United States Bankruptcy CouÉ, DÍstrict of New Jersey (Trenton) H

3033ê

lf you are a U.S. client: EI BlockFiWallet LLC (Case No. 22-19366)

MMLID: 15830146
lÍ you are a non-U.S. client: EI BlockFi lnternational Ltd. (Case No. 22-19368)

Modified Official Form 410

Wallet Account Ho]der Proof of Glaim Form
Read the instruc{ions before filling out this form. This form is for making a claim based on asseb held in account of the Debtots. use this 894!
form to assert any other pre-petition claims. Do not use this Íorm to make a request Íor payment of an administraüve expense. Make such a request
[Link] to 11 U.S.C. § 503.
Filers must leave out or redact infonnation that is entitled to privacy on this íorm or on any attached documenls. Attact redacted copies of any
documents that support the claim, such as promissory notes, purchase orders, invoices, itemized statements of running accouilts, contracts, judgments,
mortgages, and securi§ agreements. Do not send original docurnents; they may be destroyed after scanning. If the documents are not available,
explain in an atÍachment.
A person who Íiles a fraudulent claim could be fined up to $500,000, imprisoned for up to 5 years, or both. 18 U.S.C. §§ 152, 157, and 3571.

Fill in all the information about the claim as of the date the case was filed {November 28,2422L

ldentiff t{re Glaim

GonÇaló CEIqúInha§
creditor?
Name oÍ lhe cunent creditor (the person or entity to be paid for this claim)

Other names the cred:tor used with thêdebtor

Cuslomer ldentifrcation Numbe(s):

Email Mdress Used to Siqn Up for vour BlockFi Accouni{s):

Has this claim been

acquired from
E t'to
someone else? E Yes. Fromwhom?
lÍlÍhere should notices Slhere shouH notices to the ereditor besent? Ulllrere should payments to the creditor be sêff?(iÍ
and payments to the diÍferent)
creditor besent? Gonçalo Calquinhas
Federat Rute of Rua Damão N13, 3Dto Queluz Lisboa 2745-884 Nalne-
Bankruptcy Procedure Quetuz Lisboa 2745884
iFRBP) 2002{9) Portugal
Numbêr Streêt

Siate ZIP Code

Country (lf outside of the US)

Contact phone
Contact phone

Contact email Contact email

Does this claim amend E No

onealreadyfiled? E yes. claimnumberoncourtclaimsregistry(ifknown)- Filedon
MM IDD /YYYY

Do you know ifanyone tr No

else has filed a prooÍ
of claim for this claim?
u Yes. Who made the earlierÍiling?

Wallet Account Holder Proof of Claim Form page 1

 Give Information About the Glaim as of November ZBr 2OZ2

5. Do you have anynumberyou E Uo

use to identiÍy thedebtor? U Yes. Last 4 digits oÍ the debtor's account or any number you use to identify thedebtor;

a. To the extent that you asseÉ a a

laim that is denominated in US
rollars, list thê value of the claim in
lS Dollars as of the date the ca$e was
led {November 28,20221

rb. ListthenumberofeachtypeofcoinheldinyourWalletaccount(slasofÍhedatethecaseyyasfiled(November28,2O22)(í.e.,
listthelNKIND
]OlN BALANCE in your Wallet account{s) as of the daÍe the case was filed).

Sitcoin {BTC) $16,206.3000

ithereum {ETH} $í,'r672400
Êemini Dollar {GUSD) $r.0000
JSD Goin {USDG} $í.0000
linch Neâror*1 {INCH} $0.5170
\ave (ÂAVE) $60.í500
\lgorand (ALGO) $0.2359
\valanche (ÀVAX) $12.4500
lxie lnfinity (AXS) s6.5600
Basic Âttertion Tokea {BÀT) io.?,.32
3inance Coin (BNB) $292.7865
3itcoin Cash (BCH) $109.9í00
linance USB {BUSD) $'r.0000
Sardano (ADA) $0.3064
)hainlink (LlN§ §7.194{)
)elo (CE|-O) $0.6í70
)hiliz (CHZ) $0.Í642
)ompound (COMP) $37.í600
Sosmos {ATOM} $9.8590
]uwe DAOToken {CRV) $0.6450
)eeentraland (MANA) $0.3862
)ogeCoin (DOGE) $0.09506
rYdx (DYDX) $1.6660
Elrond (EGLD) $42.í390
injin Coin {ENJ} $0.2960
ios (Eos) $0.9034
:antom
{FTM) $0.2049
:ilecoin (FlL)
$4.2530
TX Token {FTr) $1.2923535
iala (GA|-"A) $0.02478
{edera Hashgraph {HB/\R} $0.0/186

Wallet Account Holder Proof of Claim Form page 2

tusama (KSM) $25.5900

-itecoin (LTC) $73.8500

-oopring (LRC) $0.2368

lÀaker (ItllKR) $645.4100

úulti Gollateral Dai (DAl) s0.9997

{ear (NEAR) $í.5900

}MG Network (OMG) $í.1505

3ne Coin {ONE) $0.0í37

,AX Gold {PAXG} $1,7/10.6400

,axos Standard Token {PA§ $1.0000

,olkadot {DOT) $5.1340

,olygon {MATIC) $0.8209

luant (QNT) $í12.4í00

lenderToken (RNDR) $0.4672

ierum {SRM} $0.2330

iolana (SOL) $13.3200

ttellar (XLM) $0.087í83

SushiSwap (SUSHI) $'r.s348

SynthetÍx {SNX} $1.6€20

[erra 2.0 (LUNA]

=-"*-*§õ.6õõ15ãã
lether {USDT} $0.9995

lezosffiZ) $0.9750

lhe Graph (GRT) $0.0622

[he Sandbox (SÀND] $0-5531

lH0Rchain {RUNE} $r.1670

lron (IRX) $0.052973

IrueUSD (TUSD) $0.9997

Jniswap (UNl) $5.2830

lYaves (tiÍAVES) $2.3300

í[Link] {YFl} $6,266.5000

)ther íPlease Specifu)

Wallet Account Holder Proof of Claim Form page 3

 What is the basis of Exarnples: Client Âccount, goods sold, rnoney loaned, Iease" seruices perÍormed, or personal injuryfurrongfill death.
i, the clairn?
Attach redacted copies of any documents supporting the claim required by Bankruptcy Rule3001(c).
Limit disclosing information ihat is entitled to privacy, such as health careinformation.

ie. ls all or part of the E tto

claim secured? Ü Yes. The claim is secured by a lien cn properiy.
Nature of propedy:
D Reat estate, IÍ the claim is secured by the debtor's principal residence, file a Mortgage Proof of Claim
Attachment (OÍfrcial Form 410-A) with lhis Proaf af Claim.
ff Motor vehicle
E Other. Describe:

Basis for perfection:

Attach redacted copies oí documents, if any, that show evidence of perfection of a security inierest{for example,
a mortgage, Iien, certificate of title, financing statement, or other document that shows the lien has been filed or
recorded.)

Value of property:

Amount of the claim that is secured:

Amount of the claim that is unsecured: $_____________(The sum of ihe secured and unsecured
amounts should match the amount in tine 7.)

Amount necessary to cure any deÍautt as of the datê of thepetition:

Annual lnterest Rate (when case was Íiled)_%

B rixed
D Variable

10. ls this claim based ü t'to

on a lease?
f,l Yes" Amount necessary to cure any default as of the date of the petition.

1 1. ls this claim []ruo

subject to a right of
setoff? E Yes. ldentÍÍy the property:

12. ls all or paÉ of the fl tto

claim entitled to
priority under 11 fl Yes. Checkone: Amount entitled to priori§
U.s.c. § 507(a)?
I Domestic support obligations (including alimony and child support)
A claim may be under I 1 U.S.C. § 507(a)(1)(A) or (a)(1)(B). b
partly priority and
partly nonpriority. E Up to $3,350- of deposits toward purchase, lease, or rental of property or services
For example, in for personal, Íamily, or household use. 11 U.S,C. § 507(a)(7).
some categories,
E Wages, salaries, or commissions (up to $15,150") eamed within 180 days beforethe
bankruptcy petition is filed or the debtor's business ends, whichever is earlier.
11 U.S.C. § 507(a)(4).

E Taxes or penalties owed to governmental units. 11 U.S.C. § 507(a)(8).

E Contributions to an employee beneÍit plan. '11 U.S.C. § 507(a)(5).

B Other. Speciíy subsection oÍ 11 U.S.C. § 507(a)( ) that applies.

" Amounis are subject to adjustment on 4/01/25 and every 3 years âfter that for cases begun on or after the date of

Wallet Account Holder Proof of Claim Form page 4

 S-gn BeIow

The person completing Check the appropriate box:

this proof of claim must
sign and date it. I I am the creditor.
FRBP S01í(b).
tr l am the creditor's attorney or authorized agent.
lÍ you Íile this claim tr I am the trustee, or the debtor, or their authorized agent- Bankruptcy Rule 3004.
electronically, FRBP
5005{a)(2) authorizes ceurts
tr I am a guarantor, surety, endcrser, or other codebtor. Bankruptcy Rule 3005.
to establish local rules I understand that an authorized signature on this Proof of Claim serves as an acknowledgment that when
calcutratingihe
specÍfying what a signature amount of the claim, the creditor gave the debtor credit Íor any payrnents received toward thetiebt.
is.
I have examined the inÍormation in this Froof of Clairn and have a reasonable belief that the information is true
A person who files a and correct.
fraudulent claim could be
fined up to $500,000, I declare under penalty of perjury that the foregoíng is true and corêct.
imprisoned for up to 5
years, or botà. Executed on date (mm/ddlyyyy)
18 U.S-C. §§ 152, 157, and
357Í.

Signature

Name of the person who is compteting and signing this claim:

Name
First name Middle name Last name

Title

Company
ldeniífy the corporãie servicêr as thê company if the auihorizêd agênt is a servicer

Staie ZIP Code

Contact phone Email

Wallet Account Holder Proof of Claim Form page 5