Name

CPF(CIC)

Filiation (Mother and Father)

Birth date 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929

Birth place

Nationality

Marital status   Single     Married     Other  

Matrimonial regime

Depend. Nº

Identity card Nº

Iss. agency

State

Occupation

Current residence (street, av., floor Nº. etc) ZIP Code

City

District

State

Telephone

Celular

Residence   Relative     Owned     Leased  

For how long?

Personal E-mail

Company where you work (as an employee / partner or shareholder)

Title

Telephone

Branch line

Address

City

Permanence time / Admission date

Name

CPF(CIC)

Birth date 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991

Birth place

Identity card Nº

Iss. agency

State

Company of work (Employee/Partner/Shareholder)

Title

Telephone

Branch line

Address

City

For how long?

I declare that the information provided is an expression of the truth. I authorize the Banco Rendimento S/A, headquartered at Av. Brigadeiro Faria Lima, nº 2092 - 19th floor, registered under the CNPJ/IMF (taxpayers Identification Number) number 68.900.810/0001-38, to provide or consult data or information consolidated in the Central Bank of Brazil, as well as the Credit Risk Central (in terms of responsabilities according to the provisions of the Resolution Nº2.724 of 05.31.2000), to the Brazilian Credit Protection Central Service (SCPC) and the Credit Reporting Agency - SERASA or other bodies of registration information, in order to address the law in force and allow an adequate and consistent analysis of the credits conceived or to be conceived.

Through this instrument, we inform that the representatives listed below are our current representatives. However, they do not represent regarding any document or any obligation with Banco Rendimento S/A. We also inform that the persons listed below (natural and legal) declare as true their identifying information and their condition as a non politically exposed person, in accordance with the concept established by Circular Letter issued by the Central Bank of Brazil (Circular Letter 3,461/09 - Article 4, Paragraph 1 - Politically exposed persons are government agents that perform, or have performed in the last five years, positions, employment or relevant functions in the government, in Brazil or in other countries, territories or foreign dependencies, as well as their family members and other persons of close relationship). We also declare that they are aware of their obligation when updating their registration to declare to Banco Rendimento any changes in their condition, especially if they come to be a politically exposed person (for the purposes of this registration, a politically exposed person is anyone who holds a public office or position).

DECLARATION OF THE PURPOSE OF THE CLIENT'S RELATIONSHIP WITH THE INSTITUTION In accordance with Circular Letter 3461 of the Central Bank of Brazil, the client declares and the financial institution accepts the purposes of the relationship described below, indicating: In Column 1, only one option for the main relationship, and in Column 2, as many options as required for potential/temporary relationships.

We are responsible for the accuracy of the given information, in the view of the originals of identity document, of CPF/CNPJ and other evidential of information presented, under penalty of article 64, law number 8.383, 1991-12-30