AML/KYC Questionnaire -

Väike-Paala 1-507, 11415 Tallinn, Estonia

ANTI-MONEY LAUNDERING (AML) INFORMATION FORM

Dear Client,

In accordance with the Money Laundering and Terrorist Financing Prevention Act, Wizard Consult Raamatupidamisbüroo is required to collect additional information regarding the Beneficial Owner(s) of its clients.

Wizard Consult Raamatupidamisbüroo undertakes to ensure the confidentiality of all personal data provided in this questionnaire.

Thank you for your understanding.

TAX INFORMATION

Please specify all countries in which your company is tax resident and provide the corresponding Tax Identification Number(s) (TINs).

TAX INFORMATION EXCHANGE

Is your company a Financial Institution?

LEGAL REPRESENTATIVES

(Please provide details of all legal representatives authorised to represent the legal entity.)

№1

Full Name

Personal Identification Code / Date of Birth

Nationality

Identity Document Number

Type of Identity Document

Country of Issue

Residential Address

Telephone Number

Email Address

Representative's Role within the Company

Member of the Management Board
Legal Representative
Authorised Representative acting under a Power of Attorney

Please tick the relevant box and complete the fields below if the representative is a Politically Exposed Person (PEP) (i.e. an individual who holds or has held a prominent public function).

Position / Public Office

Country

Date on which the Public Office ceased (if known)

Please tick the relevant box and complete the fields below if the representative is a family member of a Politically Exposed Person (PEP) or a person known to be a close associate of a Politically Exposed Person (PEP).

Full Name of the Politically Exposed Person (PEP)

Personal Identification Code or Date of Birth

Gender

Female
Male

Country of Residence

Date on which the Public Office ceased (if known)

Nature of the Relationship to the Politically Exposed Person (PEP)

Does the legal entity have any other legal representatives?

Yes No

Are your company's shares, or the shares of any of its shareholders, listed on a stock exchange in an EU Member State (or an equivalent jurisdiction)?

Shareholders / Members

Please provide details of all individuals and legal entities that own shares or ownership interests in the legal entity. If the shares of the legal entity are traded on a regulated market in an EU Member State (or an equivalent third country), please provide details of at least the five largest shareholders.

№1

Full Name

Personal Identification Number

Date of Birth

Gender (required only if no Personal Identification Number is provided)

Ownership Interest (%)

If the shareholder or member is a Politically Exposed Person (PEP), please select the relevant option and complete the fields below.

Yes No

Position

Residential Address of the Politically Exposed Person (PEP)

Date the Position Ended (if known)

If the shareholder or member is a family member of a Politically Exposed Person (PEP), please select the relevant option and complete the fields below.

Yes No

Full Name of the Politically Exposed Person (PEP)

Personal Identification Number or Date of Birth

Gender (required only if no Personal Identification Number is provided)

Female Male

Position

Residential Address of the Politically Exposed Person (PEP)

Date the Position Ended (if known)

Relationship to the Politically Exposed Person (PEP)

Are there any other individuals or legal entities that directly own shares or ownership interests in the legal entity?

Yes No

Please provide details of any other legal entities that directly own shares or ownership interests in the legal entity.

№1

Legal Entity Name

Registration Number

Country of Registration

Ownership Interest (%)

Are there any other legal entities that directly own shares or ownership interests in your company?

Yes No

Please provide details of the individuals who directly or indirectly own more than 25% of the shares or ownership interests in your company, or who otherwise exercise control over the legal entity.

№1

Full Name

Residential Address

Personal Identification Number

Date of Birth

Gender (required only if no Personal Identification Number is provided)

Country of Birth

Nationality

Identity Document Number

Identity Document Type

Country of Issue

Countries of Tax Residence

Tax Identification Number (TIN) (e.g. VAT Registration Number, Estonian KMKR Number, or other Taxpayer Identification Number)

Ownership Interest (%) (if applicable)

Please indicate whether the beneficial owner is a Politically Exposed Person (PEP).

Yes No

Position of the Politically Exposed Person (PEP)

Residential Address of the Politically Exposed Person (PEP)

Date the Position Ended (if known)

Please indicate whether the beneficial owner is a family member or close associate of a Politically Exposed Person (PEP).

Yes No

Full Name

Personal Identification Number or Date of Birth

Gender

Male Female

Position of the Politically Exposed Person (PEP)

Residential Address of the Politically Exposed Person (PEP)

Date the Position Ended (if known)

Relationship to the Politically Exposed Person (PEP)

Are there any other beneficial owners?

yes no

Primary Business Activity

Does the business activity require a licence or special registration?

By signing this form, I confirm that the information provided in this form is true, complete and accurate.

I undertake to notify Wizard Consult Raamatupidamisbüroo in writing of any changes to the information provided in this form.

We are a team of professionals with over 20 years of experience in the accounting services market.

Väike-Paala 1-507, 11415 Tallinn, Estonia

ANTI-MONEY LAUNDERING (AML) INFORMATION FORM

GENERAL INFORMATION

TAX INFORMATION

TAX INFORMATION EXCHANGE

LEGAL REPRESENTATIVES

№1

OWNER DETAILS

Shareholders / Members

№1

Please provide details of any other legal entities that directly own shares or ownership interests in the legal entity.

№1

№1

Primary Business Activity

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