Business CDD Form

Business Customer Due Diligence Form and Engagement Agreement

Client Name:    Provider Name:

RECITALS

WHEREAS, Client Name: seeks to engage Provider Name: to provide the services described herein and requires that Provider conduct customer due diligence consistent with applicable internal compliance procedures;

WHEREAS, the parties desire to document the scope of engagement, information to be collected and verified, and the contractual terms governing the relationship, including confidentiality and payment terms;

WHEREAS, the information supplied by Client will be relied upon by Provider for risk assessment and ongoing monitoring; Client certifies that all information provided is complete and accurate to the best of Client's knowledge.

BUSINESS IDENTIFICATION

Corporation    LLC    Partnership    Sole Proprietorship    Other:

BENEFICIAL OWNERS AND CONTROLLING PERSONS

List all beneficial owners with 25% or greater ownership and all senior managing controllers. Add additional pages if necessary.

If additional owners exist, attach a separately signed schedule identifying each beneficial owner, percentage of ownership, date of birth, nationality and method of identity verification.

DOCUMENTS PROVIDED / ATTACHMENTS

Certificate of Incorporation / Formation    Articles / Charter    Operating Agreement / Bylaws

Government ID for beneficial owners    Proof of Address for business    Corporate Resolution authorizing signatory

Financial Statements    Bank Reference    Other:

SOURCE OF FUNDS / BUSINESS ACTIVITY

AML / KYC CHECKS COMPLETED

Identity verification completed    Sanctions screening performed    PEP screening performed    Adverse media review performed

Risk rating (select one):   Low   Medium   High

SCOPE OF WORK

PAYMENT TERMS

TERM AND TERMINATION

Either party may terminate this engagement for cause upon material breach that remains uncured for the notice period above. Provider may suspend services immediately upon receipt of incomplete or materially inaccurate customer due diligence information or upon reasonable suspicion of fraud, unlawful activity, or sanctions exposure.

CONFIDENTIALITY

Each party shall keep confidential all non-public business and customer information received in connection with this engagement and shall not disclose such information except (a) to employees, agents or professional advisors who have a need to know and who are bound by comparable confidentiality obligations; (b) as required by applicable law, regulation or lawful order of a competent authority; or (c) with the other party's prior written consent. Confidential information shall be used only for the purposes of performing obligations under this Agreement. Remedies at law may be inadequate for breach; the non-breaching party shall be entitled to equitable relief in addition to other remedies.

Client and Provider acknowledge and agree to the confidentiality obligations set forth above.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of without regard to its conflicts of law principles.

ENTIRE AGREEMENT

This document, including any attached schedules and exhibits, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written. Any amendment must be in writing and signed by both parties.

CERTIFICATION AND ATTESTATION

By signing below, the undersigned authorized representative certifies, under penalty of perjury to the fullest extent permitted by applicable law, that the information contained in this Business CDD Form and any supporting documents provided to Provider is true, correct and complete, and that the signatory is authorized to bind the entity identified herein.

I certify that the information provided is true and accurate.

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