Compliance Questionnaire

This information is for TMF Group internal use only and will be treated as strictly confidential!

Name of the Client Entity:      

(to be serviced)      

1. Basic Client Entity information

1.1. Purpose of the structure

     
1.2. Clear description of the activities of the Client Entity (if real estate, provide type, location etc.)
     
1.3. Show or attach a group structure chart (top down) including subsidiaries and UBO with
percentages of ownership
     

2. Expected type and volume of the transactions

2.1. Expected turnover per annum of the Client Entity

     
2.2. How this income is received (e.g. as dividends, interest, royalty, sales, etc.)
     
2.3. How often a year the Client Entity receives payments of income
     
2.4. Value of the Client Entity’s assets (current/future)
     
2.5. Number of employees
     

3. Origin of equity and provenance of funds

3.1. Please specify the origin of the Client Entity’s basic equity, the type of transactions, volume,
country of origin and country of beneficiary of these funds.
     

4. FATCA / CRS

Please fill the appropriate field regarding your FATCA / CRS clarification. Does the entity qualify
as:

FFI / FI Active NFE / NFFE Passive NFE / NFFE

Other, please specify:      

 If the answer is “FFI”, please provide TMF the Global Intermediary Identification Number
‘GIIN’:      

 In all other cases, please provide TMF the registration number with the local Tax Authorities:
     

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5. Information about the Ultimate Beneficial Owner (UBO) of the Client Entity

5.1. If the UBO is a private person:

Family name:      

First name:      
Nationalities (please indicate all):      
Tax residence:      
Private / residential address:      
(Street, City, Country)      
Phone number:      
E-mail address:      

Date of birth:      

Marital status: married single      

Profession and actual function:

     

Please indicate the annual income of the UBO:

< USD 100’000 USD 100’000 – 400’000 USD 400’000 – 1 Mil. > USD 1 Mil.

Please indicate the range of the estimated wealth of the UBO:

< USD 1 Mil. USD 1 – 5 Mil. USD 5 – 20 Mil. USD 20 - 100 Mil. > USD 100 Mil.

Please indicate the source of wealth of the UBO:

     

Does the UBO have an U.S. Taxpayer Identification Number ‘TIN’ (citizen / resident / Green Card holder / tax
resident)?

No Yes, indicate ‘TIN’:      

5.2. If the UBO is a stock listed company / financial regulated entity / Fund 1:

Entity name:      

Address:      
(Street, City, Country)      
Homepage:      
Stock Exchange /
Financial Authority:      
Date of incorporation:      

1
Regulated by a Financial Authority or no individual UBO holding 10% or more --> UBO Declaration to be signed

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 Compliance Questionnaire

6. Services to be provided by TMF

Management Services (Directorship) --> complete Annex 1
Nominee Shareholder
Power Holder Bank Account
Domiciliation Services
Bookkeeping Services
Payroll Services
Corporate Secretarial Services
Fiscal Representation / IPT
VAT Recovery
Tax Compliance
Other Services (please specify):
     
     

7. Additional information
     
     
     

This questionnaire was filled out by: ___________________________________________

Signed by:      

Place/Date: __________________________________

Please note that TMF will not be able to render services if:
- this questionnaire has not been properly completed
- TMF has not received a legalised copy of the UBO’s passport2
- the client is not approved by TMF Group Compliance

Any personal data you may need to provide in this compliance questionnaire will be processed in accordance with
applicable law and regulation, whereby TMF will act as controller of such personal data.
Any personal data will be processed only for (i) conducting self-imposed “know your client” identification procedures
for accepting clients and (ii) compliance with obligations under laws and regulations, such as the Financial Action
Task Force (FATF) recommendations, the Fourth EU Directive 2015/849, national anti-money laundering and anti-
terrorist financing laws, regulations and national supervision of trust services, fund services, financial services and
tax compliance services. By completing and signing this compliance questionnaire, you give TMF consent to
process the personal data including sharing with our affiliates worldwide, for said purpose only.

2
When sending legalised passport copies, please ensure that we receive the pages showing: The holder’s
personal details and photograph, the place and date of issue and the expiry date of the passport.

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