NCC240009_FRO Submitted_20240105

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name: Project Blue/Vinfast Phase 1 B US EV Manufacturing Facility
2. Location of land-disturbing activity: County Chatham City or Township: Cape Fear Township
Highway/Street: Moncure-Flatwood Road Latitude(dedmaldegrees)36.6170 Longitude(decima!degrees)-79.0041
3. Approximate date land-disturbing activity will commence: Summer 2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 80 acres
6. Amount of fee enclosed: $8,000. The application fee of$100.00 per acre (rounded up to the next acre)
is assessed without a ceiling amount (Example: 8.10-acre application fee is $900). Checks should be
addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed © No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name: Van Anh Nguyen E-mail Address: [e-mail]
Phone: Office#: [phone] Mobile#: [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
VinFast Manufacturing US, LLC [phone] [phone]
Name Phone: Office# Mobile#
12777 W. Jefferson Boulevard, Ste A-101 12777 W. Jefferson Boulevard, Ste A-101
Current Mailing Address Current Street Address
Playa Vista California 90066 Playa Vista California 90066
City State Zip City State Zip
10. Deed Book No. 02331 Page No. 1024 Provide a copy of the most current deed.
Deed Book No. 02318 Pane No. 0414 Provide a copy of the most current deed.
SEE ATTACHED PDF FILES FOR DEED DOCUMENTATION

Part B.
1. Company(ies)who are financially responsible for the land-disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) if the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s)of the owner(s)may be listed as the financially responsible party(ies).
VinFast Manufacturing US, LLC [e-mail]
Company Name E-mail Address
12777 W. Jefferson Boulevard, Ste A-101 12777 W. Jefferson Boulevard, Ste A-101
Current Mailing Address Current Street Address
Playa Vista California 90066 Playa Vista California 90066
City State Zip City State Zip
Phone: Office#[phone] Mobile#[phone]
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
CT Corporation System [e-mail]
Name of Registered Agent E-mail Address
160 Mine Lake Court, Suite 200 160 Mine Lake Court, Suite 200
Current Mailing Address Current Street Address
Raleigh NC 27615 Raleigh NC 27615
City State Zip City State Zip
Phone: Office#[phone] Mobile#
Matthew Baca
Name of Individual to Contact(if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
VinFast Manufacturing US, LLC anh.nguyen@vinfastauto_com
Name of Registered Agent E-mail Address
12777 W. Jefferson Blvd, Ste A-101 12777 W. Jefferson Blvd, Ste A-101
Current Mailing Address Current Street Address
Playa Vista CA 90066 Playa Vista CA 9066
City State Zip City State Zip
Phone: Office# 949-504-9001 Mobile#[phone]
Name of Individual to Contact(if Registered Agent is a company)
Anh Nguyen

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath. (This form must be signed by the Financially Responsible Person if an individual(s)
or his attorney-in-fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.
H 14/1- WNI471 Y C'O
Type or print e Title or Authority
09 Z3 / 020).3
Signature - Date
I, (on tuiran , a Notary Public of the County of (J l a
State of North Carolina, hereby certify that \nh i Van Nc u'/en appeared personally
before me this day and being duly sworn acknowledged that the abo a form was executed by him/her.
Witness my hand and notarial seal, this A3 day of IUCLA.1 , 20 cQ15
(4167diteAt4/10A-)
Notary
My commission expires l//i/ dO
CAROLINE L CURRAN
Notary Public-North Carolina
Wake County
My Commission Expires Nov 11,2025

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 3 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 4 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.

Continued from Item 1 in Part B of the Financial Responsibility/Ownership Form for
multiple parties. Attach copies of this page as needed to list all financially responsible
parties.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#