Compliance Information for Patriot Act

COMPLIANCE INFORMATION FOR PATRIOT ACT

This Compliance Information and General Business Agreement (the Agreement) is made effective as of Effective Date: by and between Client Name: (the "Client") and Service Provider Name: (the "Provider").

WHEREAS

WHEREAS, the Provider provides products and services as set forth in the Scope of Work and the Client seeks to engage the Provider to perform such services in accordance with the terms of this Agreement; and

WHEREAS, in connection with the engagement, the Provider and Client must comply with anti-money laundering and counter-terrorist financing requirements, including those derived from the USA PATRIOT Act, and must collect and retain sufficient compliance information to verify identity and beneficial ownership and to substantiate due diligence measures.

WHEREAS, the parties agree to the terms and certifications below to permit Provider to perform onboarding, due diligence and ongoing compliance monitoring required by applicable law and internal controls.

SCOPE OF WORK

PAYMENT TERMS

TERM AND TERMINATION

The term of this Agreement commences on Start Date: and continues until End Date: unless earlier terminated in accordance with this section.

Either party may terminate this Agreement for material breach by the other party if such breach remains uncured thirty (30) days after written notice. Termination for cause shall not relieve the breaching party of liability for obligations accrued prior to termination.

PATRIOT ACT COMPLIANCE INFORMATION

The parties acknowledge that Provider is required to collect information to verify identity and to identify beneficial owners in accordance with applicable anti-money laundering laws. The Client must supply accurate information and supporting documentation as indicated below.

BENEFICIAL OWNERS / CONTROLLING PERSONS

Provide information for each individual who, directly or indirectly, owns 25% or more of the entity or otherwise controls the entity. If more space is required, attach an additional page with the same fields.

IDENTIFICATION DOCUMENTS AND DUE DILIGENCE

The Client certifies that the following documents are provided to the Provider for identity and beneficial ownership verification (check all that apply):

ANTI-MONEY LAUNDERING (AML) VERIFICATION

Provider will conduct reasonable AML screening and identity verification. Indicate whether initial verification has been completed:

CONFIDENTIALITY

All information provided by the Client to the Provider pursuant to this Agreement, including identity documents, beneficial ownership data and due diligence materials, shall be treated as Confidential Information. The Provider shall not disclose such information except to comply with legal or regulatory obligations, as required by a competent authority, or as otherwise permitted in writing by the Client. The Provider shall implement and maintain appropriate safeguards to protect Confidential Information against unauthorized access or disclosure.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction specified by the parties below. The parties consent to the exclusive jurisdiction of the courts in that jurisdiction for the resolution of disputes arising under this Agreement.

ENTIRE AGREEMENT

This Agreement, including all attachments and schedules executed contemporaneously, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, negotiations, representations and understandings, whether written or oral. No modification of this Agreement shall be effective unless in writing and signed by both parties.

CERTIFICATION

The undersigned certifies, under penalty of perjury and to the best of their knowledge, that the information provided in this form is true, correct and complete; that the Client will promptly notify the Provider of any material change to the information provided; and that the Client understands that the Provider may retain copies of identity documents and may conduct periodic updates and screening in order to satisfy legal and regulatory requirements.

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