AML CDD Compliance Form

AML CDD COMPLIANCE FORM

This AML Customer Due Diligence Compliance Form is executed on by and between Client Name: located at Client Address: and Institution Name: located at Institution Address: .

RECITALS

WHEREAS: Client seeks to open or maintain a business relationship with Institution and, in connection therewith, Institution is required to perform customer due diligence, risk assessment and ongoing monitoring consistent with applicable anti-money laundering and counter-terrorist financing obligations; and

WHEREAS: The parties intend by this Form to record Client identification, beneficial ownership, source of funds and other information necessary for Institution to satisfy its AML obligations and to enable the Institution to file any reports or take any actions required by applicable law; and

WHEREAS: Client represents and warrants the accuracy and completeness of the information provided in this Form and agrees to notify Institution promptly of any material change in such information.

NOW, THEREFORE, in consideration of the mutual covenants set forth below, the parties agree as follows:

1. DEFINITIONS

For purposes of this Form, (a) "Beneficial Owner" means each natural person who, directly or indirectly, owns or controls 25% or more of the equity interests of an entity customer or who otherwise exercises substantial control over the entity; (b) "PEP" means politically exposed person; and (c) "High-Risk Jurisdiction" means a jurisdiction identified by Institution where elevated AML risk is present.

2. CUSTOMER IDENTIFICATION

3. BENEFICIAL OWNERSHIP

Provide the following information for each individual who is a Beneficial Owner as defined above. Institution may require documentary verification of each entry below.

4. RISK ASSESSMENT AND SCREENING

Institution will perform identity verification, sanctions screening and risk-based ongoing monitoring. Client indicates the following risk-related facts (mark all that apply):

5. SOURCE OF FUNDS / WEALTH

Client must describe the origin and anticipated source of funds and wealth to be used in the relationship. Institution may require documentary evidence to substantiate these statements.

6. REPRESENTATIONS, WARRANTIES AND CERTIFICATIONS

Client hereby represents and warrants to Institution that the information provided in this Form is true, complete and correct. Client certifies that no material fact has been omitted and that any funds to be transferred or deposited are derived from legitimate sources. Client agrees to promptly notify Institution of any material change to the information provided herein.

Client consents to Institution conducting screening checks, data checks and to disclosing relevant information to law enforcement, regulators or other institutions where required by law, regulation or legitimate compliance processes. Client authorizes Institution to retain copies of identification documents and to maintain records of transactions and due diligence. Institution will process personal data in accordance with applicable law for purposes of compliance, recordkeeping and suspicious activity reporting.

7. REPORTING AND RECORDKEEPING

Institution will maintain records of identification, beneficial ownership and transactional information for the period required by applicable law and will file reports, including suspicious activity reports, where Institution in good faith determines that a reporting obligation exists. Client acknowledges that Institution may freeze or suspend accounts where required by law or where Institution reasonably suspects illicit activity.

8. NOTICES

All notices required under this Form shall be in writing and delivered to the addresses provided below or to such other address as a party subsequently designates in writing.

9. AMENDMENTS; WAIVER; SEVERABILITY

This Form may be amended only by a written instrument executed by both parties. No failure or delay by either party in exercising any right under this Form shall constitute a waiver. If any provision of this Form is held invalid or unenforceable, the remainder of this Form shall continue in full force and effect.

10. GOVERNING LAW; ENTIRE AGREEMENT

This Form shall be governed by and construed in accordance with the laws of the jurisdiction indicated below without regard to conflict of law principles. This Form, together with any attachments and verifications, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior understandings, whether written or oral.

11. COUNTERPARTS

This Form may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument. A facsimile or electronic copy of a signature shall be deemed an original for all purposes.

ACKNOWLEDGEMENT

By signing below, Client certifies under penalty of perjury (to the fullest extent permitted by applicable law) that the information provided herein is true, complete and correct, that Client consents to the actions described in this Form and that Client will provide promptly any additional documentation reasonably requested by Institution to verify identity, ownership, source of funds or any other matter relevant to AML compliance.

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