Legal Financial Crime Disclosure Form

LEGAL FINANCIAL CRIME DISCLOSURE FORM

This Legal Financial Crime Disclosure Form is made as of Effective Date: by and between Discloser Name: and Recipient Name: .

RECITALS

WHEREAS, Discloser possesses information regarding past or present matters that may constitute financial crimes, including but not limited to fraud, money laundering, bribery, corruption, sanctions violations, or related regulatory enforcement actions (collectively, "Financial Crime");

WHEREAS, Recipient requires a written disclosure of such matters for the purpose of evaluation, compliance screening, regulatory reporting, and mitigation of legal and reputational risk in connection with ongoing or proposed business relationships;

WHEREAS, Discloser agrees to disclose fully and in good faith all material information concerning Financial Crime matters during the Relevant Period and to certify the truth and completeness of such disclosures under the terms set forth herein.

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows:

1. DEFINITIONS

For purposes of this Form: "Financial Crime" means any criminal, regulatory or administrative offense involving financial irregularity, dishonesty, corruption, bribery, money laundering, sanctions breaches, tax evasion, or fraud. "Relevant Period" means the time frame identified in Section 2.a below. "Disclosure" means the written statements and supporting documents provided by Discloser pursuant to this Form.

2. DISCLOSURE OBLIGATIONS

a. Relevant Period — Discloser shall disclose all Financial Crime matters occurring during the period from to (the "Relevant Period").

b. Scope of Disclosure — Discloser must, to the best of its knowledge, disclose the following categories if applicable by selecting the applicable boxes and providing the requested details:

c. Particulars Required — For each matter disclosed, Discloser shall provide: (i) date or date range of occurrence; (ii) jurisdiction(s) involved; (iii) name of prosecuting or regulatory authority; (iv) charges or allegations; (v) current status and final disposition if any; and (vi) copies of relevant court, regulatory or settlement documents. Provide a summary of particulars below and attach additional documentation as necessary.

3. REPRESENTATIONS AND WARRANTIES

Discloser represents and warrants that, to the best of its knowledge after due inquiry: (a) the disclosures provided pursuant to this Form are true, complete and accurate in all material respects; (b) Discloser has not omitted any material fact that would make the disclosures misleading; and (c) there are no other undisclosed proceedings, investigations or sanctions that are reasonably likely to result in material adverse consequences to Recipient.

4. USE, CONFIDENTIALITY AND EXCEPTIONS

a. Use — Recipient may use the Disclosures for compliance screening, internal due diligence, regulatory reporting, litigation, law enforcement cooperation, or as otherwise required by applicable law.

b. Confidentiality — Except as provided in this Section, Recipient shall treat Disclosures as confidential and shall not disclose them to third parties except to Recipient's affiliates, counsel, auditors, insurers, regulators, or professional advisors on a need-to-know basis, provided such parties are bound by confidentiality obligations no less protective than those herein.

c. Exceptions — Recipient may disclose Disclosures when compelled by law, subpoena, court order, regulatory request, or when disclosure is necessary to prevent imminent harm. Recipient shall, where permitted, provide prompt written notice to Discloser prior to compelled disclosure to allow Discloser an opportunity to seek protective relief.

5. INDEMNITY AND REMEDIES

Discloser shall indemnify, defend and hold harmless Recipient and its affiliates, officers and employees from and against any losses, claims, liabilities, damages, costs and expenses (including reasonable attorneys' fees) arising from any inaccurate, incomplete or misleading disclosure or failure to disclose a material Financial Crime matter required by this Form. Recipient's remedies at law and equity are cumulative and in addition to any other remedies available.

6. CONSENT TO REVIEW

Discloser expressly consents to Recipient conducting background checks, regulatory and public record searches, and to contacting relevant authorities or institutions to verify disclosures. Discloser authorizes third parties to disclose to Recipient any records or information reasonably necessary to verify the matters disclosed herein.

7. NOTICES

All notices, demands or communications required or permitted under this Form shall be in writing and delivered to the addresses set forth below or to such other address as a party may designate by written notice in accordance with this Section.

8. AMENDMENT, WAIVER AND COUNTERPARTS

No amendment, modification or waiver of any provision of this Form shall be valid unless in writing and signed by both parties. No waiver by either party of any breach shall be deemed a waiver of any other breach. This Form may be executed in counterparts, each of which shall constitute an original and all of which together shall constitute one instrument.

9. GOVERNING LAW; JURISDICTION

This Form shall be governed by and construed in accordance with the laws of the jurisdiction selected below without regard to its conflict of law principles. The parties submit to the exclusive jurisdiction of the courts located in the selected jurisdiction for any dispute arising under this Form.

10. ENTIRE AGREEMENT; SEVERABILITY

This Form constitutes the entire agreement between the parties with respect to its subject matter and supersedes all prior oral or written negotiations, understandings and agreements. If any provision of this Form is held invalid or unenforceable, the remainder of the Form shall remain in full force and effect, and the invalid or unenforceable provision shall be replaced by a valid provision that most closely reflects the parties' original intent.

11. CERTIFICATION; PENALTIES

By signing below, Discloser certifies under penalty of law that the information provided in this Form and any attachments is true, accurate and complete to the best of Discloser's knowledge. Discloser understands that knowingly making a false statement or omission may subject Discloser to criminal or civil penalties and to contractual remedies including termination, indemnification and pursuit of damages.

ATTACHMENTS

Discloser shall attach copies of all relevant documents, orders, pleadings, settlement agreements and regulatory correspondence. Provide a short list of attached documents below and attach originals or certified copies to this Form.

Sign Now