{"id":"court_ctb_1797_21","court":"CTB","case_no":"22-50073","doc_number":1797,"sub_number":21,"doc_type":"EXHIBIT","filed_date":null,"title":"Exhibit 21 ব","summary_zh":null,"summary_en":null,"body_en":"## **Exhibit 21**\n\nব\n\n![](_page_1_Picture_2.jpeg)\n\n## BRITISH VIRGIN ISLANDS\n\nForm: DDBVI - P2\n\nDue Diligence Verification of Identity Form for Individual Clients\n\nThe information below is required to comply with the Anti-Money Laundering Laws of the relevant jurisdiction, and to eliminate the risk that the legal operation of your company is affected in the future.\n\n|                                                                                                                                                                                                                                                                                             | Name of Company: CRYSTAL BREEZE INVESTMENTS LIMITED                                                   |  |  |  |  |  |  |\n|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------|--|--|--|--|--|--|\n| Nature of Business: (please V as appropriate)                                                                                                                                                                                                                                               |                                                                                                       |  |  |  |  |  |  |\n| (i)<br>Trading                                                                                                                                                                                                                                                                              | O Import/Export<br>V Investment Holding<br>Consultancy<br>Others (please specify):<br>O Manufacturing |  |  |  |  |  |  |\n| (ii) Please provide a brief description of Company's business activilies: Finance investment, Management<br>Source of Funds:<br>VBorrowings/Loans<br>O Others (please specify) :                                                                                                            |                                                                                                       |  |  |  |  |  |  |\n|                                                                                                                                                                                                                                                                                             |                                                                                                       |  |  |  |  |  |  |\n| Beneficial Owner / Applicant for Business                                                                                                                                                                                                                                                   |                                                                                                       |  |  |  |  |  |  |\n| (a)  Full Name:                                                                                                                                                                                                                                                                             | Guo Mei                                                                                               |  |  |  |  |  |  |\n| Room 2106, Yardley Commercial Building, No 3 Connaught Road West,<br>(b) Business address:                                                                                                                                                                                                  |                                                                                                       |  |  |  |  |  |  |\n| Sheung Wan, Hong Kong<br>(c) Permanent Residential Address: 22 SOUTH BAY ROAD, LEVEL 1 (UNIT B1), HONG KONG                                                                                                                                                                                 |                                                                                                       |  |  |  |  |  |  |\n| (d) Telephane:                                                                                                                                                                                                                                                                              | 2160 0816 / 2160 0888                                                                                 |  |  |  |  |  |  |\n| (c) Fax:                                                                                                                                                                                                                                                                                    | 2160 0808                                                                                             |  |  |  |  |  |  |\n| Email:<br>(1)                                                                                                                                                                                                                                                                               | hk.company.secretary@gmail.com                                                                        |  |  |  |  |  |  |\n| (g) Date of Birth:                                                                                                                                                                                                                                                                          | 1909-01-28                                                                                            |  |  |  |  |  |  |\n| (h) Nationality:                                                                                                                                                                                                                                                                            | TIONG KONG                                                                                            |  |  |  |  |  |  |\n| Occupation:<br>(1)                                                                                                                                                                                                                                                                          | MANAGER                                                                                               |  |  |  |  |  |  |\n| Please attach: (1) a certified copy* of Current Passport or Identily Card;                                                                                                                                                                                                                  |                                                                                                       |  |  |  |  |  |  |\n| and (2) One of the following:<br>- Residential address proof (e.g. original or certified copy* of utility bill / bank statement); or<br>- Reference from bank or qualified professional (see attached sample wording)                                                                       |                                                                                                       |  |  |  |  |  |  |\n| * Copy may be certified by Lawyer/CPA/Bank in the attached format                                                                                                                                                                                                                           |                                                                                                       |  |  |  |  |  |  |\n| I / We confirm that the above information is true and accurate, and you are authorised to supply any or all of such<br>information for due diligence purposes to the Regulators if so requested by them. We also undertake to notify you of any<br>future changes to the above information. |                                                                                                       |  |  |  |  |  |  |\n| Client Signature:                                                                                                                                                                                                                                                                           | Print Name: Guo Mei                                                                                   |  |  |  |  |  |  |\n|                                                                                                                                                                                                                                                                                             | 2017-07-04<br>Date:                                                                                   |  |  |  |  |  |  |\n\nPlease return this form and attachments to: Compliance Department Vistra Hong Kong 19/F, Lee Garden One, 33 Hysan Avenue, Causeway Bay, Hong Kong\n\n![](_page_2_Picture_1.jpeg)\n\n## CERTIFIED TRUE COPY\n\nI, the undersigned, hereby certify that this document is a true and complete copy of the original or a properly certified true copy of the original Dated Dated 4 2017 2017\n\n5\n\nYU FIONA KA WING Barrister, Hong Kong SAR\n\n被用於十八官或 以上的人士\n\nFOR A PERSON OF THE AGE OF 18 OR OVER\n\n| C<br>2<br>2<br>-5<br>0<br>0<br>7<br>3<br>a<br>s<br>e | D<br>1<br>7<br>9<br>o<br>c | i<br>l<br>d<br>/<br>7<br>-2<br>1<br>F<br>0<br>5<br>e | /<br>1<br>6<br>2<br>3<br>E<br>4 | d<br>/<br>0<br>5<br>nt<br>e<br>re | /<br>f<br>1<br>6<br>2<br>3<br>2<br>3<br>:5<br>2<br>:2<br>4<br>P<br>4<br>a<br>g<br>e<br>o 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