Wealth Declaration — Clout Capital

Please complete this declaration to enable Clout Capital to refine the structural design with precise figures. All values should be stated in USD millions, reflecting fair market value as of the declaration date. Use best estimates where exact figures are unavailable — ranges are acceptable.

This form is covered by the confidentiality terms of the Executive Summary. Upon submission, the completed declaration is sent directly to guillermo@cloutcap.com and a confirmation is sent to your email address.

CONTACT

Your email address

We use this email to send you a confirmation receipt and to coordinate the next steps in the engagement.

Email address

SECTION 4.1

Personal information

Full legal name — Michael

Date of birth — Michael

Full legal name — Ada

Date of birth — Ada

U.S. state of last domicile

Singapore address (city)

Daughter 1 — full name

Daughter 1 — date of birth

Daughter 2 — full name

Daughter 2 — date of birth

SECTION 4.2

Liquid assets

All values in USD millions.

Cash & money-market (all institutions)

Public equities — direct holdings (note any single position > 10%)

Listed equities portfolio — managed / discretionary account

Fixed income & bonds

Digital assets — staking tokens

Digital assets — other crypto

ZeroStack (ZSTK) shares

SECTION 4.3

Private holdings

Particular attention to 0g Labs valuation and ownership splits — these drive the IDGT freeze sizing.

0g Labs LLC — current estimated FMV

0g Labs — Michael ownership %

0g Labs — Ada ownership %

0g Labs — last valuation event

Other private company holdings (name + FMV)

Limited partnership / fund interests

SECTION 4.4

Real estate holdings

Include primary residence, secondary residences, investment properties, and any held via existing entities.

Property 1

Location (city, country)

Type / use

FMV (USD millions)

SECTION 4.5

Alternative assets

Art collection — aggregate FMV

Single most valuable piece

Wine, cars, watches, collectibles

Yacht, aircraft, titled luxury assets

Other (specify)

SECTION 4.6

Liabilities

Mortgages on real estate

Margin loans / securities-backed lines

Other secured loans

Personal guarantees (nominal)

SECTION 4.7

Cash flow capacity

Critical for the structural design — approximately $26M of recurring annual cash flow is required during years 1–7 to service the PPLI premium. Please provide realistic estimates for each source. Values in USD (not millions — actual dollar amount).

Annual gross income — Michael (USD)

Annual gross income — Ada (USD)

Annual portfolio income (dividends + interest)

Expected annual staking yield (USD)

Expected distributions from 0g Labs, if any

Other recurring cash flow sources

Maximum annual cash flow you would commit to premium funding (USD)

SECTION 4.8

Income and philanthropic intent

Target annual philanthropic contribution (USD)

Existing foundations or DAFs

SECTION 4.9

Existing planning structures

List any existing trusts, holding companies, family limited partnerships, foundations, or insurance policies.

Entity 1

Entity name

Type

Value (USD millions)

SECTION 4.10

Health and underwriting — preliminary

PPLI underwriting will require formal medical examinations. This preliminary section helps anticipate underwriting considerations.

Michael — chronic conditions or significant medical history

Ada — chronic conditions or significant medical history

Tobacco use

Recreational activities of underwriting concern

Daughter 1 — chronic conditions

Daughter 2 — chronic conditions

SECTION 4.11

Citizenship and residency

Michael — U.S. citizen since birth or naturalized (date)?

Ada — U.S. citizen since birth or naturalized (date)?

Past expatriation considerations or §877A exposure?

Singapore tax residency — date established

Singapore LTVP / EP / PR status

Declaration

I confirm that the information provided above represents my best estimate of fair market values and personal circumstances as of the declaration date. I understand that Clout Capital will use this information to refine the structural design and that material changes should be communicated promptly. The information is submitted under the confidentiality terms of the Executive Summary CC-2026-HRC-002.

I confirm the above and authorize submission to Clout Capital.

When you click Send declaration, the completed form is submitted securely to Clout Capital. A confirmation will be sent to your email address.

Declaration submitted

Your wealth declaration has been sent to Clout Capital. A copy has been sent to your email address as confirmation.

If you have any questions, contact Clout Capital directly at guillermo@cloutcap.com.