Client KYC Information Sheet

CLIENT KYC INFORMATION SHEET

RECITALS

WHEREAS: Client Name:

WHEREAS: The Client seeks to establish a business relationship and to obtain financial and/or professional services from the Recipient for the purposes described in this form; and

WHEREAS: The Recipient requires complete and accurate identification, ownership and source-of-funds information to satisfy applicable anti-money laundering, counter-terrorist financing and related compliance obligations.

BASIC IDENTIFICATION

ENTITY / INDIVIDUAL TYPE

Select all that apply: Individual Corporation Partnership Trust Other:

SCOPE OF RELATIONSHIP / SERVICES

Describe the intended nature and scope of the relationship, the services requested, and the expected use of accounts or facilities:

BENEFICIAL OWNERS (Individuals with 25% or more ownership OR otherwise controlling)

Provide details for up to three beneficial owners. Attach additional sheets if necessary.

AUTHORIZED SIGNATORIES

Provide the names and titles of individuals authorized to act on behalf of the Client.

IDENTIFICATION DOCUMENTS PROVIDED

Check all documents provided and enter identifying details where requested.

Passport — No.:

National ID Card — No.:

Proof of Address (utility bill/bank statement) — Date:

Certificate of Incorporation / Formation

Other:

NATURE AND SOURCE OF FUNDS / WEALTH

Provide a clear description of the origin of funds, anticipated funding sources, and any material sources of wealth.

EXPECTED ACTIVITY

SANCTIONS, PEP AND COMPLIANCE DECLARATIONS

The Client certifies the following (check where true and provide details as indicated):

The Client is not subject to any sanctions or embargoes in jurisdictions applicable to the Recipient.

The Client or any beneficial owner is a Politically Exposed Person (PEP). If checked, provide details below.

REPRESENTATIONS, CONSENT AND AUTHORIZATIONS

By signing below, the Client represents and warrants that the information provided in this form is true, complete and accurate to the best of its knowledge and that the Client will promptly notify the Recipient of any material change. The Client authorizes the Recipient to perform identity verification, background, credit and sanctions checks (including screening of beneficial owners and authorized signatories) and to obtain and retain copies of identification documents. The Client consents to the collection, use and retention of personal data for these compliance purposes and for the ongoing relationship.

CONFIDENTIALITY, GOVERNING LAW AND ENTIRE AGREEMENT

All non-public information obtained pursuant to this form will be handled in accordance with applicable confidentiality and data protection obligations. The Client acknowledges that the Recipient may disclose information to regulators, law enforcement or other parties where required by law. This document and any confirmations constitute the entire understanding between the parties with respect to the matters set forth herein and supersede prior communications. This form shall be governed by the laws of the jurisdiction specified by the Recipient at account opening, without giving effect to conflict of law principles.

TERM, RETENTION & TERMINATION

This information will be retained for the duration of the business relationship and for such period thereafter as required by applicable law. The Recipient may suspend or terminate services where the Client fails to provide requested information or where continued relationship would expose the Recipient to legal or regulatory risk.

ADDITIONAL INFORMATION / NOTES

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