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FORM A : B2B TRANSACTION

ADDITIONAL
DISCLOSURE
OF
GROUP
COMPANIES
_________________________________incorporated under the Companies Act, 1956,
having its registered office at -____________________________

This is the first and the only commercial arrangement that the Company or any related Group Companies
are contemplating with American Express Banking Corp; OR.
The following related Group Companies have commercial arrangements with American Express Banking
Corp :

S.No.

Company Name

Service Establishment or
Corporate ID Number

Nature of Relation
(Merchant / Corporate)

Definition of Related Party/ Group Company:


o Corporate Card Member has ownership of more than 50% shares of an existing
Service Establishment with American Express, or vice versa.
o Corporate Card Member controls the composition of 50% of the board of directors in
an existing Service Establishment with American Express i.e. has power to appoint or
removal all or majority of the directors, or vice versa.
o

Corporate Card Member has the ability to exercise significant influence over existing Corporate Card
Member/Service Establishment with American Express in making financial and/or operating decisions,
or vice versa

The 'Key management personnel (those persons who have the authority and
responsibility for planning, directing and controlling the activities) of Corporate Card
Member and Service Establishment are relative of each other.

05-Jun-2013

AXP Internal

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Declaration:
.
I have understood the relevance and impact of this disclosure and have disclosed the
information truthfully. Further, I understand that if any such relationship (not disclosed
herein) is found existing after this Addendum is signed, American Express Banking Corp
shall be within its right to terminate any Company or related Group Company agreements
or amend the terms and conditions of these agreements without giving prior notice.

Name ______________________

Signature _________________

Designation _______________________

Date ________________
Company Stamp

Authorised Signatory with Company Seal/Stamp

05-Jun-2013

AXP Internal

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