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

## **Exhibit 21**

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## 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)<br>Trading | O Import/Export<br>V Investment Holding<br>Consultancy<br>Others (please specify):<br>O Manufacturing | | | | | | | | (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) : | | | | | | | | | | | | | | | | | | Beneficial Owner / Applicant for Business | | | | | | | | | (a) Full Name: | Guo Mei | | | | | | | | Room 2106, Yardley Commercial Building, No 3 Connaught Road West,<br>(b) Business address: | | | | | | | | | Sheung Wan, Hong Kong<br>(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:<br>(1) | hk.company.secretary@gmail.com | | | | | | | | (g) Date of Birth: | 1909-01-28 | | | | | | | | (h) Nationality: | TIONG KONG | | | | | | | | Occupation:<br>(1) | MANAGER | | | | | | | | Please attach: (1) a certified copy* of Current Passport or Identily Card; | | | | | | | | | 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) | | | | | | | | | * 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<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. | | | | | | | | | Client Signature: | Print Name: Guo Mei | | | | | | | | | 2017-07-04<br>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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