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IDENTIFICACION
Tipo de Persona: Persona Natural Persona Jurídica X Entidad Pública
Objeto social o Actividad económica: ACTIVIDADES DE MERCADEO, DE VENTAS, IMPORTACION, EXPORTACION Y COMERCIALIZACION
DE CUALQUIER TIPO DE PRODUCTOS DE CONSUMO Y PRESTACION DE SERVICIOS DENTRO DEL TERRITORIO NACIONAL E INTERNACIONAL.
Documento de Identificación: NIT, Cédula de Ciudadanía o Extranjería, Pasaporte, etc., según corresponda
Tipo documento: C.C. C.E. NIT. X PASAPORTE OTRO:
RESPONSABILIDADES TRIBUTARIAS
Código CIIU (si es aplicable): Tarifa ICA (si es aplicable):
INFORMACIÓN SOCIAL
Socios o Accionistas (con participación mayor al 30%)
Nombres y Apellidos Identificación % Participación
RODOLFO MARTINEZ LEAL 11,309,536 100%
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Código: FOR-GFA-007
FORMATO UNICO DE VINCULACIÓN PARA
PROVEEDORES, CLIENTES Y USUARIOS Versión: 001-2012-10-11
MIEMBROS DE JUNTA DIRECTIVA
REFERENCIAS
Referencias Bancarias
Banco No. Cuenta Tipo Sucursal Teléfono Contacto
AV. VILLAS O52062569 Corriente ILarco 44441777 Jorge Patiño
Referencias Comerciales
Nombre o Razón social Contacto Teléfono
JVM IMPORTACIONES SAS FRANKYN RAMIREZ 2369433
PRODUCTOS Y SERVICIOS SURAMERICANA SAS YOHANNA ASCUNTAR PEÑA 6915123
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Código: FOR-GFA-007
FORMATO UNICO DE VINCULACIÓN PARA
PROVEEDORES, CLIENTES Y USUARIOS Versión: 001-2012-10-11
ID
Person type: Natural Person Legal Person Public Entity
Identification number: Certificate of Citizenship or Immigration, Social Security, Passport, etc., as appropriate.
(Please include the place of dispatch if ID or the country of origin if passport)
SOCIAL INFORMATION
Partners
Name and Surname Identification Number % Share
CONTACTS
Identification Number E-mail / Phone Number
Bussines Contact:
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Código: FOR-GFA-007
FORMATO UNICO DE VINCULACIÓN PARA
PROVEEDORES, CLIENTES Y USUARIOS Versión: 001-2012-10-11
Operational Contact:
Treasury Contact:
REFERENCES
Bank References
Bank No. Account Type Office Phone Number Contact
Trade References
Company Name Contact Phone Number
ORIGIN OF FOUNDS
I declare that our company and its employees are familiar with the rules concerning to detect practices associated to asset laundering, we place
utmost effort to ensure that our company is not used for such purposes.
I hereby swear under penalty of perjury, that the information provided herein and the documents attached are accurate and true, and authorize
verification of any other person or entity, public or private, without limitation, for now and while exists any relationship with any of the entities belonging
to Sociedad Portuaria Terminal de Contenedores de Buenaventura S. A. – TC BUEN S. A. or who represents their rights, and agree to update
information and / or documentation at least once a year or whenever warranted.
I further attest that the funds and/or products / merchandise engaged in this exchange transaction are derived from non-criminal origin, and are clean
and cleared. The origin of funds or goods is in compliance with the Patriot Act of 2002 and Anti-Money-Laundering Policies as set forth by the
Financial Action Task Force (TATF) 6/01.
Also, authorize TC BUEN S. A., or who represent their rights, permanently and irrevocably, for statistical purposes and for financial information or
trade, consult, inform, report, process or disclose to entities query databases, and Risk Information Centers, everything about my behavior as a client
in general.
Please complete the entire form and attach the following documents:
State Certificate
Corporative Registration
Federal ID.
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