convenience and security purposes, your Debit Card(s) will be shipped via Fedex (Courier Service) to your current mailing address. Please refer to our Fee Schedule for the shipping costs.

Para sua comodidade e como medida de segurança, seu(s) Cartão (ões) de Débito serão enviados para seu atual endereço de correspondência via Fedex (Serviço Courier). Favor consultar os custos de envio em nossa Tabela de Tarifas.

Phone Number 1(Número de Telefone 1):


Work Phone Number 1(Número de Telefone do Trabalho 1):


Please Print Clearly (Preencher com letra de forma):

Full Name (Nome Completo):

Please inform the numbers of the documents below (Favor informar os números dos documentos abaixo):

1. CPF Number (Número do CPF):

2. Social Security Number (Número do Seguro Social Americano):

3. Country ID Number (Número do Documento de Identidade do País):

Mother's Maiden Name (Sobrenome de solteira da mãe - Informe apenas 1 sobrenome):

E-mail Address: (Endereço de e-mail):

Date of Birth(Data de Nascimento):







The e-mail will be the same as per the "E-mail Agreement" Form.(O e-mail será o mesmo fornecido no Formulário "E-Mail Agreement").

The e-mail will be the same as per the "E-mail Agreement" Form.(O e-mail será o mesmo fornecido no Formulário "E-Mail Agreement").

November 25th, 2016.

Form W-8BEN(Rev. July 2017)

Department of the Treasury Internal Revenue Service

Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals)

▶ For use by individuals. Entities must use Form W-8BEN-E. ▶ www.irs.gov/FormW8BEN for instructions and the latest information.▶ Give this form to the withholding agent or payer. Do not send to the IRS.

OMB No. 1545-1621

Do NOT use this form if: Instead, use Form:

• You are NOT an individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8BEN-E

• You are a U.S. citizen or other U.S. person, including a resident alien individual . . . . . . . . . . . . . . . . . . . W-9

• You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the U.S.(other than personal services) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8ECI

• You are a beneficial owner who is receiving compensation for personal services performed in the United States . . . . . . . 8233 or W-4

• You are a person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY

Note: If you are resident in a FATCA partner jurisdiction (i.e., a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be provided to your jurisdiction of residence.

Part I Identification of Beneficial Owner (see instructions) 1 Name of individual who is the beneficial owner 2 Country of citizenship

3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.

City or town, state or province. Include postal code where appropriate. Country

4 Mailing address (if different from above)

City or town, state or province. Include postal code where appropriate. Country

5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions) 6 Foreign tax identifying number (see instructions)

7 Reference number(s) (see instructions) 8 Date of birth (MM-DD-YYYY) (see instructions)

Part II Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions) 9 I certify that the beneficial owner is a resident of

% rate of withholding on (specify type of income):

within the meaning of the income tax

treaty between the United States and that country. 10 Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article and paragraph

of the treaty identified on line 9 above to claim a

.

Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of withholding:

Part III Certification Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that:

• I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or am using this form to document myself for chapter 4 purposes,

• The person named on line 1 of this form is not a U.S. person,

• The income to which this form relates is:

(a) not effectively connected with the conduct of a trade or business in the United States,

(b) effectively connected but is not subject to tax under an applicable income tax treaty, or

(c) the partner’s share of a partnership's effectively connected income,

• The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty between the United States and that country, and

• For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.

Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner. I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect.

Sign Here

▲

Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY)

Print name of signer Capacity in which acting (if form is not signed by beneficial owner)

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25047Z Form W-8BEN (Rev. 7-2017)

Form W-9(Rev. November 2017)Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Go to www.irs.gov/FormW9 for instructions and the latest information.

Give Form to the

requester. Do not

send to the IRS.

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1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

2 Business name/disregarded entity name, if different from above

3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes.

Individual/sole proprietor or single-member LLC

C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)

Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Other (see instructions)

4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):

Exempt payee code (if any)

Exemption from FATCA reporting

code (if any)

(Applies to accounts maintained outside the U.S.)

5 Address (number, street, and apt. or suite no.) See instructions.

6 City, state, and ZIP code

Requester’s name and address (optional)

7 List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.

Social security number

– –

orEmployer identification number

–

Part II CertificationUnder penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue

Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

Sign Here

Signature of

U.S. person Date

General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.

Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.

Purpose of FormAn individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following.

• Form 1099-INT (interest earned or paid)

• Form 1099-DIV (dividends, including those from stocks or mutual funds)

• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)

• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)

• Form 1099-S (proceeds from real estate transactions)

• Form 1099-K (merchant card and third party network transactions)

• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)

• Form 1099-C (canceled debt)

• Form 1099-A (acquisition or abandonment of secured property)

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.

Cat. No. 10231X Form W-9 (Rev. 11-2017)

Form W-9 (Rev. 11-2017) Page 2

By signing the filled-out form, you:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting, later, for further information.

Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:

• An individual who is a U.S. citizen or U.S. resident alien;

• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States;

• An estate (other than a foreign estate); or

• A domestic trust (as defined in Regulations section 301.7701-7).

Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.

In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States.

• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity;

• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and

• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.

Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).

Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.

If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items.

1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.

2. The treaty article addressing the income.

3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.

4. The type and amount of income that qualifies for the exemption from tax.

5. Sufficient facts to justify the exemption from tax under the terms of the treaty article.

Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.

If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.

Backup WithholdingWhat is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 28% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.

You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.

Payments you receive will be subject to backup withholding if:

1. You do not furnish your TIN to the requester,

2. You do not certify your TIN when required (see the instructions for Part II for details),

3. The IRS tells the requester that you furnished an incorrect TIN,

4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or

5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).

Certain payees and payments are exempt from backup withholding. See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information.

Also see Special rules for partnerships, earlier.

What is FATCA Reporting?The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form W-9 for more information.

Updating Your InformationYou must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if the grantor of a grantor trust dies.

PenaltiesFailure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.

Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.


Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.

Specific Instructions

Line 1

You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return.

If this Form W-9 is for a joint account (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. If you are providing Form W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9.

a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name.

Note: ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application.

b. Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or “doing business as” (DBA) name on line 2.

c. Partnership, LLC that is not a single-member LLC, C corporation, or S corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2.

d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2.

e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a “disregarded entity.” See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on line 2, “Business name/disregarded entity name.” If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.

Line 2

If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2.

Line 3

Check the appropriate box on line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3.

IF the entity/person on line 1 is a(n) . . .

THEN check the box for . . .

• Corporation Corporation

• Individual

• Sole proprietorship, or

• Single-member limited liability company (LLC) owned by an individual and disregarded for U.S. federal tax purposes.

Individual/sole proprietor or single-member LLC

• LLC treated as a partnership for U.S. federal tax purposes,

• LLC that has filed Form 8832 or 2553 to be taxed as a corporation, or

• LLC that is disregarded as an entity separate from its owner but the owner is another LLC that is not disregarded for U.S. federal tax purposes.

Limited liability company and enter the appropriate tax classification. (P= Partnership; C= C corporation; or S= S corporation)

• Partnership Partnership

• Trust/estate Trust/estate

Line 4, Exemptions

If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space on line 4 any code(s) that may apply to you.

Exempt payee code.

• Generally, individuals (including sole proprietors) are not exempt from backup withholding.

• Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends.

• Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.

• Corporations are not exempt from backup withholding with respect to attorneys’ fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC.

The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4.

1—An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)

2—The United States or any of its agencies or instrumentalities

3—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities

4—A foreign government or any of its political subdivisions, agencies, or instrumentalities

5—A corporation

6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession

7—A futures commission merchant registered with the Commodity Futures Trading Commission

8—A real estate investment trust

9—An entity registered at all times during the tax year under the Investment Company Act of 1940

10—A common trust fund operated by a bank under section 584(a)

11—A financial institution

12—A middleman known in the investment community as a nominee or custodian

13—A trust exempt from tax under section 664 or described in section 4947


The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13.

IF the payment is for . . . THEN the payment is exempt for . . .

Interest and dividend payments All exempt payees except for 7

Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012.

Barter exchange transactions and patronage dividends

Exempt payees 1 through 4

Payments over $600 required to be reported and direct sales over

$5,0001

Generally, exempt payees

1 through 52

Payments made in settlement of payment card or third party network transactions

Exempt payees 1 through 4

1 See Form 1099-MISC, Miscellaneous Income, and its instructions.

2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup

withholding: medical and health care payments, attorneys’ fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency.

Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with “Not Applicable” (or any similar indication) written or printed on the line for a FATCA exemption code.

A—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37)

B—The United States or any of its agencies or instrumentalities

C—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities

D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i)

E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(c)(1)(i)

F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state

G—A real estate investment trust

H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940

I—A common trust fund as defined in section 584(a)

J—A bank as defined in section 581

K—A broker

L—A trust exempt from tax under section 664 or described in section 4947(a)(1)

M—A tax exempt trust under a section 403(b) plan or section 457(g) plan

Note: You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed.

Line 5

Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W-9 will mail your information returns. If this address differs from the one the requester already has on file, write NEW at the top. If a new address is provided, there is still a chance the old address will be used until the payor changes your address in their records.

Line 6

Enter your city, state, and ZIP code.

Part I. Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below.

If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN.

If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN.

Note: See What Name and Number To Give the Requester, later, for further clarification of name and TIN combinations.

How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at www.SSA.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/Businesses and clicking on Employer Identification Number (EIN) under Starting a Business. Go to www.irs.gov/Forms to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed to you within 10 business days.

If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester.

Note: Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.

Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8.

Part II. CertificationTo establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, 4, or 5 below indicates otherwise.

For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code, earlier.

Signature requirements. Complete the certification as indicated in items 1 through 5 below.


1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification.

2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form.

3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification.

4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations).

5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), ABLE accounts (under section 529A), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification.

What Name and Number To Give the RequesterFor this type of account: Give name and SSN of:

1. Individual The individual

2. Two or more individuals (joint

account) other than an account

maintained by an FFI

The actual owner of the account or, if

combined funds, the first individual on

the account1

3. Two or more U.S. persons

(joint account maintained by an FFI)Each holder of the account

4. Custodial account of a minor

(Uniform Gift to Minors Act)

The minor²

5. a. The usual revocable savings trust

(grantor is also trustee)

b. So-called trust account that is not

a legal or valid trust under state law

The grantor-trustee1

The actual owner1

6. Sole proprietorship or disregarded

entity owned by an individualThe owner³

7. Grantor trust filing under Optional

Form 1099 Filing Method 1 (see

Regulations section 1.671-4(b)(2)(i)

(A))

The grantor*

For this type of account: Give name and EIN of:

8. Disregarded entity not owned by an

individual

The owner

9. A valid trust, estate, or pension trust Legal entity4

10. Corporation or LLC electing

corporate status on Form 8832 or

Form 2553

The corporation

11. Association, club, religious,

charitable, educational, or other tax-

exempt organization

The organization

12. Partnership or multi-member LLC The partnership

13. A broker or registered nominee The broker or nominee

For this type of account: Give name and EIN of:

14. Account with the Department of

Agriculture in the name of a public

entity (such as a state or local

government, school district, or

prison) that receives agricultural

program payments

The public entity

15. Grantor trust filing under the Form

1041 Filing Method or the Optional

Form 1099 Filing Method 2 (see

Regulations section 1.671-4(b)(2)(i)(B))

The trust

1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished.2 Circle the minor’s name and furnish the minor’s SSN.

3 You must show your individual name and you may also enter your business or DBA name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN.

4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special

rules for partnerships, earlier.

*Note: The grantor also must provide a Form W-9 to trustee of trust.

Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.

Secure Your Tax Records From Identity TheftIdentity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund.

To reduce your risk:

• Protect your SSN,

• Ensure your employer is protecting your SSN, and

• Be careful when choosing a tax preparer.

If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter.

If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039.

For more information, see Pub. 5027, Identity Theft Information for Taxpayers.

Victims of identity theft who are experiencing economic harm or a systemic problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.

Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft.


The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts.

If you receive an unsolicited email claiming to be from the IRS, forward this message to [email protected]. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at [email protected] or report them at www.ftc.gov/complaint. You can contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338). If you have been the victim of identity theft, see www.IdentityTheft.gov and Pub. 5027.

Visit www.irs.gov/IdentityTheft to learn more about identity theft and how to reduce your risk.

Privacy Act Notice

Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.

1

DateData

BANK REFERENCE REQUESTSolicitação de Referência Bancária

TO:Para:

Bank NameNome do Banco

AddressEndereço

ZipCep

CityCidade

StateEstado

CountryPais

Dear Sirs:The Person whose signature appears below has opened anaccount with us, and we have been referred to you for *accountinformation and verification of signatures(s). Your reply will betreated confidentially and is without on your part and/or ours.

Sincerely,

Banco do BrasilMiami Branch701 Brickell Avenue, #2610 Miami, Florida 33131

Prezados Senhores:A pessoa, cuja assinatura figura abaixo, abriu uma contaconosco e indicou que podíamos obter *informaçõessobre a conta que mantém consigo e a verificação desua(s) assinatura(s). Sua resposta será tratada comomatéria confidencial e não implicará em qualquerresponsabilidade de sua parte e/ou da nossa.

Atenciosamente,

Banco do BrasilMiami Branch701 Brickell Avenue, #2610 Miami, Florida 33131

Client Name:Nome do Cliente

Account #:Número de conta

Client Signature:Assinatura do cliente

For the use of the Replying Bank Only:Para uso exclusive do Banco em referência

Account Opening DateData da abertura da conta

Average BalanceSaldo Médio

Account closing date (if applicable)Data do encerramento da conta (se aplicável)

Client’s business relationship with us has been satisfactory and there is no fact of our own knowledge thatsuggests the client is not reliable. / O cliente tem um relacionamento conosco satisfatório não havendo nada que odesabone.

No, our experience indicates that the client is not reliable. / Não, nossa experiência com o cliente não foi satisfatória.

Other comments/ Outroscomentários

DateData

Authorized SignatureAssinatura

*account balance and account opening date*Saldo e data da abertura da conta

POWER OF ATTORNEYProcuração

Re: Account No.Referente à Conta No.:

(“Account”)(doravante denominada simplesmente de “Conta”)

I/We,Através do presente instrumento, eu/nós,

, hereby appointnomeio/ nomeamos

(the “Attorney”) to be(doravante referido como “o Procurador”)para ser

my/our true and lawful attorney-in-fact to conduct any and all business relating to the Account, pursuant to the terms and conditions of any agreementgoverning the Account, as fully and effectively in all respects as I/we could do if personally present. Without limitation, the Attorney shall be authorized andempowered, in my/our name and on my/our behalf, to: draw, sign and deliver checks, drafts, notes, bills of exchange, acceptances, or other orders for thepayment of money from, and endorse checks, drafts, notes, bills, certificates of deposit, or other instruments owned or held by me/us for deposit into, theAccount, or for collection or discount by Banco do Brasil, Miami Agency (“Bank”); accept drafts, acceptances, or other instruments payable at Bank; waivedemand, protest, and notice of protest and dishonor with respect to any check, note, bill, draft, or other instrument made, drawn, or endorsed by me/us, or onmy/our behalf: pledge any assets held in the Account; purchase and sell, or authorize and request the Bank to purchase or sell, for my/our account, foreignexchange, securities, commodities, derivatives, and other investment assets; deal, in any and all other respects, with any and all securities, commodities, andother property of any kind belonging to or held by me/us or in which I/we may have an interest: and pay to Bank or its representative any fees or costsassociated with the Account.

I/we grant the Attorney full power and authority to do everything necessary to accomplish the foregoing purposes, in the same manner and to the same extentas I/we could do myself/ourselves, with full power of substitution and revocation, hereby ratifying and confirming all that the Attorney shall lawfully do or causeto be done by virtue of this Power of Attorney. If one or more other powers of attorney at any time executed appoint one or more additional individuals asattorney(s)-in-fact with respect to the Account, the Attorney and every such additional attorney-in-fact shall be authorized to exercise all his powers singly(without the need for the joinder or consent of any other attorney-in-fact).

I/we also authorize Bank to transact all business relating to the Account with the Attorney, and to honor, receive, or pay any instrument of any kind drawn orendorsed to the order of the Attorney, or tendered by him/her for cash, or delivered or used in payment of any individual obligation of the Attorney, ordeposited by the Attorney in his/her personal account. Bank shall under no circumstances be required to investigate the circumstances of the issuance or useof any instrument signed by the Attorney, or the application or disposition of such instrument or of the proceeds thereof. If more than one account holderexecutes this Power of Attorney, The Attorney shall not be required to sign any document more than one in order to execute such document effectively onbehalf of all such account holders.

I/we agree to indemnify, hold harmless, and defend Bank and all of its directors, officers, agents, and employees from any liability, loss, or damage, (includingreasonable attorney’s fees) that they may sustain relating to this Power of Attorney including any liability, loss or damage sustained by virtue of Bank’sreliance upon the apparent authority of the Attorney after termination of this Power of Attorney, by operation of law or otherwise, but before express writtennotice thereof is received by (and a reasonable period of time to act thereon is afforded to) the particular department, office, branch or correspondent of Bankconcerned.

meu/nosso bastante procurador legal, com plenos poderes para conduzir todo e qualquer negócio relacionado à Conta, desde que observados os termos e condiçõesde todos os acordos que regerem a Conta. O Procurador estará irrestritamente autorizado e com plenos poderes para agir em meu/nosso nome ou a meu/nosso favor,podendo para isso: sacar, assinar e entregar cheques, saques, notas, letras de câmbio, aceitações bancárias, ou emitir outras ordens de pagamento, endossarcheques, saques, notas, letras, certificados de depósito ou outros instrumentos de minha/nossa posse ou propriedade para depósito na Conta ou para cobrança oudesconto pelo Banco do Brasil, Agência de Miami, (doravante simplesmente referido como "o Banco"), aceitar saques, efetuar aceitações bancárias ou outrosinstrumentos que devem ser pagos em banco; dispensar demandas, protesto e notificação de protesto e descrédito em relação a qualquer cheque, nota, letra, saque ououtro instrumento emitido, sacado ou endossado por mim/nós ou em meu/nosso favor; caucionar quaisquer recursos depositados na Conta; comprar e vender ouautorizar e solicitar que o Banco compre ou venda para a minha/nossa conta, câmbio estrangeiro, valores mobiliários, commodities, derivativos e outros ativos deinvestimento; comercializar, em todo e qualquer âmbito, todos os tipos de valores mobiliários, commodities e outros bens de qualquer sorte que pertençam ou estejamem minha/nossa posse, ou onde eu/nós tenha/tenhamos interesse ou participação; e pagar ao Banco ou a seu representante quaisquer emolumentos ou custosrelativos à Conta.

Eu/Nós cedemos ao Procurador plenos poderes e autoridade suficiente para realizar quaisquer atos necessários ao cumprimento dos supra citados fins, da mesmamaneira e na mesma extensão da minha/nossa pessoa física, como se eu/nós aí estivesse/estivéssemos presente(s), com livre arbítrio para substituir e revogar, tendo apresente procuração o cunho de confirmar e ratificar tudo que o Procurador venha legalmente a executar ou solicitar a execução por força dos poderes a ele concedidosatravés do presente instrumento de procuração. Se uma ou outra(s) procuração(ões) executada(s) em algum dado momento indicar(em) uma ou mais pessoas comobastante procurador(es) no que diz respeito à Conta, o Procurador e cada um dos bastante procuradores adicionais deverão estar autorizados a exercer todos os seuspoderes individualmente (ou seja, sem a necessidade da presença ou do consentimento de qualquer outro bastante procurador).

Eu/Nós também autorizo/autorizamos o Banco a realizar transações relativas a todos os negócios da Conta com o Procurador e a honrar, receber ou pagar todo equalquer instrumento sacado ou endossado em favor do Procurador ou oferecido por ele(ela) em dinheiro, entregue ou usado em pagamento de qualquer obrigaçãoindividual do Procurador ou depositado por ele(ela) na sua conta pessoal. O Banco, sob nenhuma hipótese, deverá estar obrigado a investigar as circunstâncias deemissão ou uso de qualquer instrumento firmado pelo Procurador, ou a aplicação ou disposição de tal instrumento ou dos fundos a ele pertinentes. Se esta Procuraçãofor executada por mais de um titular da conta, o Procurador não estará obrigado a assinar qualquer documento mais deuma vez para executá-lo de forma efetiva e emnome de todos os titulares da conta.

Eu/Nós concordamos em indenizar, isentar de responsabilidade e defender o Banco e todos os seus diretores, administradores, agentes e funcionários de qualquerobrigação, perda ou dano, (inclusive honorários advocatícios considerados razoáveis), que possam advir em decorrência do cumprimento desta Procuração, inclusivequalquer obrigação, perda ou dano incorrido em virtude do Banco ter respeitado a autoridade aparente do Procurador após o cancelamento da presente Procuração, porforça da lei ou por outro mecanismo qualquer, mas antes de receber uma notificação expressa e por escrito neste sentido (considerando-se, naturalmente, o transcursode tempo hábil para as devidas providências por parte do Banco) no departamento em particular,escritório, agência ou banco correspondente envolvido na matéria.

Expiration Date / Data de Expiração

(Signature of First Account Holder) / Assinatura do 1o. Titularda Conta)

(Signature of Second Account Holder) / Assinatura do 2o.Titular da Conta)

(Signature of Third Account Holder) / Assinatura do 3o. Titularda Conta)

(Signature of Fourth Account Holder) / Assinatura do 4o.Titular da Conta)

Power of Attorney - Revised on January 26, 2015

(mm/dd/yyyy)

POWER OF ATTORNEYProcuração

One the day ofEm (Dia/Mês/Ano)

before me personally camecompareceu(ram) ante mim

known or verified by me to be the individual(s) named and who executed the above Power of Attorney, and acknowledged thathe/she/they executed same.

por mim conhecido(s) ou com identidade por mim verificada, a quem identifiquei como sendo a(s) pessoa(s) acima indicada(s), a(s) qual(quais) executou (taram) o presente instrumento de procuração e cuja execução, eu atesto e dou fé.

SSNo. de Registro

(Signature of Certifying Official) / (Assinatura do Oficial de Fé Pública/Tabelião)

(This form should be notarized, certified, and/or stamped in accordance with the requirements applicable in the jurisdiction where itis executed). / (Este formulário deve trazer reconhecimento de firmas e ser autenticado e/ou carimbado pelo oficial de fé pública, segundo asexigências aplicáveis na jurisdição onde for executado).

Attorney-in-Fact / Bastante Procurador

Name / Nome

Signature / AssinaturaPower of Attorney InformationInformações Sobre o Procurador da Conta

Name / Prenome Middle Name / Nomes Intermediários Last Name / Sobrenome

Single / Solteiro(a) Married / Casado(a) Widow/er / Viúvo(a) Other / Outro

Nacionality / Nacionalidade Passport/ID Number / No. do Passaporte ou da Identidade: Date of Birth / Data de Nascimento:

Home Address / Endereço Residêncial:

Zip / CEP City / Cidade State / Estado Country

Phone Number / No de Telefone Fax Cellular/ Celular E-mail

BY SIGNING THIS DOCUMENT, THE ATTORNEY-IN-FACT AGREES to the General Terms and Conditions issued by Bank doBrasil, Miami Agency, all of which he/she has read fully and understands, including, without limitation, the provisions thereinpermitting RECORDING OF TELEPHONE INSTRUCTIONS AND OF TELEPHONE CALLBACKS.

Verification of signature of Attorney-in-Fact and verification that Attorney-in-Fact has received the General Terms and Conditions.

AO ASSINAR ESTE DOCUMENTO, O(A) BASTANTE PROCURADOR(A) INDICA CONCORDÂNCIA com os Termos e Condições Gerais estipulados pelo Banco do Brasil, Agência de Miami, os quais foram por ele(ela) lidos na íntegra e devidamente entendidos, inclusive e sem limitar-se aos dispositivos aí contidos no que diz respeito à autorização expressa para GRAVAÇÃO DE INSTRUÇÕES TELEFÔNICAS E DE LIGAÇÕES DE RETORNO AO CLIENTE.

Verificação da assinatura do(a) BASTANTE PROCURADOR(A) e constatação de que o(a) mesmo(a) recebeu os Termos e CondiçõesGerais do Banco.

(Signature of Bank Officer)(Assinatura do Executivo do Banco)

Date / Data

Power of Attorney - Revised on January 26, 2015

(mm/dd/yyyy)

BB Internet Banking – MiamiAccess Request FormCarta de Opção

Dear Client:

If you are not using our Internet Banking services yet, which now offers funds transfers to any country in the world, along with balances and statements, but would like to, print the form, sign it and send it to Banco do Brasil – Miami Branch by fax, mail or as an e-mail attachment (signed) to:

Prezado Cliente:

Caso ainda não esteja utilizando as facilidades do nosso Internet Banking e deseje ter acesso a este service, que agora além desaldos e extratos, também permite efetuar transferências financeiras para qualquer país, complete os campos abaixo, assine eencaminhe este documento ao Banco do Brasil – Miami via fax, correio ou arquivo eletrônico (com assinatura) para:

Banco do Brasil Miami Branch 1215-7

701 Brickell Avenue, Suíte 2610 33131 – Miami – FL – EUA Phone: +1 (407) 608-1800 Fax: +1 (407) 608-1865E-mail: [email protected]

Name/ Nome:

(Print Name/ Letra de forma legível)

E-mail:

(Your E-mail)

Acct. No./Contacorrente no

Signature /Assinatura:

We thank you for being a Banco do Brasil –Miami Branch clientO Banco do Brasil nos EUA agradece V.Sa por continuar sendo nosso cliente.

E-MAIL AGREEMENT

Banco do Brasil Miami Branch (the “Bank”) has received numerous inquiries from clients who wish to communicate with the Bank primarily via electronic mail (“e-mail”). In response to those inquiries, the Bank is working to expand its use of e-mail as a means of communicating with those clients who prefer to use e-mail, without limiting in any manner the ability of clients to communicate withthe Bank via telephone, facsimile, or other traditional means to the extent they wish to do so.

A Agência de Miami do Banco do Brasil (“Banco”) tem recebido vários pedidos de clientes que desejam se comunicar com o Banco através de correio eletrônico(“e-mail”). Em resposta a essas solicitações, o Banco está trabalhando no sentido de expandir o uso do e-mail como meio de comunicação com clientes quepreferem utilizar este instrumento, sem limitar de nenhuma forma a possibilidade dos clientes de se comunicarem com o Banco através do telefone, fax ou poroutro meio tradicional.

If you would like to communicate with the Bank via e-mail, please provide your name and e-mail address and sign and date this formin the spaces provided below:

Se V.Sa. quiser comunicar-se com a Agência de Miami do Banco do Brasil através de e-mail, por favor, complete os dados abaixo, assine (mesmaassinatura constante de nossos arquivos) e date este formulário.

Client’s Name:Nome do Cliente:

Client’s Account (9 digits):Conta do Cliente (com 9 digitos) :

Client’s E-mail Address *:Endereço E-mail do Cliente *:

Client’s Signature *:Assinatura do Cliente *:

Date:Data (no modelo mês/dia/ano)

By signing this form, you authorize the Bank to send all statements, confirmations, and other correspondence of any nature relating toany of your accounts solely via e-mail, though you understand and agree that the Bank may elect, in its discretion, to send any suchcorrespondence to you by any other method permissible pursuant to other agreements that you have entered into with the Bank (e.g.,applicable account documentation and the Bank’s standard Terms and Conditions governing accounts). Additionally, the Bankreserves the right to require that you submit instructions or requests to the Bank in a form other than e-mail. Without limiting theforegoing, the Bank requires that all request for fund transfers be submitted in accordance with applicable security procedures fordelivery of fund transfer requests established in the Bank’s applicable account documentation.

Ao assinar este documento , V.Sa. autoriza a Agência de Miami do Banco do Brasil a enviar extratos, saldos, confirmações e todo tipo de correspondência dequalquer natureza relacionada a quaisquer de suas contas, unicamente por e-mail, muito embora V.Sa. compreenda e concorde que o Banco pod escolher, deacordo com seu interesse , enviar-lhe tais informações por qualquer outro método permitido seguindo outras instruções que V.Sa. possa ter cedido ao Banco(por exemplo, na docuemntação de abertura de conta e nos Termos e Condições do Banco que regem as contas). Por outro lado, o Banco se reserva o direitode solicitar que V.Sa. submeta instruções e pedidos ao Banco de outra forma que não seja e-mail. Sem limitar o acima exposto, o Banco exige que todos ospedidos de transferências de recursos sejam submetidos ao Banco de acordo com os procedimentos de segurança para transferências de fundos estabelecidosna documentação de abertura de conta.

By signing this form or initiating communications with the Bank via e-mail, you acknowledge that the internet is not a secure medium,and that privacy of e-mail communications cannot be ensured. E-mail communications are subject to interception and forgery, andthe Bank will not be responsible for any damages you may incur as a result of the communication of confidential or sensitiveinformation via e-mail. You hereby release the Bank from, and agree to indemnify the Bank and hold it harmless from and against,any and all losses , damages, or expenses, special, punitive, or exemplary damages) in connection with any exchange of e-mailcommunications between you and the Bank. Without limiting the foregoing, you understand and agree that the Bank will have noliability for breaches of confidentiality occasioned by the use of e-mail (whether resulting from interception, misdirection, or othercause), or for delays in transmission, receipt or processing of e-mail communications.Ao iniciar este documento ou iniciar comunicação com a Agência de Miami do Banco do Brasil através de e-mail, V.Sa. reconhece que a Internet não é um meioseguro e que a privacidade de comunicações via e-mail não pode ser assegurada. As comunicações via e-mail estão sujeitas à interceptação e fraude e o Banconão será responsabilizado por quaiquer danos que V.Sa. possa incorrer como consequência de fornecimento de informações confidenciais e sensíveis atravésde e-mail. Através deste documento, V.Sa. isenta, concorda em isentar e indenizar o Banco com relação a perdas, danos e despesas, incorridas ou a seremincorridas por V.Sa. ou por qualquer outra parte (incluindo mas não se limitando a danos indiretos, consequentes, punitivos ou de qualquer natureza) em relaçãoà troca de comunicações via e-mail entre V.Sa. e a Agência de Miami do Banco do Brasil. Sem limitar o acima exposto, V.Sa. compreende e conocrda que oBanco do Brasil não terá nenhuma responsabilidade por quebras de confidencialidade ocasionadas pelo uso do e-mail (mesmo se resultante de interceptação,direcionamento errado ou decorrente de qualquer outra causa) ou por demora e atraso na transmissão, recebimento ou processamento das comunicações via e-mail.

* IMPORTANT: In case of clients that are corporations or other entities, this form must be signed by one or more authorizedsignatories of the client in accordance with applicable account documentation and the Bank’s records. However, the e-mailaddress(es) provided on this form may be those of any person authorized by the client to exchange information with the Bankconcerning all of the client’s accounts with the Bank (whether or not an authorized signatory). By providing an e-mail address on thisform, the client acknowledges, represents, and warrants that the person(s) capable of receiving e-mail at those addresses areauthorized to correspond with the Bank (and to receive correspondence from the Bank) with respect to any matter involving theclient’s accounts with the Bank.* IMPORTANTE: Se o cliente for uma empresa ou outra entidade que não seja pessoa física, este formulário deverá ser assinado por um ou mais representantesautorizados pelo cliente de acordo com a documentação de abertura de conta e outras instruções em nossos registros. Entretanto, os endereços e-mailsfornecidos neste documento poderão ser de qualquer pessoa autorizada pelo cliente para troca de informações com o Banco relativas às contas do cliente noBanco, mesmo que estas pessoas não sejam as autorizadas conforme a documentação apresentada pelo cliente para a abertura da conta. Ao fornecerendereços e-mails neste formulário, o cliente afirma e garante que a(s) pessoa(s) capacitadas a receber comunicações via e-mail do Banco nos endereçosfornecidos são aquelas autorizadas pelo cliente a se corresponderem com a Agência de Miami do Banco do Brasil (e também a receberem correspondência daAgência de Miami do Banco do Brasil) em relação a quaisquer assuntos que envolvam as contas do cliente junto ao Banco.

x

Depósito a prazo fixo Account Number Número da Conta

Gentlemen:By signing this Agreement, I/We (the “Customer”) hereby authorize the bank to debit my/our account and open a Fixed Time Deposit in my/our name. At maturity, please renew such account as per instructions given to the account officer. Any contrary instructions shall be given 3 (three) business days prior the maturity of the Time Deposit Account, via telephone, and/or facsimile (or via any other means where the bank does not have the opportunity to confirm my/our request in person). It is my/our understanding that if any instructions in regards to this matter have not reached the bank in a timely manner, it shall not be held against the Bank. In the absence of instructions, the Fixed Time Deposit will be automatically renewed. Although the Bank is not required to do so, if I/We request to withdraw any portion of a Time Deposit principal before maturity, I/We are aware that Early Withdrawal Penalties may be applied, as per Terms & Conditions of your Account. If the Bank consents to my/our request, Federal Law and regulations require that Customer is advised of the following penalty for early withdrawals: an administrative charge of $100.00 will be payable in respect of each early withdrawal and a penalty, which shall be determined as follows: (i) if the original term of the Time Deposit is less than one (1) year, the penalty will be thirty (30) days’ interest on the principal withdrawn; or (iii) if the original term is one (1) year or greater, the penalty will be sixty (60) days’ interest on the principal withdrawn.

DEPOSITS MAINTAINED WITH BANCO DO BRASIL, ARE NOT INSURED BY THE FDIC. DEPčSITOS COM O BANCO DO BRASIL NëO ESTëO SEGURADOS PELO FDIC.

First Account Holder Name (Please Print) Nome do 1o. titular (favor usar letra de forma

Date (DD/MM/YYYY) Data (Dia/Mês/Ano)

Signature / Assinatura




Prezados Senhores:Ao assinar o presente acordo, eu (n·s) (ño(s) Cliente(s)ò), autorizo(amos) o Banco a debitar a minha (nossa) conta e abrir uma conta de dep·sito a prazo em meu (nosso) nome.No vencimento, favor renovar a presente conta, segundo as instru»es fornecidas ao executivo respons§vel pela conta. Qualquer instru«o contr§ria dever§ ser passada com 3 (três) dias úteis de anteced°ncia, via telefone, e/ou faxe (ou atrav®s de qualquer outro meio, que o Banco n«o tenha a oportunidade de confirmar a minha (nossa) solicita«o pessoalmente). Entendemos que o Banco ser§ isentado de toda e qualquer responsabilidade, caso alguma instru«o referente ao dep·sito a prazo fixo n«o chegue ao Banco em tempo h§bil. Na falta de instru«o a aplica«o ser§ renovada automaticamente. Embora n«o haja obrigatoriedade por parte do Banco, entendemos que no caso de solicitarmos a Retirada de um Deposito a prazo fixo antes do vencimento, Penalidades ser«o aplicadas. Caso haja anu°ncia do Banco, as leis e regulamentos federais exigem que o Cliente seja notificado das seguintes penalidades por retiradas efetuadas antes do vencimento: i) um encargo administrativo no valor m²nimo de $100.00 dever§ ser pago ao Banco por cada retirada antecipada por ele autorizada e uma penalidade a ser calculada de acordo com o seguinte criterio: (i) se o prazo do Deposito a Prazo for menor que (1) ano, a penalidade ser§ decorrente de juros calculados pelo per²odo de 30 dias do principal sacado; ou (ii) se o prazo do Deposito a Prazo for maior que (1) ano, a penalidade ser§ decorrente de juros calculados pelo per²odo de 60 dias do principal sacado.


Identified and signature verified by Identidade e assinatura conferida por

Date (MM/DD/YYYY) Data (Mês/dia/Ano)

Management Signature Assinatura da Gerencia


Second Account Holder Name (Please Print) Nome do 2o. titular (favor usar letra de forma

Third Account Holder Name (Please Print) Nome do 3o. titular (favor usar letra de forma

Fourth Account Holder Name (Please Print) Nome do 4o. titular (favor usar letra de forma

X

X

X

X



Rev. Dec 2017

1/4 PAY-ON-DEATH / TRANSFER-ON-DEATH SECURITIES ACCOUNT AGREEMENT

May - 2012

PAY-ON-DEATH / TRANSFER-ON-DEATH AGREEMENT

This Pay-On-Death/Transfer-On-Death Agreement ("Agreement") applies to the specific accounts listed in Paragraph 5 maintained by the undersigned Customer(s) (the "Account(s)") with Banco do Brasil, S.A., Miami Branch (the "Branch") and is intended to amend and supplement any and all other account-opening and related documents, agreements, and terms and conditions regarding the Account(s) (all such account-opening and related documents and agreements, except this Agreement, being the "Other Agreements"). The undersigned hereby agree(s) with the Branch as follows:

1. Notwithstanding the manner in which the Account(s) was/were initially opened (e.g., as an "in trust for" or"Totten trust" account): (a) with respect to all cash deposits in an Account with the Branch, this Agreement constitutes a "contract of deposit" under Florida Statutes Section 655.82 (the "Account Statute") and, (b) with respect to all securities, an Account constitutes a "securities account" within the meaning of the Florida Uniform Transfer-On-Death Security Registration Act (the "Securities Act").

2. This Agreement shall become effective on the date it is accepted by the Branch (as such date is stated atthe end of this Agreement).

3. Notwithstanding the manner in which the Account(s) was/were initially opened (e.g., as an "in trust for" or"Totten trust" account), the Account shall be a "pay-on-death account" under the Account Statute and/or a "transfer-on-death securities account" under the Securities Act. Such status is intended to be retroactive to the time of establishment of each Account.

4. For purposes of the Securities Act, all non-cash assets maintained in an Account are to be treated as"financial assets" within the meaning of Florida Statutes Chapter 678.

5. The Owner(s) of the Account(s) is(are) (name each):

Account Number:

Account Number:

6. Ownership of the Account(s) is(are) as (select one and initial same):

Sole Owner Initials: Multiple Owners Initials:


May - 2012

7. Rights at death with respect to the Accounts are (select the one consistent with the selection made inparagraph 6 and initial same):

□ Sole-Owner Account, with a Pay-on-Death Designation and/or Transfer-on-Death Designation (as applicable). The Owner may at any time close the Account and/or withdraw, transfer or otherwise dispose of any or all of the funds and/or assets therein. At the death of the Owner, ownership passes to the then surviving Beneficiary(ies) named in paragraph 8 and is not part of the Owner's estate. Initials:_

□ Multiple-Owner Account, with a Pay-on-Death Designation and/or Transfer-on-Death Designation (as applicable). At any time, all of the Owner(s) then living may close the Account and/or withdraw, transfer or otherwise dispose of any or all funds and/or assets therein. At the death of any Owner (other than the last surviving Owner), such deceased Owner's interest in the Account passes to the surviving Owner or surviving Owners. At the death of the last surviving Owner, ownership passes to the then surviving Beneficiary(ies) named in paragraph 8 and is not part of the last surviving Owner's estate. Initials: _ _ _

8. The name, address, telephone number, date of birth, relationship to Owner(s), country of citizenship andtax identification number (if any) of each Beneficiary of an Account are:

Name: Address:

Telephone No.:

Date of Birth: Relation to Owner(s):

Country of Citizenship and Tax I.D. No. Percentage of Interest:

Name: Address:

Telephone No.:



Name: Address:

Telephone No.:



%

%

%


May - 2012

Name: Address:

Telephone No.:



If there are two or more Beneficiaries living at the death of the Owner (or the last surviving Owner if applicable), they will share in the Account in the proportions designated above. Should a Beneficiary die prior to the last to survive of the Owner(s), such Beneficiary's given percentage of interest in the Account shall be divided equally amongst all surviving Beneficiaries.

9. As amended and supplemented hereby, the Other Agreements shall remain in full force and effect. Thedesignations made in paragraph 6, 7 and 8 may be canceled or changed only by means of a new "Pay-on-Death/ Transfer-on-Death Agreement" executed by the Owner(s) of the Account(s) and accepted by the Branch.

10. Any federal and/or state inheritance taxes and any related charges or fees may be paid by the Branch, atits election, from the cash or non-cash assets held in the Accounts prior to the distribution of such assets to the Beneficiary(ies). In the event that all the Beneficiaries die before the Owner(s), the Beneficiary(ies) entitlement to any funds and/or assets held in the Accounts shall automatically terminate. The Branch may pay a share of the funds and/or assets held in the Account(s) to any Beneficiary(ies) without the consent of the other Beneficiary(ies).

11. The Owner(s) of the Accounts hereby agree(s) to jointly and severally indemnify the Branch and itsaffiliates, agents, officers, directors, employees, and assigns (collectively, the "Indemnified Parties") against, and jointly and severally defend and hold them harmless from, any claims, losses, liabilities, and expenses of any kind, including attorneys fees, suffered or incurred by the Indemnified Parties in connection with this Agreement, any payments made by the Branch to the Beneficiary(ies) hereunder, the registration of the Accounts in the name(s) of the Beneficiary(ies), and/or any other actions taken by any of the Indemnified Parties pursuant to this Agreement, in accordance with the Account Statute and/or the Securities Act. The Indemnified Parties' rights under this paragraph are in addition to all of their other rights and remedies under the Other Agreements and applicable law.

%


May - 2012

Name of Owner: Name of Owner:

Signature: Signature:

Date: Date:

Name of Owner: Name of Owner:

Signature: Signature:

Date: Date:

Accepted and Agreed:

Banco Do Brasil, S.A., Miami Branch

By: Date:

Name:

Title:

PAY-ON-DEATH / TRANSFER-ON-DEATH SECURITIES ACCOUNT AGREEMENT 1/4

May - 2012

ACORDO DE PAGAMENTO POR MORTE/CESSÃO POR MORTE

O presente Acordo de Pagamento por Morte/Cessão por Morte (doravante denominado simplesmente de

"Acordo" refere-se às contas específicas que se encontram listadas no Parágrafo 5 e que são mantidas pelo(s) Cliente(s)

abaixo, (doravante denominadas de "Conta(s)") no Branco do Brasil S. A., Agência de Miami (doravante denominada

simplesmente de "Agência") e tem por finalidade emendar e suplementar toda e qualquer outra documentação de

abertura de conta e documentos conexos, assim como acordos e termos e condições no tocante à(s) Conta(s),

constituindo toda esta documentação supramencionada, com exceção deste Acordo, os "Outros Acordos". Pelo presente

instrumento, o(s) abaixo-assinado(s) concorda(m) com a Agência no seguinte:

1. Independente da forma em que a(s) Conta(s) tenha(m) sido inicialmente aberta(s) (ex.: conta de

fideicomisso em favor de outrem, ou de custódia total): (a) no que diz respeito a todos os depósitos em espécie na Conta

junto à Agência, o presente acordo constitui-se em "contrato de depósito" segundo as leis da Flórida, Seção 655.82

(doravante denominada coletivamente de "Lei da Conta"); e (b) no que tange a todos os valores mobiliários, a Conta se

constitui em "conta de valores" em consonância com o significado de Cessão Uniforme por Morte segundo a Lei de

Registro de Valores Mobiliários da Flórida (doravante denominada simplesmente de "Lei de Valores").

2. O presente deverá entrar em vigor na data em que for aceito pela Agência (ou data que constar no finaldeste Acordo).

3. Independente da forma em que a(s) Conta(s) tenha(m) sido inicialmente aberta(s) (ex.: conta de

fideicomisso em favor de outrem, ou de custódia total), tal Conta deverá ser uma "Conta de Pagamento por Morte",

segundo a Lei da Conta e/ou uma "Conta de Valores com Cessão por Morte", conforme a Lei de Valores. Tal status

deverá ser retroativo à data de estabelecimento de cada Conta.

4. Para fins da Lei de Valores, todos os ativos, à exceção de moeda circulante, que forem mantidos na

Conta serão tratados como "ativos financeiros" segundo o significado expresso no Capítulo 678 das Leis da Flórida.


May - 2012

5. O(s) Titular(es) da(s) Conta(s) é(são): (favor incluir o nome de cada um):

No. da Conta: ______________________________

________________________________________________ ________________________________________________

________________________________________________ ________________________________________________

No. da Conta: ______________________________

________________________________________________ ________________________________________________

________________________________________________ ________________________________________________

6. A titularidade da(s) Conta(s) estabelece-se conforme a seguir: (favor selecionar e rubricar uma das

opções):

□ Único Titular Rubrica:___ □ Múltiplos Titulares Rubrica: ___

7. Os direitos por morte em relação às Contas são (favor selecionar e rubricar uma opção que seja

coerente com aquela escolhida no parágrafo 6)

□ Conta com Único Titular, com designação de Pagamento por Morte e/ou designação de Cessão por

Morte (conforme o caso). O Titular poderá, a qualquer momento, encerrar a Conta e/ou retirar, transferir ou de outra

forma dispor dos fundos e/ou ativos nela depositados. Por morte do Titular, a titularidade passará para o(s)

Beneficiário(s) sobrevivente(s) especificados no parágrafo 8, excluídos aqueles que constarem no espólio do Titular. Rubrica:____

□ Conta com Múltiplos Titulares, com designação de Pagamento por Morte e/ou designação de Cessão por

Morte (conforme o caso). Todos os Titulares vivos poderão, a qualquer momento, encerrar a Conta e/ou retirar, transferir

ou de outra forma dispor dos fundos e/ou ativos nela depositados. Por morte de qualquer dos Titulares (sem ser o último

Titular sobrevivente), a participação de tal Titular falecido na Conta passará para o(s) Titular(es) sobrevivente(s). Por

morte do último Titular sobrevivente, a titularidade passará para o(s) Beneficiário(s) sobrevivente(s) especificado(s) no

parágrafo 8, excluídos aqueles que constarem no espólio do último Titular sobrevivente. Rubrica:____

8. O nome, endereço, número de telefone, data de nascimento, grau de parentesco ou relação com o(s),

Titular(es), país de cidadania e número de Contribuinte (se houver) de cada Beneficiário da Conta são os seguintes:


May - 2012

Nome:_______________________________________________________ End.:

_______________________________________________________________________________ Telefone:

Data de Nascimento:_______________________________ Parentesco com o(s) Titular(es):

País de Cidadania e No. de Contribuinte: _____________________________ Percentagem de Participação:

Nome:_______________________________________________________ End.:

_______________________________________________________________________________ Telefone:


País de Cidadania e No. de Contribuinte:_____________________________ Percentagem de Participação:

Nome:_______________________________________________________ End.:

_______________________________________________________________________________ Telefone:



Nome:_______________________________________________________ End:

_______________________________________________________________________________ Telefone.:



Se houver dois ou mais Beneficiários sobreviventes por ocasião da morte do Titular (se for o caso), eles

compartilharão a Conta na proporção acima designada. Se algum Beneficiário vier a falecer antes do último a sobreviver

ao(s) Titular(es), a sua percentagem de participação na Conta deverá ser dividida igualmente entre todos os outros

Beneficiários sobreviventes.

9. Segundo aqui emendado e suplementado, os Outros Acordos deverão permanecer em pleno vigor e efeito.

As designações feitas nos parágrafos 6, 7 e 8 só poderão ser canceladas ou alteradas por intermédio de um novo Acordo

de Pagamento por Morte/Cessão por Morte, o qual deverá ser firmado pelo(s) Titular(es) da Conta e aceito pela Agência.


May - 2012

10. Todo e qualquer imposto sobre herança de competência federal ou estadual, assim como todos os outros

encargos pertinentes poderão ser pagos pela Agência, à sua própria escolha, a partir do numerário ou bens mantidos

na(s) Conta(s) antes de serem passados aos Beneficiários. Em caso de que todos os Beneficiários venham a falecer

antes do Titular, o direito de tais Beneficiários aos fundos e/ou bens da Conta automaticamente cessará. A Agência

poderá pagar uma parcela dos fundos e/ou ativos mantidos na Conta a qualquer Beneficiário sem o consentimento

expresso de outro(s) Beneficiário(s).

11. O(s) Titular(es) da(s) Conta(s), por meio do presente instrumento, concorda(m) em indenizar individual ou

conjuntamente a Agência e suas afiliadas, agentes, executivos, diretores, funcionários e representantes (coletivamente

aqui denominados de ¨Partes Indenizadas¨) por quaisquer demandas, perdas, obrigações e despesas de qualquer

índole, protegendo-a e isentando-a de toda e qualquer responsabilidade, isolada e coletivamente, no que se relacionar a

tais ocorrências, estando aí incluídos também honorários advocatícios sofridos e incorridos pelas Partes Indenizadas em

virtude do presente Acordo, assim como quaisquer pagamentos efetuados pela Agência aos Beneficiários aqui

discriminados, emolumentos relacionados ao registro da(s) Conta(s) em nome dos Beneficiários e/ou por quaisquer

outras ações tomadas por qualquer das Partes Indenizadas no cumprimento deste Acordo e em consonância com a Lei

da Conta e/ou com a Lei de Valores. Os direitos das Partes Indenizadas à luz do presente parágrafo são adicionais a

todos os outros direitos e recursos jurídicos incluídos nos Outros Acordos e na legislação pertinente.

Nome do Titular: Nome do Titular:

Assinatura: Assinatura:

Data: Data:

Nome do Titular: Nome do Titular:

Assinatura: Assinatura:

Data: Data:

Aceito e de acordo:

Banco do Brasil, S.A., Agência de Miami

Por: Data:

Nome:

Cargo:

FACTS WHAT DOES BANCO DO BRASIL, AND ITS U.S. AFFILIATES DO WITH YOUR

PERSONAL INFORMATION?

Why? Financial companies choose how they share personal information. Federal law gives consumers the right to limit some but not all sharing. Federal laws also require us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do.

What? The types of personal information we collect and share depend on the product or service you have with us. This information can include: � Your Name, Address, and Telephone Number � Social Security number and Income� Account Balances and Payment History� Credit History and Credit Scores

How? All financial companies need to share personal information to run their everyday business. In the section below, we list the reasons financial companies can share their personal information; and whether you can limit this sharing.

Reasons we can share your personal information Does Banco do Brasil share?

Can you limit this Sharing?

For our everyday business purposes- such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus YES NO

For our marketing purposes- to offer our products and services to you

YES NO

For joint marketing with other financial companies

NO

Banco do Brasil does not share for this

purpose

For our affiliates’ everyday business purposes- information about your transactions and experiences

YES NO

For our affiliates’ everyday business purposes - information about your creditworthiness

YES YES

For our affiliates to market to you YES YES

For non-affiliates market to you

NO

Banco do Brasil does not share for this

purpose

To limit our sharing � Call (407) 608 1800 (Miami Branch): our menu will prompt you through

your choice(s) or email to: [email protected]� Mail the Form below to:

8325 South Park Circle #140 – Orlando, FL – 32819

Please note: If you are a new customer, we can begin sharing your information 30 days from the date we sent this notice. When you are no longer our customer, we continue to share your information as described in this notice.

However, you can contact us at any time to limit the sharing.

Questions? � Call (407) 608 1800 (Miami Branch): our menu will prompt you through

your choice(s) or email to: [email protected]

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Mail-in Form

Mark any/all you want to limit:

( ) Do not allow your affiliates to use my personal information to market to me.

( ) Do not share information about my creditworthiness with your affiliates for their everyday business purposes.

Mail To:

8325 South Park Circle - Suite 140 Orlando, FL 32819

Name:

Address:

City, State:

Zip, Country:

Account Number:

Who we are

Who is providing this notice? Banco do Brasil S.A. – U.S. Operations

What we do

How does Banco do Brasil protect personal information? To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings. We maintain physical, electronic and procedural safeguards that comply with federal standard to protect your nonpublic personal information.

How does Banco do Brasil collect personal information? We collect your personal information, for example, when you � Open an Account or Complete an Application� Apply for a Loan or Use our products/services� Use your Credit CardOR We also collect your personal information from others, such as credit bureaus, affiliates, or other companies

Why can’t I limit all sharing? Federal law gives you the right to limit only � sharing for affiliates’ everyday business purposes -

information about your creditworthiness � affiliates from using your information to market to you� sharing for nonaffiliated to market to you

State laws and individual companies may give you additional rights to limit sharing.

What happens when I limit sharing for an account I hold jointly with someone else?

Your choices will apply to everyone on your account.

Definitions

Affiliates Companies related by common ownership or control. They can be financial and nonfinancial companies. Our affiliates include, for example, but are not limited to, companies with a Banco do Brasil name.

Nonaffiliated Companies not related by common ownership or control. They can be financial and nonfinancial companies.

Joint marketing A formal agreement between nonaffiliated financial products or services to you.

Other important information

• You do not need to contact us, unless you want to choose an election on the Opt out Form.

• If you have responses to Privacy notice sent previously, you do not need to contact us, unless you change your Opt-OutElection.

Rev. Dec 2016

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