INVENTIS

CUSTOMER VERIFICATION FORM

VENTURES
LLC
IMPORTANT INFORMATION ABOUT PROCEDURES FOR
CONTRACTING FOR A LOAN PARTICIPATION ACCOUNT

CUSTOMER NOTICE REQUIRED BY THE USA PATRIOT ACT

To help the government fight the funding of terrorism and money laundering activities, financial institutions
are required by Federal law to obtain, verify, and record information that identifies each individual or entity that
opens an account or contracts for our loan participation program.

What this means for legal entities: When a corporation, partnership, trust or other legal entity opens an account, we
will ask for that entity’s name, physical address, tax identification number, and other information that will allow
us to identify the entity. We may also ask to see other identifying documents, such as certified articles of incorporation,
partnership agreements or trust instrument.

We thank you for your assistance.

Inventis Ventures LLC

SECTION I - GENERAL INFORMATION

Name Trade & Company Name

Address City

State Country Zip Code Date & Place of Formation

1. Nature of Business (Please describe why the client was formed and its nature of business- Job Description)

2. Number of employees : 3. Key Business locations/primary trade areas ( Place of Employment)

4. Initial Source of capitalization (The source of capitalization is the means by which the entity came into existence—who or what
entity provided the initial financing. If another company/person provided the funding, we must know a little about what that
person/company does [including their names] or from where they generate their revenue/what is their source of wealth. Note: in
case of an individual founder, a brief bio will suffice.)

5. Disclosures:
I further declare that I am not a licensed securities broker or government employee and understand that neither are you or your
organization. I further acknowledge my awareness that it is felony fraud to submit documents or altered or counterfeit currency as a
form of payment.

Client Initials:

SECTION II – PERSONAL OR COMPANY ID INFORMATION

For Identification Only Information Personal Only: Company:
US Taxpayer Identification Number (TIN): Social Security Number (SSN): For Company- EIN #:
Last 6 digits. XXX- - Last 6 digits. XXX- -

SECTION III – FEDERAL DISCLOSURES

I, ______________________________________ under penalty of perjury, with full corporate and individual responsibility, hereby irrevocably,
confirm that neither myself, nor anyone else associated with my organization, my corporation, or the individual investor are working for any
Agencies of any Government. I further state under penalty of perjury that I am not involved in any Government entrapment operation.

I, _______________________________________ under penalty of perjury, with full corporate and individual responsibility, hereby irrevocably,
confirm that neither myself, nor anyone else associated with my organization or corporation have been convicted of a felony, either
within the United States or anywhere in the world where that crime would be considered equal to a US felony. To the best of my
knowledge I am not nor are any of my associates within my organization or corporation considered to be terrorists or on any watch list
with the United States Department of Homeland Security.

IVLLC KYC -v1 05/25/23

Full compliance with KYC/AML Laws; all collected data will be only used for background, due diligence, conflict checks and 1
assessment. All information is privileged, confidential and protected.
 INVENTIS
CUSTOMER VERIFICATION FORM
VENTURES
LLC

SECTION IV - DOCUMENTATION
PLEASE ATTACH COPIES OF THE FOLLOWING DOCUMENTS:

1 Copy Government issued Driver’s license – Identification

2 Articles of Incorporation, Articles of Organization, Proof of Company (N/A if Individual)
3 Where applicable, proof of tax exempt status under IRS 501(c)(3) (N/A if Indivuidual)

SECTION V –AML/KYC QUESTIONNAIRE FORM

I. General AML Policies, Practices and Procedures: YES/NO
20. Has your Company/Self developed written policies documenting 21. Are there adequate measures taken by the Company/Self to ensure that
the processes that it has in place to prevent, detect and report no financial transactions are provided to the listed terrorists and/or
suspicious transactions ? sanctioned names notified by your competent parties ?

22. Has the Company/Self or any of it’s stakeholders been subjected to 23. Has the Company/Self implemented systems for the identification of its
a RICO, Money Laundering or Financing of Terrorists investigation in customers, including customer information in the case of recorded
the last five years ? If yes, please provide details transactions, account opening, etc. (for example; name, nationality, street
address, telephone number, occupation, age/date of birth, type of valid of
official identification and the country/state that issued it) ?

II.Know Your Customer, Due Diligence and Enhanced Due Diligence YES/NO
24. Does the Company/Self have a requirement to collect and confirm 25. Do the AML procedures of the Company/Self comply with the
legitimacy of information regarding its customers’ business activities ? international standards (i.e. Basel Committee, FATF, etc.) ?

III. Correspondent Banking Information YES/NO

26. Does the Company/Self have legal bank accounts which it is 27. Do any of your bank funds originate from the non-cooperative
operating ? countries and territories as identified by the FATF ?

IV. Transaction Monitoring YES/NO

28. Does the Company/Self have a monitoring program for suspicious 29. Does the Company/Self have an established program that includes
or unusual activity that covers funds transfers and monetary policies and procedures for review of wire transfer activity and cash letter
instruments (such as traveler’s checks, money orders, etc.) ? activity ?

AML Training
30. Does the Company/Self have policies or practices to communicate new AML related laws or changes to existing AML related policies
or practices to relevant employees ?

I certify that I have read and understood this questionnaire and that the statements made in this
questionnaire true, complete and correct, and that I am authorized to execute this questionnaire on behalf of
the Company.

SECTION VI - AUTHORIZATION
SIGNATURE

DATE

NAME & TITLE

IVLLC KYC -v1 05/25/23

Full compliance with KYC/AML Laws; all collected data will be only used for background, due diligence, conflict checks and 2
assessment. All information is privileged, confidential and protected.