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Date: May 19, 2025

Name of Company:

IBC Number:

We/I hereby declare the following on behalf of the above named company.

I hereby confirm this information.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Timestamp

Audit

January 16, 2023 8:11 pm CST

Declaration Of Corporate Structure Pre-Filled Uploaded by Jennine Hamilton - jenninebmct@gmail.com IP 190.197.117.87