Guo Wengui / Miles Guo — bankruptcy case · EXHIBIT · ECF #1797-21

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)

Others (please specify):

(ii) Please provide a brief description of Company's business activilies: Finance investment, Management Source of Funds:

O Others (please specify) :

Beneficial Owner / Applicant for Business

Room 2106, Yardley Commercial Building, No 3 Connaught Road West, (b) Business address:

(c) Permanent Residential Address: 22 SOUTH BAY ROAD, LEVEL 1 (UNIT B1), HONG KONG

Email:

Occupation:

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.

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

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 YU FIONA KA WING Barrister, Hong Kong SAR