{"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\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)
Trading | O Import/Export
V Investment Holding
Consultancy
Others (please specify):
O Manufacturing | | | | | | |\n| (ii) Please provide a brief description of Company's business activilies: Finance investment, Management
Source of Funds:
VBorrowings/Loans
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,
(b) Business address: | | | | | | | |\n| Sheung Wan, Hong Kong
(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:
(1) | hk.company.secretary@gmail.com | | | | | | |\n| (g) Date of Birth: | 1909-01-28 | | | | | | |\n| (h) Nationality: | TIONG KONG | | | | | | |\n| Occupation:
(1) | MANAGER | | | | | | |\n| Please attach: (1) a certified copy* of Current Passport or Identily Card; | | | | | | | |\n| and (2) One of the following:
- Residential address proof (e.g. original or certified copy* of utility bill / bank statement); or
- 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
information for due diligence purposes to the Regulators if so requested by them. We also undertake to notify you of any
future changes to the above information. | | | | | | | |\n| Client Signature: | Print Name: Guo Mei | | | | | | |\n| | 2017-07-04
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\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
2
2
-5
0
0
7
3
a
s
e | D
1
7
9
o
c | i
l
d
/
7
-2
1
F
0
5
e | /
1
6
2
3
E
4 | d
/
0
5
nt
e
re | /
f
1
6
2
3
2
3
:5
2
:2
4
P
4
a
g
e
o |\n|------------------------------------------------------|----------------------------|------------------------------------------------------|---------------------------------|-----------------------------------|------------------------------------------------------------------------------------------|\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |\n| | | | | | |","body_zh":"证物 21\n\n英属维尔京群岛（BRITISH VIRGIN ISLANDS）\n\n表格：DDBVI - P2\n\n个人客户尽职调查身份核实表\n\n以下信息系为遵守相关司法管辖区的反洗钱法，并消除未来影响贵公司合法运营的风险所必需。\n\n公司名称：CRYSTAL BREEZE INVESTMENTS LIMITED\n\n业务性质：（请按适用情况打勾）\n(i)\n贸易 [ ] 进出口 [ ]\n[V] 投资控股\n咨询 [ ]\n其他（请注明）：\n[ ] 制造\n(ii) 请简要说明公司的业务活动：金融投资、管理\n资金来源：\n[V] 借款/贷款\n[ ] 其他（请注明）：\n\n实益拥有人 / 业务申请人\n(a) 全名：Guo Mei（郭美）\n(b) 营业地址：香港上环干诺道西3号亿利商业大厦2106室（Room 2106, Yardley Commercial Building, No 3 Connaught Road West, Sheung Wan, Hong Kong）\n(c) 永久居住地址：香港南湾道22号1楼（B1单元）（22 SOUTH BAY ROAD, LEVEL 1 (UNIT B1), HONG KONG）\n(d) 电话：2160 0816 / 2160 0888\n(e) 传真：2160 0808\n(f) 电子邮件：hk.company.secretary@gmail.com\n(g) 出生日期：1909-01-28\n(h) 国籍：香港（HONG KONG）\n(i) 职业：经理（MANAGER）\n请随附：(1) 现行有效护照或身份证的核证副本*；\n以及 (2) 下列各项之一：\n- 居住地址证明（例如公用事业账单 / 银行对账单的原件或核证副本*）；或\n- 银行或合格专业人士出具的推荐信（见随附样例文本）\n* 副本可由律师/注册会计师/银行按随附格式进行核证\n本人/我们确认上述信息真实准确，并且若监管机构提出要求，您获授权向监管机构提供上述任何或全部信息用于尽职调查目的。我们亦承诺将上述信息的任何未来变更通知您。\n客户签名： 正楷姓名：Guo Mei\n日期：2017-07-04\n\n请将本表及附件交回至：香港铜锣湾希慎道33号利园一期19楼卓佳香港（Vistra Hong Kong）合规部\n核证无误副本\n\n本人（即下述签名人）特此证明，本文件系原件的真实完整副本，或系经适当核证的原件真实副本 日期：2017年[7]月4日\nYU FIONA KA WING（余嘉颖），香港特别行政区大律师\n\n适用于十八岁或以上的人士\n\n适用于年满18岁或以上人士\n\n[文末为页面及法院电子案卷水印等杂乱字符残迹：Case Doc filed Entered Page of]","key_entities":["Guo"],"ecf_references":[],"word_count":679,"status":"published","published_at":null,"created_at":null,"updated_at":"2026-08-23 13:16:42"}