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Date:

Messrs.
Altos Escondidos SA
Panama City, Republic of Panama
RE: Mr.

Dear Sirs
The undersigned, acting in my capacity of duly Certified Public Accountant or Attorney-at-Law in
the State of _________, United States of America, hereby declare that I provide fiscal advise to
______________________________ and that he is compliance with any and all applicable
tax and fiscal legislation that affects him as a United States resident and, furthermore, that his
business within Panama, Rep. Of Panama, to my knowledge, does not contravene any tax or
other fiscal laws or regulations in the United States of America.
I also hereby certify that _______________________, is not currently insolvent and he is
not seeking to effectuate any transfer of assets to render himself or his estate insolvent.
With his signature below, ________________________, hereby expressly, specifically and
unqualifiedly agrees to wholly hold harmless and indemnify Altos Escondidos SA. or any of its
subsidiaries, their owners, members, shareholders, officers, directors, employees and agents from
any liabilities of any kind or character arising out of any lawful actions taken by them in reliance
upon any fact or statement contained in this declaration which may hereafter prove to be untrue.
Sincerely,

XXXXXX
CPA or Attorney
Signed:_____________________________

Date:_____________________________

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USA RESIDENT CITIZEN CERTIFICATION DUE DILIGENCE

  • 1. Date: Messrs. Altos Escondidos SA Panama City, Republic of Panama RE: Mr. Dear Sirs The undersigned, acting in my capacity of duly Certified Public Accountant or Attorney-at-Law in the State of _________, United States of America, hereby declare that I provide fiscal advise to ______________________________ and that he is compliance with any and all applicable tax and fiscal legislation that affects him as a United States resident and, furthermore, that his business within Panama, Rep. Of Panama, to my knowledge, does not contravene any tax or other fiscal laws or regulations in the United States of America. I also hereby certify that _______________________, is not currently insolvent and he is not seeking to effectuate any transfer of assets to render himself or his estate insolvent. With his signature below, ________________________, hereby expressly, specifically and unqualifiedly agrees to wholly hold harmless and indemnify Altos Escondidos SA. or any of its subsidiaries, their owners, members, shareholders, officers, directors, employees and agents from any liabilities of any kind or character arising out of any lawful actions taken by them in reliance upon any fact or statement contained in this declaration which may hereafter prove to be untrue. Sincerely, XXXXXX CPA or Attorney Signed:_____________________________ Date:_____________________________