Legal AML Submission Sheet

LEGAL AML SUBMISSION SHEET

This Legal AML Submission Sheet (the "Sheet") is executed on between Client Name: , Client Identifier: , and Reporting Entity: , registered address: (each a "Party" and together the "Parties").

RECITALS

WHEREAS, the Reporting Entity maintains obligations under applicable anti-money laundering and counter-terrorist financing laws and regulations to identify, investigate and report suspicious transactions and related information; and

WHEREAS, the Client has provided information or engaged in one or more transactions that the Reporting Entity has determined warrant internal submission, review and, where required, disclosure to competent authorities; and

WHEREAS, the Parties wish to record, certify and transmit factual details, supporting materials and risk assessments regarding such matters as set forth in this Sheet.

NOW, THEREFORE, in consideration of the mutual covenants and representations contained herein, the Parties agree as follows:

1. DEFINITIONS

For the purposes of this Sheet, the following terms have the meanings set out below:

"Report" means the record of suspicious activity compiled in this Sheet together with any documents attached or referenced herein. "Submitting Party" means the individual or entity completing and delivering this Sheet to the Reporting Entity's compliance function. "Beneficial Owner" means any natural person who ultimately owns or controls the Client as defined under applicable law. "PEP" means politically exposed person as defined under applicable law. "Suspicious Activity" means any transaction or behavior that gives rise to a reasonable ground for suspicion of money laundering, terrorist financing, fraud or other illicit conduct.

2. SUBMISSION DETAILS

3. SUPPORTING DOCUMENTS

Indicate documents attached or available for review:

Account statements Identification Wire messages

Contracts or agreements Internal review notes Other

4. RISK ASSESSMENT

Low Medium High

Abrupt or unusual transactional patterns Structuring to avoid reporting thresholds Funds from high-risk jurisdiction

5. REPRESENTATIONS, WARRANTIES AND CERTIFICATIONS

The Submitting Party represents and warrants that: (a) the information contained in this Sheet and any attachments is true, accurate and complete to the best of the Submitting Party's knowledge and belief; (b) the Submitting Party has disclosed all material facts known to it that are relevant to the matters reported; (c) the submission is made in good faith and for legitimate compliance, investigative or reporting purposes; and (d) the Submitting Party will promptly notify the Reporting Entity of any material change to the facts herein.

The Submitting Party further certifies that it is not aware of any legal restriction that would prevent the Reporting Entity from using or disclosing the information in accordance with applicable law, including disclosure to competent authorities, regulators or law enforcement. The Submitting Party acknowledges that the Reporting Entity may retain and process this information in accordance with its legal obligations.

6. CONFIDENTIALITY AND USE

The Parties acknowledge that information submitted under this Sheet may be treated as confidential by the Reporting Entity; provided, however, that the Reporting Entity may disclose such information to regulators, law enforcement or other competent authorities when required or permitted by law. No provision of this Sheet shall constrain or limit the Reporting Entity's duty to disclose information where disclosure is required by statute, regulation or court order.

7. NOTICES

8. AMENDMENTS, WAIVER, GOVERNING LAW, ENTIRE AGREEMENT, SEVERABILITY

This Sheet may be amended only by a written instrument signed by both Parties. No failure or delay by any Party in exercising any right under this Sheet will operate as a waiver of that right. This Sheet is governed by the substantive laws of the governing jurisdiction selected by the Reporting Entity in accordance with its policies and applicable law; the Parties submit to the exclusive jurisdiction of the courts competent to hear matters in that jurisdiction for disputes arising under or related to this Sheet.

This Sheet constitutes the entire agreement between the Parties with respect to the subject matter hereof, superseding all prior proposals and communications, whether oral or written. If any provision of this Sheet is held invalid or unenforceable, the remaining provisions will continue in full force and effect.

9. SIGNATURES

The undersigned certify that they are authorized to execute this Sheet on behalf of the Party they represent and that they have read, understood and agree to be bound by the terms, representations and certifications contained herein.

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