Exhibit A.4 – Excerpt from the Bylaws of the Brazilian College of Digestive Surgery (Colégio Brasileiro de Cirurgia Digestiva – CBCD), Article 4(III), demonstrating that membership as a Specialist requires outstanding professional achievements.

Criterion 2. Membership in associations in the field for which classification is sought that require outstanding achievement of their members, as judged by recognized national or international experts in their disciplines or fields · groupOrder=1 · order=3