Our main focus is our customers

The purpose of this checklist is to ensure that the identity of our clients and their source of funds are properly verified in order to achieve compliance with the Financial Obligations Regulations 2010. This checklist must be completed and submitted as part of our Due Diligence to be applied to existing clients in conformity with Anti-Money Laundering Laws and Regulations.

Name and address of the application mentioned on the KYC form, should match with the documentary proof submitted.

Company Profile

a. Nature of Business

b. Full Registered Company Name

c. Legal Status

d. Incorporation Date

e. Country of Incorporation

f. Company Registration Number

g. Registered (Street) Address

h. Business/Trading Address

i. Telephone No.

j. Contact person

k. Mobile Number

l. Email Address

m. Website/Home Page

a. Names and Nationality of each Individual Director

b. Ultimate Beneficial Owner Information - Please note if Company is owned by a holding company, the individuals who are the ultimate beneficial owners of the holding company will need to be included as well as their percentage ownership.

c. Controller Information - Please give full name and nationality of any controller(s) if different from shareholders and directors. Please put N/A if not applicable.

a. Principal Bankers

b. Swift BIC

c. Bank Branch Address

d. Bank City & Country

e. Beneficiary Name

f. Currency of Bank Account

g. Bank Account Number

a. Please confirm you understand and have appropriate controls designed to implement the principles of the UK Bribery Act and / or the US FCPA?

b. Please confirm that you understand and have appropriate controls designed to implement the principles of the Joint Money Laundering Steering Group or equivalent internationally recognised anti-money laundering standards?

c. Please confirm that you understand and have appropriate controls designed to ensure that the Company’s activities are undertaken in compliance with all applicable laws and regulations related to competition / anti-trust?

d. Are you aware of any allegations, investigations or convictions pertaining to the Company, its directors, shareholders or senior members of staff, relating to bribery and corruption, anti-money laundering or completion law / anti-trust?

e. Have you, your company or any members of your company been debarred from bidding on government contracts for any length of time in any country?

f. Is the Company, its directors or shareholders subject to any criminal convictions or ongoing criminal proceedings relating to any matter?

g. Has the Company ever been declared bankrupt or been the subject of any other insolvency procedure?

h. Are there any individuals or other entities not disclosed in this document that have the ability to exert control over the Company?

i. Are any of the directors, shareholders or senior members of staff of the Company a politically exposed person (PEP) as defined under the UK Money Laundering Regulation 2007

j. Do you have any dealings involving a sanctioned person* or sanctioned country (i.e. Belarus, Iran, Syria, Sudan, Cuba, Russia, Venezuela and North Korea) “dealings” includes sales to, purchases from, trade through or other business activities with or involving any person or entity. *sanctioned person means any person sanctioned by the UN, EU, or US (OFAC)

Please tick as appropriate

Completed Questionnaire signed and dated

Certificate of Incorporation

Names of Ultimate Beneficial Owners & percentage ownership i.e. share certificate

Memorandum /Articles of Association

Names of Directors

Power of Attorney or signatory authority granted to person if individual signing form is not a shareholder

Bank Reference Letter

Organisation chart showing all of the parent and subsidiary entities which are part of the same consolidated group as the Company

Copy of the Code of Business Conduct

Copy of any further documentation demonstrating implementation of Compliance program

At least one authorised signatory is required in signing the form below:

I confirm that the information provided in the form and any other documents provided are accurate and complete to the best of my knowledge and belief.

1. Name of Company authorised signatory

a. Job Title

b. Date

c. Signature

2. Name of Company authorised signatory

a. Job Title

b. Date

c. Signature

d. Trading/Business licence

e. Company Profile

Our main focus is our customers

Company Profile

At least one authorised signatory is required in signing the form below:

Galazio EnergyDMCC

1.Company Details

Galazio Energy
DMCC