Legal Beneficial Owner Declaration

LEGAL BENEFICIAL OWNER DECLARATION

This Legal Beneficial Owner Declaration (the Declaration) is made as of between Declarant Name: with Registered Address: and Recipient Name: with Registered Address: .

RECITALS

WHEREAS, Recipient has requested that Declarant provide a declaration identifying the natural person(s) who are the ultimate legal and beneficial owner(s) of the equity, voting rights or control of the Declarant or any entity for which Declarant acts as agent or intermediary;

WHEREAS, Declarant has knowledge of and access to the ownership and control information required by Recipient for compliance with applicable anti-money laundering, counter-terrorist financing and beneficial ownership laws and internal policies; and

WHEREAS, Declarant agrees to provide accurate, complete and timely information and to update Recipient upon any material change in beneficial ownership or control.

NOW, THEREFORE

In consideration of Recipient's reliance on the representations and warranties contained herein, the parties agree as follows:

1. DEFINITIONS

For the purposes of this Declaration: "Beneficial Owner" means the natural person(s) who ultimately owns or controls a legal person or arrangement, whether through direct or indirect ownership, voting rights, contractual arrangement or other means; "Declarant" means the named Declarant identified above; and "Recipient" means the named Recipient identified above.

2. IDENTIFICATION OF BENEFICIAL OWNER(S)

Declarant hereby declares that the following natural person(s) is/are the legal Beneficial Owner(s) of the interest in the Declarant or in the specified entity for which Declarant is making this declaration:

Passport National ID Other

Individual Entity (if entity, provide natural person who controls)

Direct ownership Indirect ownership (through intermediary or chain of ownership)

3. REPRESENTATIONS AND WARRANTIES

Declarant represents and warrants to Recipient that: (a) the information provided in this Declaration is true, complete and accurate in all material respects as of the date hereof; (b) Declarant has the authority to disclose the information set forth herein and to make the certifications contained in this Declaration; (c) no material information has been omitted that would render any statement herein misleading; and (d) Declarant will provide supporting documentary evidence upon reasonable request by Recipient for verification purposes.

4. CERTIFICATION AND CONSENT

Declarant certifies, under penalty of law, that the person(s) identified above is/are the ultimate beneficial owner(s). Declarant authorizes Recipient and its agents to collect, use and retain any documentation or information provided in connection with this Declaration for the purpose of compliance with applicable laws and for verification of the identity and beneficial ownership of the Declarant. Declarant consents to any due diligence, screening or reporting required by Recipient's policies or applicable law.

5. OBLIGATION TO UPDATE

Declarant shall notify Recipient in writing of any material change to the information contained in this Declaration within days of such change. Failure to provide timely notice or knowingly providing false information shall constitute a breach of this Declaration and may subject Declarant to contractual and legal liabilities.

6. INDEMNITY

Declarant shall indemnify, defend and hold harmless Recipient and its officers, directors, employees and agents from and against any and all claims, losses, liabilities, costs and expenses (including reasonable attorneys' fees) arising out of or resulting from the breach of any representation, warranty or obligation contained in this Declaration, or from any inaccurate or misleading information provided by Declarant.

7. CONFIDENTIALITY AND USE OF INFORMATION

Recipient will treat information provided under this Declaration as confidential to the extent permitted by law and internal policy, but may disclose such information to regulators, governmental authorities or third parties where required by law or for compliance with applicable regulations. Recipient shall not be liable for disclosures made in compliance with lawful obligations.

8. NOTICES

All notices, requests, demands and other communications required or permitted under this Declaration shall be in writing and delivered to the addresses set forth below (or to such other address as a party may designate in writing).

9. REMEDIES; GOVERNING LAW

Remedies under this Declaration are cumulative and in addition to any remedies provided by law. This Declaration shall be governed by and construed in accordance with the laws of the jurisdiction specified by the parties below, without regard to conflict of law principles.

10. ENTIRE AGREEMENT; SEVERABILITY; AMENDMENTS; WAIVER; COUNTERPARTS

This Declaration constitutes the entire agreement between the parties with respect to its subject matter and supersedes all prior communications and agreements, whether written or oral. If any provision of this Declaration is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect. Any amendment or modification to this Declaration must be in writing and executed by both parties. No waiver of any breach or default shall be effective unless in writing and signed by the waiving party. This Declaration may be executed in counterparts, each of which shall be deemed an original.

11. ACKNOWLEDGEMENT

Declarant acknowledges that knowingly providing false or misleading information in this Declaration may constitute an offense under applicable laws and may subject Declarant to civil and criminal penalties. Declarant further acknowledges that Recipient may retain this Declaration and related records in accordance with Recipient's record retention policies and legal obligations.

Sign Now