Business Incorporation & KYC Form

BUSINESS INCORPORATION & KYC FORM

This Business Incorporation & KYC Form (the Form) is entered into on this date: by and between Incorporator Name: and Registered Agent/Filing Agent Name: .

RECITALS

WHEREAS, the Incorporator desires to form a business entity and seeks to file all necessary organizational documents for formation of the Proposed Entity under the laws of the Jurisdiction of Formation identified below; and

WHEREAS, the Registered Agent will prepare, submit and effect filings, and will perform Know Your Customer (KYC) and anti-money laundering (AML) due diligence as required by applicable law and the policies of the Registered Agent; and

WHEREAS, the parties wish to record incorporation instructions, beneficial ownership information, and certifications necessary to complete formation and to satisfy KYC requirements.

NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein, the parties agree as follows:

1. DEFINITIONS

For purposes of this Form, the following definitions apply: "Applicant" means the Incorporator identified above; "Registered Agent" means the filing agent identified above; "Beneficial Owner" means any natural person who ultimately owns or controls, directly or indirectly, 25% or more of the ownership interests of the Proposed Entity or otherwise exercises substantial control.

2. INCORPORATION INSTRUCTIONS

Corporation Limited Liability Company (LLC) Limited Partnership (LP) Other:

3. REGISTERED OFFICE AND AGENT

4. INCORPORATOR / ORGANIZER INFORMATION

Passport Driver's License National ID Other:

5. BENEFICIAL OWNERS (DISCLOSE ALL WHO CONTROL OR OWN ≥25%)

Politically Exposed Person (PEP)? Yes No    Subject to Sanctions/Watchlist? Yes No

Politically Exposed Person (PEP)? Yes No    Subject to Sanctions/Watchlist? Yes No

6. KYC CERTIFICATIONS AND AUTHORIZATIONS

The Applicant hereby certifies, under penalty of perjury, that all information provided in this Form is complete, true and accurate to the best of the Applicant's knowledge. The Applicant authorizes the Registered Agent and its representatives to obtain, verify and retain such information as necessary to satisfy KYC, AML and other regulatory obligations, including but not limited to identity verification, beneficial ownership verification, and sanctions screening.

The Applicant warrants that no Beneficial Owner or the Applicant is subject to sanctions or designated on a restricted persons list and that none is a known Politically Exposed Person unless disclosed above. If any representation is incorrect or becomes incorrect, the Applicant will promptly notify the Registered Agent in writing.

The Applicant further certifies that source of funds provided is lawful and will supply supporting documentation upon request. The Applicant agrees to indemnify and hold harmless the Registered Agent from liabilities arising from reliance on the information provided, except for willful misconduct or gross negligence of the Registered Agent.

7. DATA PROCESSING & PRIVACY

The Applicant consents to processing, storage and transfer of personal data contained in this Form for the purposes of entity formation, compliance and recordkeeping. Such processing may include transfer to service providers and competent authorities where required by law. The Applicant acknowledges that documentation submitted may be retained for regulatory recordkeeping in accordance with applicable retention requirements.

8. NOTICES

Any notice required or permitted under this Form shall be in writing and delivered to the contact details provided below. Notices are effective upon receipt.

9. AMENDMENTS, WAIVER, GOVERNING LAW, ENTIRE AGREEMENT

No amendment, modification or waiver of any provision of this Form is effective unless in writing and signed by both parties. The failure or delay by either party to exercise any right does not constitute a waiver of that right.

This Form is governed by and shall be construed in accordance with the laws of the Governing Jurisdiction specified below without regard to conflict of laws principles.

This Form, including all schedules and attachments, constitutes the entire agreement between the parties with respect to its subject matter and supersedes all prior agreements and understandings, oral or written.

10. SEVERABILITY; COUNTERPARTS

If any provision of this Form is held to be invalid or unenforceable, the remaining provisions will remain in full force and effect. This Form may be executed in counterparts, each of which is an original and all of which constitute one instrument.

11. MISCELLANEOUS

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