Corporate 1000 Program

Corporate 1000 Format Request & Authorization Form

The Corporate 1000 Program includes exclusive card formats that are developed specifically for use by individual end-user
organizations. Organizations must qualify, formally enroll and be accepted by HID Global Corporation.

End User Company Information

Company Name : Gerao Futuro Corretora de Valores S.A.
Mailing Address: Praa Quinze de Novembro, 20; 12. andar/ Sala 1201B
City: Rio de Janeiro
State/Province/County: RJ
Country: Brasil
Zip/Postal Code: 20091-020
Company Website Link: https://www.gerafuturo.com.br/

End User Authorized Contact Names Information (Fill in 2 Contacts)

Primary Contact Secondary Contact
Contact Name: Aldeir Silva Iury Pedroso da Silva
Title: Support analyst it Support analyst it
Phone Number: +55.21.216.999.26 +55.21.216.999.04
Fax Number: +55.21.216.999.26 +55.21.216.999.26
E-mail Address: aldeir.silva@gerafuturo.com.br iury.silva@genialinvestimentos.com.br

Contact Signature:
Date Signed: 26/06/2017
Authorized HID Purchaser
Company # 1 Company # 2
Company Name Wellcare Automao Ltda
Contact Name Anderson Cavalheiro
Phone Number +55.11.993.438.479

Card numbers available within the Corporate 1000 48 bit model are 0 8,388,607. All card numbers following this number will
be blocked from use. Your first order will start at 0 unless otherwise specified.

Use this form to communicate all authorization concerning your Corporate 1000 format. It is recommended for each end-user to
maintain an original copy of this form listing all authorizations. As the End User, it is up to you to let HID know of any changes to
your Authorized HID Purchasers.

Your enrollment in this program is conditional on HIDs acceptance and approval of your request to join the program.

Send this form to HID Global for approval and processing to the following regional contacts: For the Americas:
credentialprograms@hidglobal.com , For Europe, Middle East and Africa: emea-orders@hidglobal.com. For Asia
Pacific: hidhkg_customerservice@hidglobal.com.

To add or remove authorizations, submit an HID Global Corporate 1000 Format Change Form to the same locations.
*This form must be legible to be considered acceptable. Please print or type.

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