Legal Money Laundering Form

LEGAL MONEY LAUNDERING FORM

This Legal Money Laundering Form (the "Form") is executed on by and between Client Name: with Registered Address: ("Client"), and Reporting Party Name: with Registered Address: ("Reporting Party"). Each of Client and Reporting Party may be referred to herein as a "Party" and collectively as the "Parties."

RECITALS

WHEREAS, the Reporting Party is engaged in financial or fiduciary services and is required by applicable anti-money laundering and counter-terrorist financing laws and regulations to obtain, verify and maintain accurate information concerning customers and transactions;

WHEREAS, the Client seeks to establish or maintain a business relationship, account or transactional arrangement with the Reporting Party and will provide information and documentation to satisfy the Reporting Party's due diligence, recordkeeping and reporting obligations under applicable law;

WHEREAS, the Parties desire to record Client representations, certifications and consents regarding source of funds, beneficial ownership and cooperation with reporting and investigative obligations.

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

1. DEFINITIONS

For purposes of this Form: "AML Laws" means all applicable anti-money laundering, counter-terrorist financing, sanctions and related laws, regulations and supervisory requirements; "Beneficial Owner" means any natural person who ultimately owns or controls the Client or on whose behalf a transaction is being conducted; "Proceeds" means property derived from or obtained, directly or indirectly, through unlawful activity; "Suspicious Activity" means any transaction or conduct that gives rise to a reasonable suspicion, in light of the facts and circumstances, that the transaction involves Proceeds of unlawful activity, evades reporting requirements, or otherwise violates AML Laws.

2. CLIENT REPRESENTATIONS AND WARRANTIES

The Client hereby represents and warrants to the Reporting Party that, as of the Effective Date and on an ongoing basis:

(a) The Client's legal form is: Individual Corporation Trust Other

(b) The Client's principal place of business or residence is:

(c) The Client has disclosed to the Reporting Party the identity of all Beneficial Owners. List Beneficial Owners and identification details below:

(d) The Client certifies that all funds, assets and benefits to be provided to the Reporting Party originate from lawful sources and are not directly or indirectly the proceeds of unlawful activity. Describe the primary source(s) of funds, including estimated amounts and origin jurisdictions:

Estimated aggregate amount related to the described funds:

(e) The Client confirms that it is not subject to any financial sanctions, trade restrictions or government asset freezes known to the Client, and that it is not listed on any applicable sanctions or watch lists to the Client's knowledge. The Client acknowledges that the Reporting Party will perform screening and may take protective action as required by AML Laws.

3. DUE DILIGENCE, RECORDS AND REPORTING

The Client shall promptly provide, upon request, originals or certified copies of identification documents, corporate formation documents, ownership charts, transaction records and any other information reasonably required by the Reporting Party to satisfy its obligations under AML Laws. Government-issued identification provided:

The Client acknowledges and consents that the Reporting Party may retain records of transactions and disclosures for the period required by AML Laws and may file Suspicious Activity Reports or similar notices with competent authorities when the Reporting Party determines, in its reasonable discretion, that such filing is required or advisable.

Client expressly consents to such filings and to the Reporting Party's disclosure of relevant documents and information to government, regulatory or law enforcement authorities as required by law: I consent

4. COOPERATION WITH INVESTIGATIONS

The Client shall cooperate fully with the Reporting Party and with any competent authority in connection with any internal or external investigation concerning potential violations of AML Laws, including by providing documents, testimony and timely responses to inquiries. The Client agrees to preserve records and not to knowingly destroy information relevant to any such investigation.

5. CONFIDENTIALITY; EXCEPTIONS

Except as required by AML Laws, court order or other legal process, the Reporting Party shall keep Client information confidential. Notwithstanding the foregoing, the Reporting Party may disclose Client information to its legal counsel, auditors and service providers for the purpose of compliance, and to government authorities where disclosure is required or permitted by law.

6. INDEMNIFICATION

The Client shall indemnify, defend and hold harmless the Reporting Party and its officers, directors, employees and agents from and against any and all claims, losses, liabilities, damages, fines, penalties, costs and expenses (including reasonable attorneys' fees) arising from or relating to: (a) materially false or misleading statements or omissions made by the Client; (b) a failure by the Client to provide required information or documents; or (c) the Client's breach of any representation or warranty in this Form.

7. NOTICES

All notices under this Form shall be in writing and shall be delivered by personal service, nationally recognized overnight courier, or certified mail (return receipt requested) to the addresses set forth below or to such other address as the Party may designate by notice in accordance with this section.

8. AMENDMENTS; WAIVER; COUNTERPARTS

This Form may be amended only by a written agreement executed by authorized representatives of both Parties. No failure or delay by either Party in exercising any right hereunder shall 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.

9. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

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

10. CERTIFICATIONS

By signing below, the Client certifies, under penalty of perjury to the best of Client's knowledge and belief, that the information provided in this Form and accompanying documentation is true, correct and complete, that the funds described are from lawful sources, and that the Client will promptly notify the Reporting Party of any material change to the information provided.

The Client acknowledges that providing false or misleading information may subject the Client to civil or criminal liability under applicable law.

Execution of this Form constitutes authorization for the Reporting Party to take such actions as may be necessary to comply with applicable AML Laws, including but not limited to making reports to competent authorities, freezing or restricting transactions when required by law, and terminating relationships where continued engagement would expose the Reporting Party to regulatory or legal risk.

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