CLIENT INFORMATION SHEET-CIS2 – Bitcoin Mansions – A NextGen Bitcoin Houses Series

Client Information Sheet - CIS2

CLIENT INFORMATION SHEET - CIS Form

Date: 2/20/2025 In accordance with Articles 2 and 5 of the due diligence and federal banking commission circular of December 1999, concerning the prevention of money laundering, and Article 305 of the Swiss Criminal Code, the following information may be supplied to banks and to financial institutions for purposes of verification of identity and activities of the investing member, and the nature and origin of the funds which are to be utilized.

This Web Form is on a Dedicated Server and has a Secured SSL Certificate

The data collected here is CONFIDENTIAL and is not share with anyone outside of the buyer or seller principals

INSTRUCTIONS

This form can take anywhere from 20 minutes to 1 hour to complete depending on the information you have to gather. You can CLICK the SAVE button to complete later and receive a link to your Client Personal email address to reload all your data. Any Photos you loaded will NOT be reloaded, so you'll need to re-attach those files to this document at that time. Check your email for the LINK to finish and complete this form for easy reloading. The email link will come from: contact (AT) nextgenlivinghomes.com

Personal Information

Client Full Name(Required)

First Last

Client Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Client Cell Phone No.(Required)

Client Personal Email Address(Required)

Enter Email Confirm Email

For BEST Practice and Confidentiality we recommend you NOT use a 3rd Party Public email address, use an encrypted email account like https://proton.me or your corporate email account.

Nationality(Required)

Country

Passport Number(Required)

Issued By(Required)

Issue Date

Expiration Date(Required)

Upload a Photo JPEG of your PASSPORT(Required)

Max. file size: 8 MB.

Use your Mobile phone to photograph top page and photo page of your passport and attach the high resolution image here. No photo copies, No Stamps or Writing or Blockout will be accepted from your image. Must be the original passport image. IF YOU ARE SAVING THIS FORM TO COMPLETE LATER YOU WILL NEED TO REATTACH YOUR PHOTO HERE AGAIN.

Drivers License No.(Required)

Upload a Photo JPEG of your Drivers License(Required)

Max. file size: 8 MB.

Use your Mobile phone to photograph FRONT SIDE OF YOUR LICENSE and attach the high resolution image here. No photo copies, No Stamps or Writing or Blockout will be accepted from your image. Must be the original LICENSE image. IF YOU ARE SAVING THIS FORM TO COMPLETE LATER YOU WILL NEED TO REATTACH YOUR PHOTO HERE AGAIN.

Date of Birth(Required)

Place of Birth(Required)

Social Security or Medicare Number

For U.S. Residents

Where did you hear about our services?(Required)

Internet

Referral

Other

Who was your Referral?(Required)

Attorney Information

Attorney Name(Required)

First Last

Law Firm Name(Required)

Law Firm Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Attorney Office Phone(Required)

Attorney Mobile Phone(Required)

Fax number

Attorney Business Email Address(Required)

Accountant Information

Accountant Name(Required)

First Last

Accountant Firm Name(Required)

Accountant Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Accountant Phone(Required)

Accountant Mobile Phone(Required)

Accountant Fax

Accountant Business Email address(Required)

For BEST Practice and Confidentiality we recommend you NOT use a 3rd Party Public email address, use an encrypted email account like https://proton.me or your corporate email account.

Origin Of Funds Section

Origin Of Funds(Required)

Are Funds Free and Clear(Required)

YES Funds Are Free and Clear

NO Funds Are NOT Free and Clear

Brief Corporate Activity(Required)

Brief Corporate Activity Facilitator and/or Intermediary for transactions between groups and/or Buyers and Sellers of: Commodities/Banking Instruments/Bonds/Currency Exchange

Signature(Required)

I hereby swear under penalty of perjury that the information given above is accurate and true. Any information, work or service conducted hereunder is that of a private placement transaction that is exempt from the Securities Act and not intended for the general public but for Private Use Only.

Signatory Name(Required)

First Last

Passport Number(Required)

Country

Today's Date(Required)

BANKING COORDINATES FOR CLIENT DISBURSEMENTS

BANK NAME:(Required)

BANK ADDRESS:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

SWIFT CODE:

BANK OFFICER NAME(Required)

First Last

BANK PHONE No:(Required)

BANK FAX No:(Required)

A/C NUMBER:(Required)

IBAN A/C NO:(Required)

BANK ACCOUNT NAME:(Required)

BANK OFFICER'S Email(Required)

PROOF OF FUNDS

CURRENT BANK STATEMENT CURRENT BANK STATEMENT OR RECENT FIVE (5) DAYS TEAR SHEET IS THE REQUESTED ACCEPTABLE PROOF OF FUNDS. BCL, BANK LETTERS SIGNED BY BANK OFFICER(S), CERTIFICATE OF ACCOUNT OR CONFIRMATION OF FUNDS MAY BE INCLUDED AS SUPPLEMENTAL BANKING. KINDLY INCLUDE UN‐SANITIZED CURRENT BANK STATEMENT OR TEAR SHEET WITH YOUR SUBMISSION. TRANSMIT HIGH-QUALITY, COLOR SCANS OF REAL DOCUMENTS. THANK YOU.

PROOF OF FUNDS PDF DOC(Required)

If you have multiple files you can add them here

Drop files here or

Max. file size: 12 MB.

Please Read before submission

When you click SUBMIT and have attached your photos and documents please wait for this page to go to the SUCCESS page as the upload can take 30 seconds or longer depending on your Internet speed.

Bitcoin Mansions – A NextGen Bitcoin Houses Series