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Print Form Al Overseas Management Company Form CR-400 COMPANY APPLICANT FORM/ Fornulario de solicitud de Sociedad |A. COMPANY INFORMATION’ :NFORMACION DE LA COMPARTA New Company Shalit Compan tradition! wie: [BV OR isan or BVL Bahomas and AcguilComprie ony, leas ndcat which type ase sequel Por for incr qe clase eset reper fl prea BY, akanesy Anata) econic Seat Raber Seat Mtl Sea (hod eo ni nt) CNetennes — CDSavetnem ei tmatcnms arenes 2.Company nes cvie/ nonin seas [Dorado Asset Management utd | Te utr epi {lst choies for no companis) [usp $50,000 (figs omer mopensonsmes) 3. Pps offing th Company! ri Sena ‘Oumeship of Bank Account mera ofa Vessel Abert Ose Oem Oters(Ove) —_Pirancial Ravice & Tnvestnents Spec Deals roperone Cte: Losin veils Potato (eb ea) DD coneuting (anaes) Real Estate Ivesnent i a OT faerie) a [tree mestnin) Holding of dass — SS Omar en) es Pat of Sucre Termes) —— 4. Estimated Turnover Wa Estimated Hoidings Value [50,000 ‘ond ote Acoso lp eat Type of ascs held in the name ofthe Company Please speily regions ofsctvtes and estimated tumover foreach region PE oF ass Be’ he name Of Feynman 6 Fa | 5. Leeson of Acooing Reds Ate Gath apace Dnenn P) 7 [2665 $ Bayshore Dr, Suite 715 ca USA oe, Miami 6. Bank Account (6) C1 Y€*/5' ape of Bank — — Nombre de Banco ‘Ubicaci6n 1 Soe ot Pine == Basins Profits! sda Ditters sale ot Asis veneer Dorrer oor B, DIRECTORS AND OFFICERS | DIRECTORES Y DIGNATARIOS. |. The Directs) wl be provided by OMC to 2 The Officers) wil be provided by OMC Ne inact prota OE Yestst []No scram promo par OM! yest 1 Sim oor ipsa rae ‘Sm se pegeiner eeh once: A.Name! ste Ci iectar O npatrn Adres! rec atonaliy esata Passport NoMa dent snail Cre cori “TelephonelFax! Tao Fe ‘Occupation and Business Activites ove the pat fve year/dngacon yaa deri dno ior oe Officer 1B. Name! ake —] piece C1 Dinas Address! penn Nationality Auta Passport Nod Ka expr TelephonelFand ruin Fox E-mail Careers ‘Occupation and Business Activites over the pst five year Cpacin ye qt cn gc hn mrt a oftcer coneminne | Sitter ire M$ Addr Die Nati Neconalda Passport Nos pe Telephon in Ems cesar cwption a Busnes Activites oe th ps ve ea try ou tal snide ee ‘pease ote tht rectors rn concent te appanimentin wring (Vand Angulla Companies Individual Oretor(Otces, must be at east ght yea 98 cae occas grads eben cr corsentnie orca re raed Argue Ls dees ese eyes 1B ‘For adtonal Dieter Officer pease attach an adons page wit hl pertinent oration. neat de decay cates esotropia conocer. ©. SHAREHOLDERS/ ACCIONISTAS. Inshore sane she Doser" Yeu) ot Hem viel aa fa Sta Sm ferret ‘A.Namel time [Pedro Pablo Kuczynski Number of Share inresaainer [50,000 ‘Address teesin [2665 S Bayshore Dr, Suite 715, Coconut Grove, FL 33133 Nationality sess Peru & USA PassportNo/ naderaumene [previously provided ‘TelephoneFax! reine te [305-285-7995 Femail Corsten [dhernandez@laeficom COseupation and Business Activites ave the past five yeas! dace ya ans dea ab ores aes ee investment Advisor 1. Nel | vember tS set ie ‘Aes! ress ] [Nationality sant! Passport No de Prepare Telephone rin smal re cherie ‘Occupation and Business Actives over the past five yeurs/ punyu qr mths de tad eons So C.Name! sate Numb of Shares sine decir Ades! teen 2 [Natonaity cuss ‘Passport No. Na ePaper | ‘TeleponelPan! ron ean coro eno ‘Occupation and Busncss Activities over he past five year! Ospina mi dm ante in i D.Namel ae ‘Number of Shared ime dean Aes! cn _ ition Names Passport Nos Rr “elephonean! rend er E-mail cemodtorbatce ‘Occupation and Business Activities over he past five years/dnpacny ek ecw nent es 3s or abo! Sharh, lose ach an akon page wit thee pertain cretia dnclonmun elernuen few amar pis deal on erin periene D. BENEFICIAL OWNER(S)’ BENEFICIARIOS sth Reel Ones these 2 he dao (5% Ys haw hrc roi a dea of a Be Ome Eihegfane np soctoci? 5 [hie man for wom ect ha A Name! ste Atess/ reese Nationality nave Passport No/ An age “Telephones! Toe he E-mail car decrine Ocaupaton! ompecse B. Name! omtre Adres bie Nationality oma Passport No. Maa Paper ‘Telephone/Fax! resin ax Emil Cordes Occupation! ces Name! habe Address! vee [Natonaiy vat Passport Nod na erga “Telephone Tem a email Caractere ‘Cccopatin! een Name! rane Are! Drea Nationality Aina Passport No/ 3. epee “TelephonelF x! Tn ow Emil es ents Qecapation! aspen D.Name! namie Ades! ores atonal mana Passport No Na Pepe small Crear TelephonetF ad rin Pee ceupaton! dapein ‘mie adivon! Bests Owner, auch ational pae wit i pins nforton, nce ea nal ado fra pina oa ofa porn E. DUE DILIGENCE REQUIREMENTS! REQUISITOS DE DEBIDA DILIGENCIA cae provid he fetlowing documents for cach Director Sarsheher and Braet Oweer [ron ppc ordnance ny ong |, Nofariedor etifiod passport copes. Helder of dual madonlity should provide certified copies ofa passports apace pono tin orifice cot mae mena dhet opener cpl det | One financial ference on oii! etebead minimum 3 yeas) Cinco rjeronie hen de inn ao papel mend 2. One character reference ied by 6 poesinal (Le, ary, acount, i) on origi! ered (iia 3 yes "Un cor efor enon emi porn Pfsn abgaka coor dc) mn 3 ab reatin cameo enpope! monic 4. Proof of addres (Le. ity bier card statement Compendia seri pio sod ech de ea de er) oO a a o ‘te: athe vt that he drctor oo harsher oars ep entity pease provide ncapy of is M&AA and Certiene of Incorporation, cl cmt que ctr eclnsa ennaetad eg prfororprpercon wer cop eo ec cron erin de carport 0 dca de ‘Note 2: OMC reserves the sights rated agent reqs any ndional information andor documentation regarding Directors, Ocer, Shareholders and ‘Benetal Ovnera any caer where OMC is onnider ascesey ln ode comply with appealed dligence laws aed elation. Connon eee OMCs eaa el derek dle frmacn ese solve cuales Arca, digetr, Acme Bnei ial « maa de cmp in remiss at Bgentey campimtos ‘SIGNATURE 1. Ap, eden at ey whi fw mien ome in e gman ond wer te ‘my be vale Honor wert tre pon (Gato nd den ef acpi) wl On aie owet ie ee, (Socom gssingpid sedi tecgem usr and asurnsanaer eat ‘ean albany Apo ve dct an wort at ion Le hae proved ee pon a ic iin seta tote aS ome ny sch ‘Siosmpron reef Szey hc snc aoe [Name of The Applicant Signature PEbeo PIBLO KueZyesE; To fake cn nee ct ais dcr ego on mon prc aon, pt pa one Snag, ‘Trclgeyarenaney haces arp da le) ‘emma por Myon prone ante oye ae oe de ‘ne yay dent on eae sca te remobairpartslae Sm az tr ifn ee mpc {Nae deamon aa Apert a echo e r oarptsone emp pre Date Oct. 4,203 [EMMnam April, 2013

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