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Handelsbanken Customer due diligence

Private
Branch name/Unit Branch no. Date
Uppsala Luthagen 6513 2021-10-11
Processing officer Tel. no. (incl. area code)
Ludvig Larsson

Personal data
Name Civic registration number

Postal address Date of birth (if no civic registration number)

Postcode and town/city Country

Domicile for tax purposes (for new customers, the form entitled Certification of residence for tax purposes - Individual A668-EN must be filled in)

Tax identification number (for residence abroad for tax purposes)

Subject to US tax due to US citizenship, residence or Green Card. I US tax identification number/US-TIN
[] Yes [] No
Citizen of the following country/ies

E-mail Mobile no.

Politically exposed person - PEP

I LJ Yes. Use the form for PEPs

[] No

• a politically exposed person is a person who has, or has recently had, important public functions or is a family member or associate/business partner of such a
person, for example, a judge at the Supreme Court, an ambassador or a member of parliament.

d Purpose of banking relationship

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y Account
□ Wealth management
□ Representative of a third party
0

□ Payments
□ Loans
□ Beneficial owner

□ Investments
□ Pension/insurance

□ None of the above

If your address or domicile for tax purposes is outside Sweden, the type of connection to Sweden must be stated.

Type of connection to Sweden: [] work

□ Study [] Famy

[] Formerly resident in Sweden

□ Other

Additional information: Describe the type of connection. For example "Employed at XX AB. Need an account for salary and bills."

Anticipated duration of the customer relationship (if the tax domicile or address is outside Sweden) I Date

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Handelsbanken Customer due diligence

Private

Payment flows
Regular incoming payments
What do the payments relate to?
Ii Do not intend to receive regular incoming payments
□ Salary
□ Sale of goods/services/assets

□ Pensions/insurance
□ From own account with another bank

□ Social security
□ Transfer from family/relatives

□ Student grant
□ Other payment

□ Income from capital

Additional information. Describe what the payments relate to (mandatory when "Other payment· is selected)

Estimated amount per year (SEK)

Assets
To be completed if assets totalling more than SEK 500,000 are held with or are to be transferred to Handelsbanken, or if you are a PEP, family member of a PEP, or
known associate of a PEP.

Origin of the assets:

□ Own savings
□ Sale of other assets

□ Insurance
□ Sale of property/apartment

□ Inheritance or gift
□ Other

Describe the origin of the assets. For example: "SEK 1,000,000 is the final payment from sale of a property in 2016. SEK 200,000 is monthly savings over several
years."
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 3 (4)
Handelsbanken Customer due diligence
Private

Cross-border payments
Incoming Ii Do not intend to receive incoming cross-border payments

What do the payments relate to?

□ Salary D Sale of goods/services

□ Pension/insurance
□ Sales of assets

□ From own account abroad

□ Other

□ Transfer from family/relatives

Estimated number per year I Estimated amount per year (SEK)

From which countries do the payments come?

Additional information. Describe incoming cross-border payments (mandatory when "Other" is selected)

Outgoing ID Do not intend to send outgoing cross-border payments

What do the payments relate to? D To own account abroad

□ Purchase of goods/services

[] Transfer to family/relatives
□ Investments

0
□ Contributions to aid organisation
□ Other

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Estimated number per year I Estimated amount per year (SEK)
To which countries will the payments be sent?
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Additional information. Describe outgoing cross-border payments (mandatory when "Other" is selected)

Handelsbanken's notes
ldenti check
Type of ID document ID number Validity date of ID Issued, country

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 4 (4)
Customer due diligence
Handelsbanken Private

Sole trader with business commitments at Handelsbanken

Company information
Sector - business I Turnover

Customers of the business

[]Private individuals in Sweden O Private individuals outside Sweden

[Companies/organisations in Sweden [_] Companies/organisations outside Sweden

O No customers

Suppliers to the business

D Suppliers in Sweden D Suppliers outside Sweden

O No suppliers

Description of business operation

Cash handling sole trader

Deposits \D Do not intend to make cash deposits

Estimated amount per year (SEK)

What do the deposits relate to:

□ Daily takings

□ Other

Additional information. Describe what the deposits relate to (mandatory when "Other" is selected)

Withdrawals \0 Do not intend to make cash withdrawals

Estimated amount per year (SEK)

What do the withdrawals refer to?

□ Small change/Petty cash

□ Other

Additional information. Describe what the withdrawals relate to (mandatory when "Other" is selected)

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