Legal KYC Entity Form

LEGAL KYC ENTITY FORM

This Legal KYC Entity Form is made effective as of by and between Requesting Party Name: (the "Requestor") and Entity Name: (the "Entity").

RECITALS

WHEREAS, Requestor requires certain verified identification, ownership, organizational and compliance information from Entity to satisfy applicable know-your-customer, anti-money laundering and sanctions screening obligations; and

WHEREAS, Entity is willing to provide such information and to make the representations and warranties set forth in this Form to enable Requestor to evaluate Entity's identity, ownership and compliance status; and

WHEREAS, Requestor will rely upon the accuracy of the information and documents provided by Entity to establish the business relationship and meet regulatory obligations.

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

1. DEFINITIONS

For purposes of this Form: "Beneficial Owner" means any natural person who directly or indirectly owns or controls, or exercises substantial influence over, the Entity, including any person who owns 25% or more of the equity interests, and any individual who controls the Entity through other means.

2. ENTITY INFORMATION

Corporation    LLC    Partnership    Trust    Other

3. BENEFICIAL OWNERS (UP TO THREE)

Beneficial Owner 1

Beneficial Owner 2

Beneficial Owner 3

4. AUTHORIZED SIGNATORIES

5. DOCUMENTS PROVIDED

Please indicate documents provided to Requestor (check all that apply):

Articles of Incorporation / Formation Certificate    Operating Agreement / Bylaws    Certificate of Good Standing   

Government-issued photo ID for each Beneficial Owner    Proof of Address for Entity or Beneficial Owners

6. REPRESENTATIONS AND WARRANTIES

Entity represents and warrants to Requestor that: (a) the information provided in this Form and accompanying documents is true, complete and correct in all material respects as of the date signed; (b) Entity is validly organized and in good standing under the laws of its jurisdiction of formation and has authority to enter into this Form; (c) no Beneficial Owner or signatory identified herein is a person subject to sanctions or prohibited from engaging in business under applicable sanctions, anti-money laundering or counter-terrorist financing laws; and (d) Entity will promptly notify Requestor of any material change to any information provided.

7. USE, DISCLOSURE AND CONFIDENTIALITY

Requestor may use and disclose the information and documents provided by Entity for the purposes of customer due diligence, ongoing monitoring, regulatory reporting, fraud prevention and related compliance activities. Requestor will treat such information as Confidential to the extent permitted by law, but Entity acknowledges that Requestor may disclose information to regulators, law enforcement, auditors or when required by legal process.

8. DATA PROTECTION

Each party shall comply with applicable data protection and privacy laws in respect of personal data processed under this Form. Entity consents to Requestor's collection, processing and retention of personal data supplied in connection with the purposes described herein and acknowledges that such processing may occur across borders where permitted by law.

9. INDEMNIFICATION

Entity shall indemnify, defend and hold harmless Requestor and its officers, directors, employees and agents from and against any loss, liability, claim or expense (including reasonable attorneys' fees) arising out of or relating to any misstatement, omission or breach of a representation, warranty or covenant made by Entity in this Form or any inaccuracy in the information or documents provided.

10. NOTICES

11. MISCELLANEOUS

Governing Law: This Form shall be governed by and construed in accordance with the laws of the jurisdiction specified by Requestor in writing, without regard to conflict of laws principles.

Entire Agreement: This Form constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements and understandings, whether written or oral, relating to the same subject matter.

Severability: If any provision of this Form is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Amendments; Waiver: No amendment or waiver of any provision of this Form shall be effective unless in writing and signed by both parties. The waiver by either party of a breach of any provision shall not operate as a waiver of any subsequent breach.

Counterparts: This Form may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument. Facsimile or electronic signatures shall be treated as original signatures for all purposes.

12. CERTIFICATION

By signing below, Entity certifies, under penalty of perjury and to the best of its knowledge, that the information provided in this Form is true, correct and complete, and that the undersigned is authorized to make the representations, warranties and certifications contained herein on behalf of Entity.

I acknowledge and certify the accuracy of the information provided in this Legal KYC Entity Form.

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