Appendix 4.

3: Due Diligence Questionnaire

Suppliers, Representatives dealing with Public Officials, Agents with a
commercial activity, Trading and/or Shipping Counterparties in Standard
Transactions

To be completed by the third party

Foreword

Pursuant to the anti-corruption laws that apply to Total (France’s Sapin II Law, U.S. Foreign Corrupt
Practices Act, etc.), please provide us with the information and documents requested below when
entering into any contract with our company. Please see the definitions at the end of the
questionnaire before completing the form.
If any documents or information cannot be provided, please specify the reasons.
If some questions do not apply to your situation, please provide details.
Please contact your contact person at the Total Group if you have any questions relating to this
questionnaire.
Total will use this information, and is likely to share it with its associates, as well as with its Affiliates
concerned, and/or its experts, advisors or consultants appointed for the prevention of Corruption in
order to identify risks relating to the anti-corruption laws that apply to it.
Total will use and protect this information in accordance with applicable laws and regulations.
Accordingly, within the scope of applicable laws and regulations, any person who is the subject of
this information has the right to exercise his/her right to access, correct or object to information
concerning him/her by sending a request to his/her contact person within Total.

Kassa and son’s construction plc

Name and contact details 011-6-60-23-73 or 0911-203874
(telephone number and email Ato Getahun kassa general manager
address) of contact person Email address- kasconplc@gmail.com
responsible for the
relationship with Total
 1. Stakeholders
A. Your company

1.1 Please provide the following information:

Name1
Kassa and son’s construction plc

Address Addis Abeba yeka k/ketema woreda 09

011-6-60 23 73 or 011-6-60 94 34
Telephone no.

Website

General contractor
Type of company

Number of 165
permanent
employees
1991 E.C
Year of creation

Place of Adiss Abeba yeka k/ketema

registration
05/2/5/17794/02
Registration no.

Please provide a copy of the registration certificate

Stock exchange(s)
on which your
company or a No
company which
controls it
is listed
Bank, name of the
account holder and No Bank ID Bank name Account number
country of bank 1 101 Commercial bank of Ethiopia (harbuguba) 1000215161742
account to which 2 102 Oromia international bank s.c (legeetafo) 658631
payments will be 3 103 Awash international bank s.c (legetafo) 01304131099200
made 4 104 Dashen bank s.c (CMC) 0061781328013
5 105 Bank of abyssinya (lamberet) 0000002760843/48

1 If your company has changed names in the last five years, please also provide its previous names.
 6 106 United bank s.c (legetafo) 3341816368969010
7 107 Commercial bank of Ethiopia (gurdshoala) 1000009142057
8 108 United bank s.c beshale) 1581816185878010
9 109 Oromia international bank s.c (gurdshoala) 0041873200101
10 110 Birhan international bank s.c (karalo) 2601450010933
11 112 Cooperative bank of Oromia 1000049796483
12 114 Bunna international bank 1759601000360
13 115 Enat bank s.c 0311111077340001
14 116 Bank of abyssinya 17802844

1.2 Please describe the share ownership structure (provide a diagram if necessary) and identify all the
Beneficial Owners of your company. If one of these persons is a Public Official or a Friend or Relative of
a Public Official, please provide details in the "comments" column.
If your company is listed, only identify shareholders holding more than 5% of the shares.
Nationality/Country of
Name of company or natural person registration % held Comments

Kassa G/Tsadik Abebe Ethiopian 2554

W/ro Ethiopia W/Hawaryat Ethiopian 2554

Kelelew
Getahun Kassa Ethiopian 2358

Alemayew Kassa Ethiopian 2358

Dawit Kassa Ethiopian 2358

1.3 Please identify all the Directors, Executives and Key Staff Members likely to participate for the purposes
of the proposed contractual relationship, whether they are natural or legal persons. If one of these
persons is a Public Official or a Friend or Relative of a Public Official, please provide details in the
"comments" column.

Name Sex Nationality Job title

Getahun Kassa M Ethiopian General manager

Alemayew Kassa M Ethiopian Deputy general manager

Dawit Kassa M Ethiopian Transport & machinery

general manager
Yidenekachew Negesse M Ethiopian Ass. General manager

Yared Seyoum M Ethiopian Finance manager

Abera Bayssa M Ethiopian HR & property admin.

Department manager
 Kaleab Bbrham M Ethiopian Transport & machinery
Department manager
Yonatan Besrat M Ethiopian Furniture and steel
engineering head
Mengesha Guleta M Ethiopian Busines support head

Selam Asefa F Ethiopian Procurement and marketing

dept head
Asnake Belayhun M Ethiopian Safety officer

1.4 Please provide or describe the program/actions implemented by your company to prevent and combat
Corruption and Influence Peddling (code of conduct, policies, procedures, etc.).

See attached documents

1.5 In the last five years, has your company, any of its Affiliates, any of its Executives or any of its owners
been the subject of civil or criminal proceedings or entered into a transaction for a business deal based
on Corruption or Influence Peddling? If the answer is yes, please describe the procedure and Mitigation
Measures implemented internally.

No

B. Its Affiliates

1.6 Please identify the Affiliates of your company that are likely to participate for the purposes of the
proposed contractual relationship. Specify the nature and location of their activities in connection with
the proposed service.

Name Activities Country Comments

No

No
 No

1.7 For each of the Affiliates above that is not wholly owned by your company directly or indirectly, please
describe the shareholder ownership structure (provide a diagram if necessary) and identify all the
Beneficial Owners with their percentage of ownership. If one of these persons is a Public Official or a
Friend or Relative of a Public Official, please provide details in the “comments” column.
If the Affiliate is listed, please indicate the shareholders holding more than 5% of the shares.
Nationality/Country of
Name of company or natural person registration % held Comments

1.8 For each of the above Affiliates, please identify all the Directors, Executives and Key Staff Members likely
to participate for the purposes of the proposed contractual relationship, whether they are natural or
legal persons. If one of these persons is a Public Official or a Friend or Relative of a Public Official,
please provide details in the “comments” column.

Name Nationality Job title Comments

C. Its Subcontractors

1.9 Please identify the Subcontractors likely to participate for the purposes of the proposed contractual
relationship. If applicable, please specify in the "comments" column those which:

a. are likely to deal with Public Officials,

b. are held directly or indirectly, wholly or in part, by a Public Official or by a Friend or Relative
of a
Public Official,

c. are managed and/or administered by one or more Public Official(s) or Friend(s) or Relative(s)
of a Public Official.

Name Assignment Comments

2. Proposed service

2.1 Please give a brief description of the proposed service (nature, country in which it is performed, etc.)
Construction, Ethiopia

2.2 To the best of your knowledge, will the proposed service involve working with, or submitting work
of any kind or a request to, a Public Official? If yes, please specify the nature of the work or the
request and the government agency concerned.

No

2.3 To the best of your knowledge, do any of the following persons have close ties to a Public Official
identified in the previous question:
- any of the shareholders or Beneficial Owners, or
- any of the Directors or Executives or any of the employees likely to participate in the
contractual relationship under consideration, or - any of the Subcontractors?
If yes, please provide details.

No

2.4 Could a Public Official or Friend or Relative of a Public Official benefit personally from the
performance of the service? If yes, please provide details.

No
 2.5 Do you believe that a conflict of interest might occur in relation to the proposed service (for
example, if a friend or relative of an employee in your organization is employed at Total)?

No

*********************************************************
Definitions:

Director: person responsible for controlling management bodies: for example, depending on the corporate
structure in question, members of the Board of Directors or the Supervisory Board.

Affiliate: irrespective of the company or the time, any other entity: (1) in which the company directly or
indirectly holds or controls more than 50% of the capital or voting rights; or (2) which directly or indirectly holds
or controls more than 50% of the capital or voting rights of said company; or (3) in which an entity referred to
in (2) above holds or controls more than 50% of the capital or voting rights; or (4) in which the said company
(or any other legal entity) or any of its Affiliates, as defined in (1), (2) or (3) above, directly or indirectly holds or
controls less than 50% of the outstanding shares to which voting or appointment rights of the Directors are
attached at the general shareholders meeting of that company (or any other legal entity), but in which the said
company or any of its Affiliates exercises de facto management of the day-to-day business or of the
management of that company (or any other legal entity).

Public Official: mainly refers to the following persons acting as: (a) officials, employees and representatives of
governments, national, regional or local administrations, or governmental or administrative agencies; (b)
consultants and employees of non-governmental organizations to the extent that they are employed on behalf
of their government or home administration; (c) candidates for a governmental or administrative position; (d)
Executives and managers of political parties; (e) members of royal families; (f) members of international public
organizations (such as the United Nations, the World Bank, etc.) and their advisors; (g) officials or employees of
companies or entities controlled by the State or owned by the State; and (h) persons employed by a
government, including members of the military, police or civil service, i) members of parliament.

Beneficial Owner: any natural person who directly or indirectly holds securities/units/shares in the proposed
third party.

Key Staff Member: a staff member of the contractor who is authorized to take largely autonomous decisions
in connection with the proposed relationship.

Executive: person responsible for managing the company: for example, depending on the corporate structure,
the CEO(s), manager, co-managers, Chairman, Chairman and CEO, members of the Management Board, the
Board of Directors, etc.
Friend or Relative of a Public Official: the spouse or partner of a Public Official, his/her children, his/her
siblings, his/her parents, a spouse or partner of his/her children, his/her brother- or sister-in-law or father- or
mother-in-law, or any other member of his/her close social circle.

Subcontractor: a third-party legal or natural person that your company will use to provide the proposed
service (e.g., suppliers or consultants).

3. Declaration

The undersigned, being duly authorized for this purpose, hereby declares the following:
All the information in this questionnaire is accurate, clear and complete.
I understand that Total will rely on the information I have provided to decide whether to
establish a contractual relationship with my company.
I declare that neither I, nor my agents, nor my company nor its agents, have offered, paid
or given anything of value to a Public Official or a private individual, with the intent to
bribe, in the course of business covered by the contract signed between my company
and Total, and I pledge that neither I, nor my agents, nor my company nor its agents,
shall make such an offer, payment or gift.

Name: _______________________________ Job title: ___________________________________

Signature: ___________________________ Date: ______________________________________