Business Transparency Form

BUSINESS TRANSPARENCY FORM

WHEREAS, Company Name: (the "Company") is engaged in the provision of goods and/or services and is required to disclose certain ownership, control and compliance information to facilitate transparent commercial relationships; and

WHEREAS, Recipient Name: (the "Recipient") will receive information, engage in commercial activity, or act on behalf of the Company under the terms described herein; and

WHEREAS, the parties desire to set forth material facts concerning ownership, beneficial control, potential conflicts of interest and compliance assurances to ensure business transparency and regulatory integrity.

1. Company Information

Corporation   Limited Liability Company (LLC)   Partnership   Sole Proprietorship   Other

2. Ownership and Beneficial Control

The Company certifies that the following individuals or entities are beneficial owners holding, directly or indirectly, 25% or more of ownership or control, and will be disclosed in full below. If there are no such beneficial owners, mark the box: No beneficial owners meeting the foregoing threshold.

3. Scope of Work

Describe the goods, services or activities for which this transparency information is provided. Include deliverables, key milestones, and the recipient's role.

4. Payment Terms

Late Payment Fee: The Recipient shall pay interest on any undisputed past-due amount at the lesser of 1.5% per month or the maximum rate permitted by applicable law, calculated from the due date until paid. Specify an agreed fixed late fee if preferred:

Invoices shall include sufficient detail to identify the underlying services and shall be delivered to the invoice address provided above unless otherwise agreed in writing.

5. Term and Termination

Term Commencement Date: . Term Expiration Date: .

Either party may terminate for convenience upon written notice to the other party delivered not less than days prior to the effective termination date. Termination for cause may be effected immediately upon material breach if such breach remains uncured for a period of 15 days after written notice, or immediately for fraud or willful misconduct.

6. Confidentiality

The parties acknowledge that certain information disclosed in connection with the business relationship may be confidential, proprietary, or constitute trade secrets. Each party agrees (a) to maintain the confidentiality of the other's Confidential Information using at least the same degree of care it uses to protect its own confidential information but no less than reasonable care; (b) not to disclose Confidential Information to any third party except as required by law or with the disclosing party's prior written consent; and (c) to use Confidential Information solely for the purpose of performing obligations described in this form.

Confidential Information does not include information that (i) is or becomes generally available to the public through no breach of this obligation, (ii) was known to the receiving party prior to disclosure, (iii) is lawfully received from a third party without breach of any obligation of confidentiality, or (iv) is independently developed by the receiving party without use of the disclosing party's Confidential Information.

I acknowledge and accept the confidentiality obligations set forth above.

7. Compliance and Disclosures

The Company represents and warrants that, to its knowledge, it is not subject to sanctions, debarment, or other restrictions that would prohibit its engagement, and that it will comply with applicable anti-corruption, anti-money laundering and export control laws in performance of the Scope of Work.

Is the Company a Politically Exposed Person (PEP) or affiliated with a PEP?

Yes   No

8. Governing Law; Entire Agreement

Governing Law: The parties agree that this Business Transparency Form and any dispute arising hereunder shall be governed by and construed in accordance with the laws of:

Entire Agreement: This form, together with any attachments or exhibits incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings, representations, negotiations and agreements, whether written or oral. Any amendment or waiver must be in writing and signed by authorized representatives of both parties.

9. Certifications

By signing below, the undersigned certifies, under penalty of perjury and to the best of their knowledge, that the information provided in this Business Transparency Form is true, accurate and complete, that the signatory is authorized to bind the entity identified above, and that the entity will notify the Recipient promptly of any material changes to the disclosed information.

I certify the accuracy and completeness of the information contained herein.

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