Client Screening Questionnaire

CLIENT SCREENING QUESTIONNAIRE AND AGREEMENT

Client Name:   Primary Contact:

Client Address:

Service Provider:   Provider Contact:

RECITALS

WHEREAS, Client seeks to engage Service Provider to perform screening, due diligence, and related advisory services described in this Questionnaire and Agreement; and

WHEREAS, Service Provider represents that it has the experience, personnel, and procedures necessary to perform the services in accordance with applicable laws and industry-standard practices; and

WHEREAS, the parties desire to record the scope, terms, and screening information provided by Client and to set forth payment, confidentiality, and other contractual provisions.

SECTION A — BUSINESS INFORMATION

Individual    Corporation    Limited Liability Company (LLC)    Partnership    Other:

SECTION B — OWNERSHIP AND CONTROL

List all beneficial owners and controlling persons with ownership equal to or greater than 25%. Provide full legal name and ownership percentage.

SECTION C — REGULATORY, LITIGATION, AND COMPLIANCE

Has the Client or any controlling person been subject to regulatory enforcement, criminal conviction, sanctions, or bankruptcy in the past ten years?

Yes    No

SECTION D — RISK FACTORS

Indicate any material risk characteristics that apply (check all that apply):

Offshore beneficiaries or operations    Cash-intensive business    Politically exposed person(s)    High-volume or high-value transactions

SECTION E — SERVICES REQUESTED & SCOPE OF WORK

Select services requested (check all that apply):

KYC screening    AML screening    Enhanced due diligence    Compliance advisory

SECTION F — PAYMENT TERMS

Fee Amount:   Currency:

SECTION G — TERM AND TERMINATION

Term Commencement Date:   Term End Date:

Either party may terminate for material breach that remains uncured for the notice period specified above. Termination does not relieve either party of obligations accrued prior to termination, including payment for services rendered.

SECTION H — CONFIDENTIALITY

The parties acknowledge that Service Provider will receive Confidential Information from Client. Confidential Information means non-public information disclosed by Client in any form. Service Provider shall: (a) hold Confidential Information in strict confidence; (b) use Confidential Information solely to perform the services set forth in this Agreement; and (c) not disclose Confidential Information to third parties except as required by law or with Client's prior written consent. Obligations of confidentiality survive termination for a period of three (3) years unless otherwise agreed in writing.

Exceptions to Confidential Information include information that is or becomes public through no breach by Service Provider, was known to Service Provider prior to disclosure, or is independently developed by Service Provider without use of Client information.

SECTION I — REPRESENTATIONS, WARRANTIES, AND CERTIFICATIONS

Client represents and warrants that the information provided in this Questionnaire is accurate and complete to the best of Client's knowledge. Client agrees to promptly notify Service Provider in writing of any material changes to such information.

Client certifies that it has authority to provide the information and that providing such information does not violate any contractual or legal obligation to a third party.

SECTION J — GOVERNING LAW; ENTIRE AGREEMENT

This Agreement shall be governed by and construed in accordance with the laws of the state identified below. Any dispute arising out of or related to this Agreement shall be resolved in courts located in the agreed jurisdiction unless the parties agree otherwise in writing.

This Questionnaire and Agreement, including any attachments and statements of work executed by the parties, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior proposals, discussions, and agreements, whether written or oral. Any modification must be in writing and signed by both parties.

SECTION K — ATTACHMENTS

Attach or list any supporting documents included with this Questionnaire (e.g., corporate formation documents, identification for beneficial owners, prior audit reports).

ACKNOWLEDGMENT

By signing below, the parties acknowledge and agree that (a) the information provided in this Questionnaire is complete and accurate to the best of their knowledge; (b) Service Provider may rely on the information to perform the agreed services; and (c) the parties are bound by the terms set forth in the RECITALS and Sections above.

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