Fill out the issuer's data below:

(*) Mandatory filling

• Type of issuer Foreign National
  

• Company name: *
• Tax ID: *
• CNPJ: *
• State enrollment:
• Municipal enrollment: * Yes No
  
• Investment fund? * Yes No
  Please fill out with the fund’s data and not the administrator’s.
• Government body? * Yes No
  Federal body State body Municipal

  With Agreement Without Agreement

• Full address

  • Place designation: *
  • Number: *
  • Additional address details:
  • CEP: *
  • Zip code: *
  • Area: *
  • Country: * Afghanistan Albania Algeria American Minor Outlying Islands American Samoa American Virgin Islands Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Islnd Coconut Islands Colombia Comoros Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Dutch Antilles East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guyana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauretania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Islands North Korea North Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the Southern Sandwich Islands South Korea Spain Sri Lanka St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Islands Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay USA Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis and Futuna Islands Yemen Zambia Zimbabwe
  • Name of state: * estado
  • Town: *
  • Contact (name and surname): *
  • Email address: *
  • Telephone: *

  Select your option: *

  • Analysis Fee for Listing of Issuers
  • Analysis Fee for Exclusive Deposit
  • Analysis Fee for Public Offerings of Equities
  • Analysis Fee for Public Offerings of Investment Funds - Listed B3
  • PTO and Real Estate Investment Fund PTO Analysis Fee
  • Accreditation Fee
  • Prior Analysis (20% in advance)
  • Prior Analysis (80% remaining)
  • Exceptional Treatment
  • •       Authorized ParticipantValue of the Fee: R$12,000.00
            Agribusiness DepositoryValue of the Fee: R$5,189.33
  • •       PTO Analysis FeeValue of the Fee: R$331,027.91
            Real Estate Investment Fund PTO Analysis FeeValue of the Fee: R$61,000.00

  • Select your option *	Category for Listing	Value of the Fee
    	Shares or other securities that grant the holder the right to acquire shares through conversion or exercise of rights, except for convertible debentures	R$84,412.23	84,412.23
    	Sponsored Level I BDRs	R$9,930.90	9,930.90
    	Sponsored Level II or III BDRs	R$3,974.24	3,974.24
    	Unsponsored Level I BDRs (per program to be admitted to trading)	R$3,974.24	3,974.24
    	Investment funds - Listed B3	R$12,744.96	12,744.96
    	Listing without designation of the security accepted for trading	R$16,387.19	16,387.19
    	Other Securities, per securities type to be admitted to trading	R$16,387.19	16,387.19
    	Company listing for admission to exclusively trade fixed-income securities at OTC B3	R$12,744.96	12,744.96

    Quantidade: *

    • Valor Total: R$3.500,00

    Exempt from this Fee:

    • Municipalities that request acceptance for trading of Additional Construction Potential Certificates;
    • Issuers that have had securities of their issuance accepted for trading on the organized OTC market and migrated these securities to the exchange market, or vice versa;
    • Issuers that have requested listing on and, simultaneously, adhesion to the Bovespa Mais or Bovespa Mais Nível 2 corporate governance segments;
    • Depository institution, per Unsponsored Level I BDR program, in the case of program substitution due to cancellation of trading in the underlying in the country of origin of the originally-listed Unsponsored Level I BDR.

  • Select your option *	Securities	Analysis Fee for Exclusive Deposit
    	Equities or other securities that grant the holder the right to acquire shares through their conversion or exercise of rights, except for convertible debentures	R$84,212.23
    	Real Estate Investment Funds, Equity Investment Funds and Exchange Traded Funds (ETF)	R$12,744.96
    	Other Securities	R$12,744.96
  • • Enter the Financial Value foreseen for the offer (without considering an additional lot, over-allotment option or future distribution): * (Numbers only. Use "." for cents and avoid thousands separator.)
    • Issuance: *
    • Series: *
    • Do documents for the public offering foresee distribution and trading of fixed-income securities exclusively at BM&FBOVESPA?
      Yes No

    • Select your option *	Type of security	Percentage on the financial value foreseen in the offer (%)	Value of the Fee
      	Debentures (DEB)	0.004% Minimum value: R$6,530.00 Maximum value: R$43,536.00
      	Financial Bills (LF)	0.001% Minimum value: R$6,530.00 Maximum value: R$43,536.00
      	Mortgage-Backed Securities (CRI)	0.001% Minimum value: R$1,088.00 Maximum value: R$21,768.00
      	Agribusiness Receivables Certificates (CRA)	0.001% Minimum value: R$1,088.00 Maximum value: R$21,768.00
      	Other Securities	0.001% Minimum value: R$6,530.00 Maximum value: R$43,536.00

  • Value of the Fee: R$82,775.90

    There shall be the exemption of this Fee for issuers of shares listed, or for those requesting listing, at the Bovespa Mais and Bovespa Mais Nível 2 corporate governance segments, in the scope of the Smaller Offerings Project.

  • Value of the Fee: R$15,200.12

  • Value of the Fee: R$16,882.45

  • Value of the Fee: R$67,529.78

  • Value of the Fee: R$20,000.00

• Email address for payment slip receipt: *

The issuer is entirely responsible for correctly filling out the information requested in this form and must compy with the prevailing B3 rules and policies, as applicable. If you have any questions about filling out this form, please contact us by email at [email protected].

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