Legal Anti-Money Laundering Form

LEGAL ANTI-MONEY LAUNDERING FORM

This Legal Anti-Money Laundering Form (the "Form") is made and entered into as of by and between Client Name: , a(n) organized under the laws of with principal address (hereinafter "Client"), and Company Name: , a(n) organized under the laws of with principal address (hereinafter "Company"). Client and Company may be referred to individually as a "Party" and collectively as the "Parties."

RECITALS

WHEREAS, the Company provides services for which applicable law requires the Company to obtain and verify customer due diligence, beneficial ownership information, and to conduct ongoing anti-money laundering screening and monitoring; and

WHEREAS, the Client will provide information and documentation to enable the Company to comply with anti-money laundering and counter-terrorist financing obligations and to reasonably assess risk associated with the Client and its beneficial owners; and

WHEREAS, the Parties desire to record the representations, warranties, consents, and acknowledgements of the Client regarding anti-money laundering compliance on the terms set forth below.

NOW, THEREFORE, in consideration of the mutual covenants set forth herein, the Parties agree as follows:

1. DEFINITIONS

1.1 "Beneficial Owner" means each natural person who, directly or indirectly, owns or controls twenty percent (20%) or more of the equity interests in the Client, or otherwise exercises ultimate effective control over the Client. The Client shall identify all Beneficial Owners as required by this Form.

1.2 "Customer Due Diligence" or "CDD" means the information, documentation, screening and verification activities performed by the Company to satisfy applicable anti-money laundering and counter-terrorist financing laws and regulations.

2. REPRESENTATIONS AND WARRANTIES OF THE CLIENT

The Client represents and warrants that, as of the Effective Date and at the time of each submission of information to the Company: (a) all information provided to the Company is complete, true, accurate and not misleading in any material respect; (b) the Client will promptly notify the Company of any material change to such information; and (c) the Client is not aware that any Beneficial Owner is subject to sanctions, designated as a terrorist or a terrorist financier, or is a politically exposed person except as expressly disclosed herein.

3. CUSTOMER DUE DILIGENCE INFORMATION

4. IDENTIFICATION DOCUMENTS

Provide primary identification for the Client's authorized signatory and for each Beneficial Owner if a natural person. Acceptable documents include passport, national identity card, or government-issued photographic identification.

5. BENEFICIAL OWNERS

Provide details for each Beneficial Owner. If additional space is required, attach a certified list and indicate attachment here:

6. SOURCE OF FUNDS

7. RISK CLASSIFICATION & SCREENING

The Client acknowledges that the Company will classify the Client's risk level based on the information provided and conduct screening against sanctions lists, adverse media and other risk indicators. The Client attests to the following:

Low Medium High

Is any Beneficial Owner or the Client a politically exposed person (PEP) or subject to sanctions? Yes No

8. CONSENT TO SCREENING, VERIFICATION AND DATA SHARING

The Client hereby authorizes the Company to obtain, collect, access and verify identification and background information from third parties, to perform sanctions and adverse media screening, and to disclose information to regulators, law enforcement, auditors, or other third parties where required by law or reasonably necessary for compliance. The Client further consents to the retention of records for purposes of regulatory compliance.

The Client acknowledges that such screening and verification may include electronic checks and automated matching processes and that the Company may retain records and copies of identification documents and verification results.

9. RECORD RETENTION, AUDIT AND ACCESS

The Company shall retain records and supporting documentation in accordance with applicable legal and regulatory requirements. The Client agrees that the Company, its auditors, and relevant regulatory authorities may have access to documentation and information necessary to demonstrate CDD and compliance practices.

10. CONFIDENTIALITY AND DATA PROTECTION

All information provided shall be treated as confidential by the Company, subject to disclosure where required by law or as necessary for regulatory compliance, fraud prevention or risk management. The Client is responsible for ensuring any personal data submitted is provided in compliance with applicable data protection laws and has obtained any necessary consents from Beneficial Owners and authorized signatories.

11. INDEMNITY

The Client agrees to indemnify, defend and hold harmless the Company and its affiliates, officers, directors and employees from and against any losses, liabilities, claims, damages, fines, penalties and expenses (including reasonable legal fees) arising out of the Client’s breach of its representations, warranties, or obligations under this Form or arising from the provision of false, misleading or incomplete information.

12. TERM, TERMINATION AND SUSPENSION

The obligations under this Form shall continue for as long as the Company maintains a business relationship with the Client or as required by applicable law. The Company reserves the right to suspend services or terminate any relationship if the Client fails to provide satisfactory information, if new adverse information arises, or if required by law.

13. NOTICES

14. AMENDMENTS; WAIVER; COUNTERPARTS

Any amendment to this Form must be in writing and signed by authorized representatives of both Parties. Failure of a Party to exercise any right will not operate as a waiver of such right. This Form may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one instrument.

15. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Form shall be governed by and construed in accordance with the laws of the jurisdiction selected by the Parties. This Form constitutes the entire agreement between the Parties with respect to its subject matter and supersedes all prior discussions, understandings and agreements. If any provision of this Form is held to be invalid or unenforceable, it shall be severed and the remaining provisions shall remain in full force and effect.

16. CERTIFICATION

The undersigned certifies, warrants and represents that he or she is authorized to execute this Form on behalf of the Client, that the information and documentation provided are true, complete and correct, and acknowledges that providing false information may constitute a criminal offense under applicable law and may subject the Client and the signatory to civil and criminal penalties.

By signing below, the Client acknowledges receipt of this Form, consents to the actions and disclosures described herein, and agrees to be bound by its terms.

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