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Client Information Sheet For Paymaster Services: Helio Medeiros Maia

Hélio Medeiros Maia is providing client information and documentation for paymaster services. The document includes Maia's personal details like name, address, passport information, and contact details. It also lists the origin of funds as free and clear, and that Maia will facilitate transactions between groups for commodities, banking instruments, bonds, and currency exchange. Attached are copies of Maia's passport, proof of address, and driver's license.

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Gilson Lopes
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516 views6 pages

Client Information Sheet For Paymaster Services: Helio Medeiros Maia

Hélio Medeiros Maia is providing client information and documentation for paymaster services. The document includes Maia's personal details like name, address, passport information, and contact details. It also lists the origin of funds as free and clear, and that Maia will facilitate transactions between groups for commodities, banking instruments, bonds, and currency exchange. Attached are copies of Maia's passport, proof of address, and driver's license.

Uploaded by

Gilson Lopes
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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HELIO MEDEIROS MAIA

ADDRESS: RUA JAVORAÚ, 90 APTº 81 – VILA ALBERTINA – SÃO PAULO – SP – BRAZIL – ZIP CODE 02732-000
PASSPORT: FP 679414 – PHONES +55 11 95894 2558 WhatsApp / +55 11 97186 1715
E-MAIL: [email protected]

CLIENT INFORMATION SHEET


FOR PAYMASTER SERVICES
DATE: June 7, 2021

In accordance with Articles 2 and 5 of the due diligence and federal banking commission
circular of December 1999, concerning the prevention of money laundering, and Article 305 of
the Swiss Criminal Code, the following information may be supplied to banks and to financial
institutions for purposes of verification of identity and activities of the investing member, and
the nature and origin of the funds which are to be utilized.

Client Full Name Hélio Medeiros Maia


Nationality Brazilian
Passport Number FP 679414
Issued By Brazil
Issue Date 25/04/2016
Expiration Date 24/04/2026
Social Security Number (Medicare No:) if any CPF 082.855.378-54
LICENCES HELD(IF ANY) N/A
Phone no +55 11 95894 2558 / +55 11 97186 1715
E mail address [email protected]
Skype address TBA
Date of Birth Aug 12, 1966
Place of Birth Jaboatão dos Guararapes – PE - Brazil

Company Name N/A


Registered Office N/A
Registered Number N/A
Business Telephone N/A
Mailing Address N/A
Email Address N/A

Attorney ( if you have one) N/A


Address N/A
Telephone N/A
Fax N/A
Mobile N/A
HELIO MEDEIROS MAIA
CLASSIFIED AND CONFIDENTIAL

Initial: HMM Page 1 of 6


HELIO MEDEIROS MAIA
ADDRESS: RUA JAVORAÚ, 90 APTº 81 – VILA ALBERTINA – SÃO PAULO – SP – BRAZIL – ZIP CODE 02732-000
PASSPORT: FP 679414 – PHONES +55 11 95894 2558 WhatsApp / +55 11 97186 1715
E-MAIL: [email protected]

Email Address N/A

Origin Of Funds re this activity


Are Funds Free and Clear YES
Brief Corporate Activity YES

Facilitator and/or Intermediary for


transactions between groups and/or Buyers YES
and Sellers of:

Commodities/Banking
Instruments/Bonds/Currency Exchange YES

I hereby swear under penalty of perjury that the information given above is accurate and true.
Any information, work or service conducted hereunder is that of a private placement
transaction that is exempt from the Securities Act and not intended for the general public but
for Private Use Only.

SIGNATURE

Signatory:
Title: Individual
Passport: FP 679414
Country: Brazil
Expiration Date: 24/04/2026

DATE: June 7, 2021

HELIO MEDEIROS MAIA


CLASSIFIED AND CONFIDENTIAL

Initial: HMM Page 2 of 6


HELIO MEDEIROS MAIA
ADDRESS: RUA JAVORAÚ, 90 APTº 81 – VILA ALBERTINA – SÃO PAULO – SP – BRAZIL – ZIP CODE 02732-000
PASSPORT: FP 679414 – PHONES +55 11 95894 2558 WhatsApp / +55 11 97186 1715
E-MAIL: [email protected]

BANKING COORDINATES FOR


INDIVIDUAL ( THE BANKING INFO IS FOR RECORD PURPOSES ONLY)

BANK NAME: BANCO ITAÚ S/A

BANK ADDRESS: PRAÇA CHARLES MILLER, 117- PACAEMBÚ - SÃO PAULO - SP - BRAZIL

SWIFT CODE: ITAUBRSP

BANK OFFICER: JULIANA RODRIGUES

BANK PHONE No: +55 11 96422 0137 / +55 11 4004 0030

BANK FAX No: N/A

A/C NUMBER: Account Number: 10231-5 Agency Number: 6647

IBAN: BR 73 6070 1190 0664 7000 0102 315C 1

BANK ACCOUNT NAME: HELIO MEDEIROS MAIA

EMAIL: [email protected]

SIGNATURE

HELIO MEDEIROS MAIA


CLASSIFIED AND CONFIDENTIAL

Initial: HMM Page 3 of 6


HELIO MEDEIROS MAIA
ADDRESS: RUA JAVORAÚ, 90 APTº 81 – VILA ALBERTINA – SÃO PAULO – SP – BRAZIL – ZIP CODE 02732-000
PASSPORT: FP 679414 – PHONES +55 11 95894 2558 WhatsApp / +55 11 97186 1715
E-MAIL: [email protected]

COPY OF BENEFICIARY
PASSPORT.

HELIO MEDEIROS MAIA


CLASSIFIED AND CONFIDENTIAL

Initial: HMM Page 4 of 6


HELIO MEDEIROS MAIA
ADDRESS: RUA JAVORAÚ, 90 APTº 81 – VILA ALBERTINA – SÃO PAULO – SP – BRAZIL – ZIP CODE 02732-000
PASSPORT: FP 679414 – PHONES +55 11 95894 2558 WhatsApp / +55 11 97186 1715
E-MAIL: [email protected]

PROOF OF RESIDENTIAL
ADDRESS (Note that P.O.BOX
is not acceptable)
To validate the home
addresses of all parties,
please provide at least ONE
COPY of the following:
(a) Original and
recent bank
statement from a
recognized bank
(b) Original and
recent credit card
statement
(c) Letter from your
employer (on headed
paper) confirming
your permanent
address
(d) Utility bill

HELIO MEDEIROS MAIA


CLASSIFIED AND CONFIDENTIAL

Initial: HMM Page 5 of 6


HELIO MEDEIROS MAIA
ADDRESS: RUA JAVORAÚ, 90 APTº 81 – VILA ALBERTINA – SÃO PAULO – SP – BRAZIL – ZIP CODE 02732-000
PASSPORT: FP 679414 – PHONES +55 11 95894 2558 WhatsApp / +55 11 97186 1715
E-MAIL: [email protected]

COPY OF
BENEFICIARY
DRIVERS LICENCE

Signatory:
Title: Individual
Passport: FP 679414
Country: Brazil
Expiration Date: 24/04/2026 DATE: June 7, 2021
HELIO MEDEIROS MAIA
CLASSIFIED AND CONFIDENTIAL

Initial: HMM Page 6 of 6

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