Certificate of Foreign Status of Beneficial Owner

Substitute Form W-8BEN for United States Tax Withholding

(Rev. February 2014)
(Section references are to the U.S. Internal Revenue Code.)

Do not use this form for: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Instead, Use Form:

A U.S. citizen or other U.S. person, including a resident alien individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-9
A person claiming that income is effectively connected with the conduct of a trade or business in the U.S. . . . . . . . . . . W-8ECI

Definitions:
Beneficial Owner - The beneficial owner of income is generally the person who is required under U.S. Tax principles to include the income in
gross income on a tax return. A person is not the beneficial owner of income to the extent that person is receiving the income as nominee, agent
or custodian.
Permanent Residence - Your permanent residence address is the address in the country where you claim to be a resident for purposes of that
country's income tax. Do not show the address of a financial institution, a post office box, or an address used solely for mailing purposes.

Part I Identification of Beneficial Owner (See Instructions)

1 Name of individual or organization that is the beneficial owner 2 Country of Citizenship
Daniel George

3 Permanent residence address (street, apt., or suite no.) Do not use a P.O. box or in-care-of address.

Lavander Place 902 115/10-14 Liap Klong Phasi Charoen Fang Tai

City or town, state or province. Include postal code where appropriate. Country (do not abbreviate)

Nongkhaem , Bangkok , 10160 Thailand

4 Mailing address (if different from above)
Lavander Place 902 115/10-14 Liap Klong Phasi Charoen Fang Tai
City or town, state or province. Include postal code where appropriate. Country (do not abbreviate)

Nongkhaem , Bangkok , 10160 Thailand

5 U.S. taxpayer identification number, if required (see instructions) 6 Foreign tax identifying number, if any (optional)

7 Reference number(s)  'DWHRI%LUWK00''<<<<

04/23/1979

Part II Certification
Under penalties of perjury, I declare that the payee providing this certification is not a United States person (i.e., a citizen or resident of the United
States as determined for U.S. federal tax purposes, a corporation or partnership created or organized in the United States or under the law of the
United States or of any State, any estate that would be subject to U.S. federal income tax on income from sources without the United States which
is not effectively connected with the conduct of a trade or business within the United States, or any trust if a court within the United States is able to
exercise primary supervision over the administration of the trust and one or more United States persons have the authority to control all substantial
decisions of the trust), that the income to which this certification relates is not effectively connected with the conduct of a trade or business in the
United States, and that the undersigned has examined the information on this form and to the best of my knowledge and belief it is true, correct, and
complete. Furthermore, I authorize this form to be provided to any person that has control, receipt, or custody of the payment to which I am entitled
or any person that can disburse or make the payments to which I am entitled.

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications (Part II of the Substitute
W-8BEN) required to establish your status as a non-U.S. person.

E-Signed by:Daniel George Fluture 10-01-2016

Sign Here
Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM/DD/YYYY) Capacity in which acting