---
type: court_doc
id: "court_ctb_1797_21"
court: "CTB"
case_no: "22-50073"
doc_number: 1797
doc_type: "EXHIBIT"
filed_date: null
lang: "zh"
url: "https://mubeitech.com/court/court_ctb_1797_21"
json_url: "https://mubeitech.com/api/court/court_ctb_1797_21"
---
# Exhibit 21 ব
> 原始法庭文件为英文；下方为英文全文，顶部为中文摘要。
## **Exhibit 21**
ব
## BRITISH VIRGIN ISLANDS
Form: DDBVI - P2
Due Diligence Verification of Identity Form for Individual Clients
The 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.
| | Name of Company: CRYSTAL BREEZE INVESTMENTS LIMITED | | | | | | |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------|--|--|--|--|--|--|
| Nature of Business: (please V as appropriate) | | | | | | | |
| (i)
Trading | O Import/Export
V Investment Holding
Consultancy
Others (please specify):
O Manufacturing | | | | | | |
| (ii) Please provide a brief description of Company's business activilies: Finance investment, Management
Source of Funds:
VBorrowings/Loans
O Others (please specify) : | | | | | | | |
| | | | | | | | |
| Beneficial Owner / Applicant for Business | | | | | | | |
| (a) Full Name: | Guo Mei | | | | | | |
| Room 2106, Yardley Commercial Building, No 3 Connaught Road West,
(b) Business address: | | | | | | | |
| Sheung Wan, Hong Kong
(c) Permanent Residential Address: 22 SOUTH BAY ROAD, LEVEL 1 (UNIT B1), HONG KONG | | | | | | | |
| (d) Telephane: | 2160 0816 / 2160 0888 | | | | | | |
| (c) Fax: | 2160 0808 | | | | | | |
| Email:
(1) | hk.company.secretary@gmail.com | | | | | | |
| (g) Date of Birth: | 1909-01-28 | | | | | | |
| (h) Nationality: | TIONG KONG | | | | | | |
| Occupation:
(1) | MANAGER | | | | | | |
| Please attach: (1) a certified copy* of Current Passport or Identily Card; | | | | | | | |
| 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) | | | | | | | |
| * Copy may be certified by Lawyer/CPA/Bank in the attached format | | | | | | | |
| 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. | | | | | | | |
| Client Signature: | Print Name: Guo Mei | | | | | | |
| | 2017-07-04
Date: | | | | | | |
Please return this form and attachments to: Compliance Department Vistra Hong Kong 19/F, Lee Garden One, 33 Hysan Avenue, Causeway Bay, Hong Kong
## CERTIFIED TRUE COPY
I, 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
5
YU FIONA KA WING Barrister, Hong Kong SAR
被用於十八官或 以上的人士
FOR A PERSON OF THE AGE OF 18 OR OVER
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