Finance Compliance Questionnaire

FINANCE COMPLIANCE QUESTIONNAIRE

Purpose: This Finance Compliance Questionnaire collects information to assess the respondent's compliance with applicable anti-money laundering, sanctions, anti‑corruption, tax reporting and information security obligations. The respondent certifies that responses are true, complete and may be relied upon for ongoing monitoring and regulatory due diligence.

1. IDENTIFICATION

Entity Type: Corporation LLC Partnership Sole Proprietor Trust Government Entity

Tax Identification Number (EIN/SSN/TIN):    Date of Formation/Registration:

2. REGULATORY LICENSING & JURISDICTIONS

List regulatory licenses/registrations held. Provide issuing authority, license number and expiration.

3. OWNERSHIP & BENEFICIAL OWNERS

Does any individual or entity own 25% or more of the respondent? Yes No

4. ANTI‑MONEY LAUNDERING (AML) & KYC

Does the respondent maintain a formal AML/KYC compliance program? Yes No

Frequency of sanctions screening and remediation processes:

Is there a formal suspicious activity reporting (SAR/STR) policy? Yes No

5. ANTI‑BRIBERY / ANTI‑CORRUPTION

Does the respondent maintain an anti‑bribery / anti‑corruption policy? Yes No

6. INFORMATION SECURITY & PRIVACY

Does the respondent process or store personal financial or customer data on behalf of others? Yes No

Information security certifications (check all that apply): SOC 2 ISO 27001 PCI DSS None

7. ADVERSE HISTORY

Has the respondent, any affiliate, or any beneficial owner been subject to a regulatory enforcement action, criminal conviction, civil penalty, or sanction in the past ten years? Yes No

8. SANCTIONS & POLITICALLY EXPOSED PERSONS (PEP)

Are you subject to sanctions screening and adverse media monitoring as part of your compliance program? Yes No

Are any current directors, officers or beneficial owners PEPs or immediate family members of PEPs? Yes No

9. DOCUMENTS PROVIDED

Check all documents being submitted with this questionnaire:

Articles of Incorporation / Organization
Beneficial Owner List
Regulatory Licenses / Registrations
AML/KYC Policy
Anti‑Bribery Policy
Recent Information Security Audit / Report
Other (specify below)

10. DECLARATIONS, AUTHORIZATION & CERTIFICATION

By signing below, the undersigned certifies, to the best of their knowledge and belief, that the information provided in this Questionnaire is true, complete and accurate. The undersigned authorizes the recipient and its affiliates to verify any information provided herein, to obtain and share information with governmental authorities and service providers for compliance, monitoring and due diligence purposes, and acknowledges that intentional misrepresentation may result in termination of relationship and civil or criminal liability.

The undersigned further represents that the respondent has implemented and maintains policies, procedures and controls reasonably designed to ensure compliance with applicable anti‑money laundering, sanctions, anti‑corruption, tax reporting and data protection laws and agrees to promptly notify the recipient of any material change to the information provided.

I attest under penalty of perjury that the foregoing is true and correct.

I confirm that I am authorized to execute this certification on behalf of the respondent.

Certification (check to attest)

I certify the statements above and authorize verification.

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