DNO DUE DILIGENCE

QUESTIONNAIRE FOR PROPOSED BUSINESS PARTNERS

Directions: Please complete this questionnaire by providing responses to each question and by providing the
requested documents. If a question is not applicable, please so indicate. If additional room is necessary, please
attach extra pages. For any documents not in English, please provide an English translation. Once completed,
please sign and date the questionnaire, and return it to the issuer.

I: BACKGROUND INFORMATION ABOUT BUSINESS PARTNER

Name of Business Partner

Legal structure
(corporation, partnership,
individually owned, other)
Primary industries/lines
of business
Number of years of
experience in relevant
business
Location where the
services will be provided
Head office address
Telephone
Email
Website
Name of contact person
Business registration
number
Date of registration
Expiry date
Agency of registration
Country of registration
Registered office address
(if different from head
office address)
Tax identification number
and country
Number of employees in
total
Number of employees at
location where services
will be provided
Main clients/customers

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 and three business
references
Banking references
Proposed means of
receiving compensation
from DNO (e.g. Name of
Bank and Location)

II: DOCUMENTATION

Please provide the following documentation or note whether it is provided or why it is not
applicable.

DOCUMENTATION PROVIDED REASON WHY NOT APPLICABLE

Documentation of
establishment of
incorporation
Registration or other
document authorizing
business partner to
carry on business
Organization chart
Required business
registrations or licenses
for services to be
provided to DNO
Financial statements or
appropriate alternate
financial information
for the last two years
(audited, if available)
Compliance policy and
procedure (see section
IV)

Documentation of
ownership (shareholder
register or similar)

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III: STRUCTURE, OWNERSHIP, AND MANAGEMENT

1. Please list the Members of the Board and the senior officers/management of the
Business Partner, including Name, Title, Residence (if other than Nationality)
Nationality and Date of Birth:

Name, Title and Residence Nationality Age, or Date of Birth

2. Please identify all owners/principals, both legal and beneficial, including Name,
Address, Nationality, Date of Birth and Percent of Ownership:
(Note: If an owner is a corporate entity, please also identify all ultimate individual or
beneficial owners (persons). Ownership must equal 100%. If the corporation is public,
please identify all shareholders holding greater than 5%, and provide a copy of the current
annual report.)

Name and Residence Nationality Age, or Date of % Ownership

Birth

3. Please identify all key employees who will be performing work or services for DNO,
provide their nationality and date of birth, and describe their experience and
qualifications:

Name and Residence Nationality Age, or Date of Key

Birth qualifications

4. Please list all companies affiliated with the Business Partner, including any Parent
Company, Subsidiary Company(ies), Affiliate Company(ies), Joint Ventures or Similar
Entities:

Company Affiliation

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IV: COMPLIANCE & ETHICS POLICY AND PROCEDURES OF BUSINESS
PARTNER

1. Please provide a copy of and describe your compliance with law and business ethics
policies and procedures, including items such as your anti-corruption, trade controls,
environmental, human rights, child labor and social responsibility, and competition
policies and procedures. Please expressly address such items as facilitation payments,
gifts and entertainment, reimbursement of travel costs and per diems, donations and
contributions and due diligence and compensation for third parties engaged to provide
goods or services.

2. Please provide the name and contact details of your Chief Compliance Officer or
equivalent manager with similar functions.

V: GOVERNMENT INTERACTIONS

Note: “Public Official” means anyone employed by or acting on behalf of, whether on a full or
part time basis, a national, regional or local government; government owned or controlled
company or other entity; employees or agents of public international organizations (such as the
United Nations, European Union, World Bank and other international development
organizations); political parties, political party officials and candidates for public office; and
anyone else acting in an official capacity for or on behalf of a government agency or entity,
including persons holding a legislative, administrative or judicial post and members of the
military and police.

Yes/No. If yes, please specify.

Does any Public Official have any
beneficial ownership or other interest,
direct or indirect, in the Business
Partner?
Is any director, officer, or employee of
the Business Partner a Public Official?
Was any owner, director, officer, or
employee of the Business Partner a
Public Official within the last five
years?
Is or was (within the last five years)
any Close Relative or close business
associate of a Public Official an owner,
director, officer, or employee of the
Business Partner?
Is any owner, director, officer or

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employee of the Business Partner
otherwise in a position to influence any
government, or any agency or
instrumentality of a government, or a
government owned or controlled
company, or any public international
organization that has or may have any
oversight or involvement with DNO or
the services to be provided to DNO?
Has Business Partner made any public
disclosures to any government
authorities or agencies involving any
fraudulent or corrupt conduct or
improper accounting, including fraud,
bribery or money laundering or of any
other violations of applicable laws or
regulations?
In the past five (5) years, has the
Business Partner (including any
associated or previously associated
entity or any predecessor entity), or
any present or former owner, director,
officer, or employee of the Business
Partner been:
(1) suspended from doing business in
any capacity or debarred from
competing for a World Bank contract,
(2) investigated for, charged with,
convicted of or a party to a settlement
or plea arrangement involving any
violation of laws or regulations, or
(3) subject to any allegation of fraud,
misrepresentation, money laundering,
bribery, corruption, tax evasion, other
related fraudulent or corrupt activities
or other violations of applicable laws
or regulations?

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VI: DECLARATION OF COMPLETENESS

I have reviewed this questionnaire and I am duly authorized to respond to this

questionnaire and provide the information contained herein. I declare and certify that
the information provided is accurate and complete to the best of my knowledge and belief.

I also understand and agree on behalf of Business Partner that DNO will rely on the
information contained herein to perform its due diligence and to determine whether to
enter into any contractual or other business relationship with Business Partner.
Business Partner and I hereby authorize DNO to obtain and use the information
contained herein and we hereby waive any restrictions or limitations on DNO’s receipt
and use of the information under any applicable data protection or date privacy laws
and regulations.

__________________________________
Name:
Date:
Title:
Company:

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