REGISTRATION AND UPDATING OF INTERNATIONAL SUPPLIERS

GENERAL INFORMATION

CÓDIGO: DC-03

VERSIÓN: 2

FECHA: 4/08/22

BANK INFORMATION

CLIENTS REFERENCE

In South America

In the rest of world

IMPLEMENTED MANAGEMENT SYSTEMS

VOLUNTARY DECLARATION OF SOURCE OF FUNDS AND OTHER DECLARATIONS

A. Acting on my own behalf, voluntarily, I declare under oath that the resources come from the following sources

do not come from illicit activities, nor linked to cultivation , production or trafficking of narcotic drugs, or activities contemplated in the Colombian Penal Code or in any rule that modifies or adds to it, complying with what is stated in Circular 304 - 000001 of February 2014 issued by the Superintendency of Companies, the Anti-Corruption Statute ( Law 190 of 1995) and other concordant legal regulations. The company does not allow third parties to make deposits on its behalf with funds from illicit activities or in favor of people related to them. I authorize the payment of deposits that I maintain in this institution, in the event of infraction of any of the numerals contained in this document, exempting the entity from all responsibility derived from erroneous, false or inaccurate information that I have provided in this document, or in violation of it. I authorize IMPUCHE S.A. to consult and report, to the company I represent or acting on my own behalf, to credit bureaus. As a sign of Acceptance, I sign in the place indicated on this form.

PERSONAL DATA PROCESSING AUTHORIZATION

As the owner of the data and under the parameters of Law 1581 of 2012 and the regulations that add and/or modify it, I authorize IMPUCHE S.A. to collect, store, process and dispose of the personal data requested here in accordance with its Data Processing Policy, which I have consulted on the website www.agofer.com.co. As a sign of Acceptance, I sign in the place indicated on this form.

With this signature I declare that everything stated in this form is true.

Sign Here