MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
Date: July 03, 2022
Undertakings have to be given to the Financial Institutions in order that everything may be in place
to ensure proper execution of the obligations concerning verification of the identity of the
contracting partner and identification of the beneficial owner as established in the articles 2 to 5 of
the Due Diligence Convention, the Federal Banking Commission circular of December 1991
concerning the prevention of money laundering and articles 305 the terms of the Swiss Criminal
Code. When an Investor is introduced, undertakings have to be given to the Financial Institutions
to supply all the information concerning the Investor’s identification and activities and the nature
and origin of the funds, which are to be deposited with the Financial Institution. All parties are
obligated to respect professional secrecy and take all appropriate precautions to protect the
confidentiality of the information in holds in respect to their activities. Each party has a legal
obligation to respect professional secrecy, which shall remain in force at all times.
PERSONAL INFORMATION
COMPANY NAME: MEDEVI GMBH
REPRESENTED BY: MR. REIKO BLAHA
PASSPORT NUMBER: C3FWFFN22
DATE OF ISSUANCE: 15.05.2019
DATE OF EXPIRATION: 14.05.2029
COUNTRY GERMANY
BUSINESS INFORMATION
COMPANY NAME: MEDEVI GMBH
REGISTER ADDRESS: KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
REGISTRATION NO. DISTRICT COURT OF POTSDAM HRB 34753 P - 07 09 2016
REPRESENTED BY: MR. REIKO BLAHA - MANAGING DIRECTOR
ACTIVITY COMPANY HOLDING COMPANY
MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
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MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
HIP OMMERCIALCOMERCIAF TUNG HIP OMMERCIA
:
BANK INFORMATION
BERLIN
BANK NAME: DEUTSCHE BANK AG
BANK ADDRESS: BAHNHOFSTR. 6, 12555 BERLIN – KÖPENICK, GERMANY
BANK BRANCH/SORT CODE: 89022
BANK SWIFT CODE: DEUTDEDB101
GPI CODE DEUTDEDB101
BANK ACCOUNT NUMBER: 0156 4640 00
IBAN NUMBER DE21 1007 0124 0156 4640 00
ACCOUNT NAME: MEDEVI GMBH
BANK OFFICER NAME STEFAN SCHMIDT - WINKEL
BANK OFFICER EMAIL stefan.chmidt@db.com
BANK PHONE FAX Tel.: +49 30 6566010 Fax: +49 30 65 66 01 20
ISIN: DE0005140008
TRANSACTION SERVER ID: AS8373
TRANSACTION SERVER IP: 193.150.166.0/24
BANK SOURCE TRANSACTION ID: 09512DEUTDEFFXXX886479
COMMON ACCOUNT / LEDGER ACCOUNT 20338000000
SERVER TERMINAL DB: S020005635
IDENTITY CODE: HSB1288400
TRANSACTION CODE: DE68709696633/NCM36BNI54
UNIQUE TRANSACTION REFERENCE (UTR): DE552908057743318/5397
DB IDENTIFICATION CODE: 27CDBFRDE17BEH
CLIENT NAME: DEUTSCHE BANK AG
GLOBAL SERVER ID (ORIGIN): AS8373
GLOBAL SERVER IP: 193.150.166.0/24
USER NAME: HK980535
CURRENCY: EURO
IDENTTITY CODE: HSB1288400
LOGON DOMAIN HK980535
SERVER ID AS8373
SERVER COMMON ACC N° S020005635
WTS SERVER AS8373
WINDOW TERMINAL SERVER S020005635
IP LOGIN TO. SERVER (DOMAIN): 193.150.166.0/24
MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
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MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
HIP OMMERCIALCOMERCIAF TUNG HIP OMMERCIA
I hereby swear under the full penalty of perjury, that the information provided herein is both true
and accurate. I am in control of the assets stated above, and have signatory authority on the
aforementioned bank account and have full authority to execute all contracts and agreements
relating to pleading the assets for a loan. The funds are in full compliance with the anti-money
laundering policies set forth by the Financial Action Task Force (FATF) 6/01.
All Statements made herein are under penalty of perjury and with my full responsibility so stated
on this day the date: JULY 03, 2022
MEDEVI GMBH
___________________________________________
NAME MR. REIKO BLAHA
PASSPORT NR C3FWFFN22
DATE OF ISSUE 15.05.2019
DATE OF EXPIRY 14.05.2029
COUNTRY GERMANY
MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
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MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
HIP OMMERCIALCOMERCIAF TUNG HIP OMMERCIA
PASSPORT COPY - MR. REIKO BLAHA
MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
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MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
REGISTER COMPANY
MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
Page 5 of 7
MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
Page 6 of 7
MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
IBAN VALIDATION
MEDEVI GMBH
KIRCHSTRASSE 1, 15806 ZOSSEN, GERMANY
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