<?xml version='1.0' encoding='UTF-8'?>
<AOAT003 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:noNamespaceSchemaLocation="AOAT003_20254.xsd">
	<Form>
		<Identification>AOAT003</Identification>
		<FormCreationDate>2022-08-11</FormCreationDate>
		<FormCreationHour>09:14:58.082</FormCreationHour>
		<AttestationStatus>0</AttestationStatus>
		<TypeForm>SU</TypeForm>
		<DclInformation>
			<LanguageCodePdf>1</LanguageCodePdf>
		</DclInformation>
		<Reference>
			<ReferenceType>2</ReferenceType>
			<ReferenceOrigin>2</ReferenceOrigin>
			<ReferenceNbr>789123456745</ReferenceNbr>
		</Reference>
		<Reference>
			<ReferenceType>2</ReferenceType>
			<ReferenceOrigin>2</ReferenceOrigin>
			<ReferenceNbr>XXXYYYZZZ</ReferenceNbr>
		</Reference>
		<EmployerDeclarationLink>
			<NOSSRegistrationNbr>141137377</NOSSRegistrationNbr>
			<Trusteeship>0</Trusteeship>
			<CompanyID>1111111111</CompanyID>
			<NaturalPerson>
				<NaturalPersonSequenceNbr>1</NaturalPersonSequenceNbr>
				<INSS>57040610511</INSS>
				<WorkRecovery>
					<WorkRecoveryDate>2003-10-01</WorkRecoveryDate>
				</WorkRecovery>
				<InsuranceLink>
					<InsurerId>1018</InsurerId>
					<PolicyIdentifier>123456789</PolicyIdentifier>
				</InsuranceLink>
				<AccidentLink>
					<AccidentDate>2003-09-14</AccidentDate>
				</AccidentLink>
			</NaturalPerson>
		</EmployerDeclarationLink>
	</Form>
</AOAT003>