name · on the basis of this power of attorney "unidata" ltd its officers and/or...

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NAME

MIDDLE NAME

SURNAME

+12345678911 11 11

1 2 3 4 5 6 7 8 9

11 06 01 11 09 07

2011

2 OHIO

WALMARTOcean Street, Shopping Plaza

Cleveland, OH+123456789email@email.com

BURGER KINGEden Street, Reston

Cleveland, OH+123456789email@email.com

SIGNATUREDATE

email@email.com

SIGNATURE

SIGNATURE

x

x

NAME, SURNAME

11-11-11 1 2 3 4 5 6 7 8 9

HOME ADDRESS

DATE

USA DOCUMENTS (SAMPLES)

W-2 FORM SOCIAL SECURITY CARD USA VISA

LAST PAYSLIP

DS-2019 FORM

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