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This information is for the jury onlyApplication 12th INVESTORS DINNER November, 3rd 2016 Company: Street: Postal Code, City: Telephone Number:Date Founded: Contact: Email: Internet (URL):Shareholders

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This information is for reporting financial transactions to the government.

Who is required to file this information is for?

Entities that have engaged in certain financial transactions are required to file this information.

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The purpose of this information is to track financial transactions for regulatory and tax compliance purposes.

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Information such as transaction amounts, dates, and parties involved must be reported.

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