Dados Pessoais

Nome Completo Data de Nascimento CPF

JOSÉ AUGUSTO GONÇALVES FERREIRA 07/08/1968 951.649.017-49

Telefone Celular Telefone Residencial E-Mail

+55 (21) 996110485 augusto.f2003@gmail.com

RG UF Expedição Orgão Emissor

07748701-5 RJ Diretoria de Identificação Civil

Data de expedição

12/03/2020

CNH - Número de Registro Número de segurança

-- --

Sexo Nacionalidade Naturalidade

Masculino Brasileira Rio de Janeiro

Estado Civil Nome do Cônjuge

União Estável Tanice Borges dos Santos

Nome da Mãe Nome da Pai

Zulmira da Conceição Lima Gonçalves Ferreira José Ferreira

Dados Residenciais

Endereço Residencial
Logradouro Número

Rua São Francisco Xavier 92 A

Complemento Bairro

casa 1 Tijuca

Cidade Estado CEP

Rio de Janeiro RJ 20550012

País

BRA
Dados do Beneficiário
Nome Completo CPF

Data de nascimento

--

Endereço Beneficiário
Logradouro Número

-- --

Complemento Bairro

-- --

Cidade Estado CEP

-- -- --

País

--

Dados Comerciais
Atividade Atual Posição Tipo de Negócios

Empregado Agente Administração Pública

Empresa

DEGASE

Endereço Comercial
Logradouro Número

Rua Taifeiro Osmar de Moraes 111

Complemento Bairro

Galeão

Cidade Estado CEP

Rio de Janeiro RJ 21941455

País

BRA

Dados Financeiros
Renda Mensal Valor aprox. Dos Bens Aplicações Financeiras

R$ 5.000,00 R$ 600.000,00 R$ 150.000,00

Banco Agência Conta

341 4096 464138

Perfil de Investimento
Prazo de Investimentos Necessidade de Liquidez Experiência com Investimentos

Médio Prazo Média Média

Perfil de Risco Objetivo de Investimento

Agressivo Gerar Renda Adicional

Contato de Confiança
Nome Completo Telefone

Rosa Cristina Gonçalves Ferreira +55 (21) 992582724

Informações Adicionais
Você, seu cônjuge ou qualquer outro membro da família, incluindo pais, sogros, irmãos e dependentes são empregados ou associados ao Setor de Valores Mobiliários? (Exemplo:

proprietário, sócio, diretor ou gerente de filial de uma corretora ou uma agência reguladora financeira) Não

Você é um diretor ou acionista com 10% (ou mais) em uma empresa pública? Não

Você é um oficial militar, membro do governo ou organizações políticas? (Consideram-se pessoas politicamente expostas os agentes públicos que desempenham ou tenham
desempenhado, nos últimos cinco anos, no Brasil ou em países, territórios e dependências estrangeiros, cargos, empregos ou funções públicas relevantes, assim como seus

representantes, familiares e outras pessoas de seu relacionamento próximo (Circular BCB 3.461/2009)) Não

US Person? Não

Aceite eletrônico dos termos

Termos de Uso (Avenue Securities): d692d3b2-77f5-4bf9-8df1-
0de31be0874e;terms_us_agreement.pdf;1545423034632836;2ada0773d952cf0a8a601008e02c5c309ac0565a294d0d9c272b5edd9b270d5d;2804:14d:5c20:44c5:93e:c303:c592:5058;2022-
01-18T14:01:04.914Z
Política de Privacidade (Avenue Securities: d692d3b2-77f5-4bf9-8df1-
0de31be0874e;privacy_agreement.pdf;1544109889968571;668202c22898918d18f5ddcb593b49b72e420cd0cbb6182fa9d16a9e8a0be88e;2804:14d:5c20:44c5:93e:c303:c592:5058;2022-
01-18T14:01:04.913Z
Customer Agreement (Avenue Securities): d692d3b2-77f5-4bf9-8df1-
0de31be0874e;customer_agreement.pdf;1602768207828480;d6f120d86aac35d3d1f516747b2fcc39e6e68c750ab22d0b11ab467c1aded184;2804:14d:5c20:44c5:93e:c303:c592:5058;2022-
01-18T14:01:04.911Z
Customer Account Agreement (Drive Wealth):
Termos de Uso (Avenue Meios de Pagamento):
Contrato de Abertura de Conta (Bexs): d692d3b2-77f5-4bf9-8df1-
0de31be0874e;bexs_agreement.pdf;1544109890374840;7b25f452c9a63750fd3055e26ff85aac772e2c49cdfa0fdb16b88a89b16ac6ec;2804:14d:5c20:44c5:93e:c303:c592:5058;2022-01-
18T14:01:04.911Z
Customer Account Agreement (Apex): d692d3b2-77f5-4bf9-8df1-
0de31be0874e;apex_customer_agreement.pdf;1602768175891494;560506c7cff2847a7c2f8d8fc67c354c404dd9d267ab411e188132742ca2a930;2804:14d:5c20:44c5:93e:c303:c592:5058;2022-
01-18T14:01:04.915Z
Formulário CRS: d692d3b2-77f5-4bf9-8df1-
0de31be0874e;form_crs_pt.pdf;1631570145470838;da6d1f0f4d2bbce977aaa749d0a8eb03f6c1536a646cef6aa4b0be4e6921e6e0;2804:14d:5c20:44c5:93e:c303:c592:5058;2022-01-
18T14:01:04.915Z
Outros Contratos: Sim
 Form W-8BEN Certificate of Foreign Status of Beneficial Owner for United
Form W-8BEN States Tax Withholding and Reporting (Individuals)
(Rev. July 2017) Certificate of Foreign Status of Beneficial Owner for United OMB No. 1545-1621
For use by individuals. Entities must use Form W-8BEN-E.


(Rev. July of
Department 2017)
the Treasury States
 Tax Withholding and Reporting (Individuals) OMB No. 1545-1621
 Go
For to www.irs.gov/FormW8BEN
use for instructions
by individuals. Entities must and the latest information.
use Form W-8BEN-E.
Internal Revenue Service 
Give this form to the withholding agent or payer. Do not send to the IRS.
Department of the Treasury 
Go to www.irs.gov/FormW8BEN for instructions and the latest information.

Internal Revenue Service Give this form to the withholding agent or payer. Do not send to the IRS.
Do NOT use this form if: Instead, use Form:
Do NOT
• You areuse
NOTthis
an form if:
individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Instead, use Form:
. . W-8BEN-E
•• You
You are
are a U.S.ancitizen
NOT or other
individual . . U.S.
. . .person,
. . . . including
. . . . . a. resident
. . . . .alien
. . .individual
. . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. W-8BEN-E
W-9
•• You
You are
are aa U.S.
beneficial owner
citizen claiming
or other that income
U.S. person, is effectively
including connected
a resident with the. conduct
alien individual . . . . .of. trade. . . or . .business
. . . . .within. . . the. . U.S.
. . . . . . . . . . . . . . . W-9
• You are (other than personal
a beneficial services)
owner claiming that. income
. . . . .is.effectively
. . . . . .connected
. . . . . .with
. . the
. . conduct
. . . . .of. trade
. . . or . .business
. . . . .within. . . the. . U.S.
. . . . . . . . . . . . . . . W-8ECI
• You are (other
a beneficial owner who
than personal is receiving
services) . . . compensation
. . . . . . . . for
. .personal
. . . . .services
. . . . performed
. . . . . . in
. .the
. .United
. . . .States
. . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. W-8ECI
8233 or W-4
•• You
You are
are a
a beneficial
person acting as who
owner an intermediary . . . . . . . . for
is receiving compensation . .personal
. . . . .services
. . . . .performed
. . . . . in
. .the
. .United
. . . .States
. . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. W-8IMY
8233 or W-4
• You are a person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY
Note: If you are resident in a FATCA partner jurisdiction (i.e., a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be
provided to your
Note: If you jurisdiction
are resident in aof partner jurisdiction (i.e., a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be
residence.
FATCA

Part I provided
Identification jurisdiction
to your of BeneficialofOwner
residence.
(see instructions)
Part I 1 Name of individual
Identification who is the Owner
of Beneficial beneficial
(seeowner
instructions) 2 Country of citizenship
JOSÉ AUGUSTO GONÇALVES FERREIRA Brasileira
1 Name of individual who is the beneficial owner 2 Country of citizenship
Brasileira
3 JOSÉ AUGUSTO
Permanent GONÇALVES
residence FERREIRA
address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
Rua São Francisco Xavier, #92 A casa 1
3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
Rua
City orSão Francisco
town, Xavier, #92
state or province. A casa
Include 1 code where appropriate.
postal Country
Rio de Janeiro, RJ, 20550012 BRA
City or town, state or province. Include postal code where appropriate. Country
4 Rio de Janeiro,
Mailing addressRJ, 20550012
(if different from above) BRA

4 Mailing address (if different from above)

City or town, state or province. Include postal code where appropriate. Country
City or town, state or province. Include postal code where appropriate. Country
5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions) 6 Foreign tax identifying number (see instructions)
951.649.017-49
5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions) 6 Foreign tax identifying number (see instructions)
7 Reference number(s) (see instructions) 951.649.017-49
8 Date of birth (MM-DD-YYYY) (see instructions)
1968-08-07
7 Reference number(s) (see instructions) 8 Date of birth (MM-DD-YYYY) (see instructions)
Part II 1968-08-07
Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions)
Part II9 Claim
I certifyofthat
Taxthe
Treaty Benefits
beneficial (forischapter
owner 3 purposes
a resident of Brasileira
only) (see instructions) within the meaning of the income tax
9 Itreaty
certifybetween
that thethe United owner
beneficial States is
and that country.
a resident of Brasileira within the meaning of the income tax
10 Special rates and
treaty between the conditions (if applicable—see
United States and that country.instructions): The beneficial owner is claiming the provisions of Article and paragraph
10 Special rates and conditions (if applicable—see
of the treatyinstructions):
identified onThe
line beneficial
9 above toowner
claimisa claiming the provisions
% rateofofArticle and paragraph
withholding on (specify type of income):
of the treaty identified on line 9 above to claim a % rate of withholding on (specify type of income):

Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of withholding:
Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of withholding:

Part III Certification

Part III Certification
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further
certify under penalties of perjury that:
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further
•certify
I amunder
the individual
penalties that is the that:
of perjury beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or
am using this form to document myself for chapter 4 purposes,
• I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or
•am The
usingperson named
this form on line 1 of
to document this form
myself is not a4U.S.
for chapter person,
purposes,
person named
• The income onthis
to which lineform
1 of relates
this form
is: is not a U.S. person,
(a)
• not
Theeffectively
income toconnected
which this with
formthe conduct
relates is: of a trade or business in the United States,
(b) effectively
(a) not connected
effectively but with
connected is notthe
subject to tax
conduct of aunder
tradean
or applicable
business inincome tax treaty,
the United States,or
(c) the partner’s share of a partnership's effectively connected .
income,income tax treaty,
(b) effectively connected but is not subject to tax under an applicable or
•(c) the
Thepartner’s
person named onaline
share of 1 of this form
partnership's is a resident
effectively of theincome,
connected . on line 9 of the form (if any) within the meaning of the income tax treaty between
treaty country listed
the
• TheUnited States
person and that
named country,
on line andform is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty between
1 of this
•the For broker
United transactions
States or barterand
and that country, exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
• For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.

Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or
any withholding
Furthermore, agent that
I authorize thiscan disburse
form or make to
to be provided payments of the income
any withholding agent of which
that I am the receipt,
has control, beneficial
or owner.
custody of the income of which I am the beneficial owner or
I agree
any that I will
withholding submit
agent thatacan
new form within
disburse 30 days
or make if anyofcertification
payments the income ofmade onI this
which form
am the becomes
beneficial incorrect.
owner.
I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect.
JOSÉ AUGUSTO GONÇALVES FERREIRA 2022-01-18



Sign Here
JOSÉ AUGUSTO
Signature GONÇALVES
of beneficial owner (or FERREIRA
individual authorized to sign for beneficial owner) 2022-01-18
Date (MM-DD-YYYY)
Sign Here
JOSÉ AUGUSTO
Signature GONÇALVES
of beneficial owner (or FERREIRA
individual authorized to sign for beneficial owner) Date (MM-DD-YYYY)
JOSÉ AUGUSTO GONÇALVES FERREIRA
Print name of signer Capacity in which acting (if form is not signed by beneficial owner)
Print
For Paperwork Reduction Act Notice, seename of signer
separate instructions. Capacity in 25047Z
Cat. No. which acting (if form is not
Form signed by
W-8BEN beneficial
(Rev. 7-2017)owner)
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25047Z Form W-8BEN (Rev. 7-2017)