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CIS AND CARD DETAILS K CABLE 1B-1

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33 views8 pages

CIS AND CARD DETAILS K CABLE 1B-1

Uploaded by

t28851731
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Investor Transaction Code: KTPOS- 1B-26-06-23

CLIENT INFORMATION SHEET

Directions: This document must be completed in full. If a line item does not pertain then insert
the term:
“N/A” (non-applicable).

Client/Investor Information
First: Kirtsen
Middle Kirtsen Cable(s): Derin
Last Cable
Nationality: Saint Kitts and Nevis
Passport No: RE0068991
Date of Issue 05/24/2018

Expiration Date: 05/23/2028

Issued by: Saint Kitts & Nevis


Date of Birth: April 26th, 1977
Place of Birth: Saint Kitts & Nevis

Home Address
Street Address: 1576 Leslie Street, Apt. 1L
City: Hillside
State: NJ
Country: Union
Postal Code: 07205

Contact Information
TelephTen No:
Fax No: N/A
Mobile No:
Email Address: [email protected]
Skype ID: N/A

Languages / Translator
Languages: English
Does the Signatory speak English? Yes
If No, Name of Translator: N/A
TelephTen Number: N/A
Email Address: N/A
Skype ID: N/A

Legal Advisor
Full Name: Michael J. Rubin
Company: Michael J. Rubin Attorney at Law
Address: 5 Nathan Pratt Dr Unit 104
City: Concord
Investor Transaction Code: KTPOS- 1B-26-06-23

State: MA
Country: United States
Postal Code: 01742-4641
TelephTen No: 617-417-1749
Email Address: [email protected]
Skype ID: N/A

Investment
Funds available for this VISA CERTIFIED FUNDS
transaction:
Type of currency: US DOLLARS
Origin of funds: TRADE & CONSULTING PROFITS
Are these funds free and clear of YES these funds free and clear of all liens, encumbrances and
all liens, encumbrances and third third party interests:
party interests:

I, (KIRTSEN CABLE), hereby swear under penalty of perjury, that the information
providedherein is accurate and true as of this date: June 6th, 2023

Kirtsen Cable:
Title: President/CEO
Passport Number: RE0068991
Date of Issue: 05/24/2018

Date of Expiry: 05/23/2028

Country of Issuance: Saint Kitts & Nevis


Investor Transaction Code: KTPOS- 1B-26-06-23
Investor Transaction Code: KTPOS- 1B-26-06-23
Investor Transaction Code: KTPOS- 1B-26-06-23
Investor Transaction Code: KTPOS- 1B-26-06-23
Investor Transaction Code: KTPOS- 1B-26-06-23
Investor Transaction Code: KTPOS- 1B-26-06-23

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