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Of Double Taxation) Certificado (Certificate) No l.- IDENTIFICACION DE LA PERSONA (Identification of the person) 1 Nombre o Raz n Social (Name) 1 1 Tipo de contribuyente h 1 e of taxpayer) Persona Natural (IndMduaU Persona Jur dica (LegaiPerson) Otra Entidad (Other Entity) 1 Direcci n (Address) 1 Calle (Street) Comuna (Municipality) N" l l Se certifica, para efectos del Convenio para Evitar la Doble Tributaci nvigente entre Chile y , que la persona individualizada en el pres.

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