COUNTERPARTY FORM

The requested information is required for KYC clearance and registration purposes.
Please complete all sections or mark 'N/A' if not applicable. Absence of supporting documentation may result in delay of Registration.
COUNTERPARTY DETAILS

REGISTERED NAME

Registered Address

Mailing Address

Phone e-mail

Fax website

DOCUMENTS ATTACHED

Incorporation Date Articles / M.O.A.

Certificates :
Country of Incorporation Incorporation + Good Standing

Registration Number Registry Extract

VAT Number Trading License

Nature of Business Brief Presentation

Audited Financial Statements

Auditors (last 3 years)

Primary Bank Bank Reference letter

PARENT COMPANY Organization Chart

Showing Affiliated Co's & Shareholders
up to Ultimate Beneficial Owners
Affiliated Companies 1
Please list Subsidiaries and/or
Sister Companies
2 Important Note:
In case Audited Financial Statements
3 are not available, please provide two (2)
Bank reference letters.
4

NAME Percentage

Ultimate Beneficial Owners 1

Identification document required for
Shareholders exceeding 15%
2
Passport or ID
3

4 - -

5 - -
Capacity
Directors / Partners / 1
Authorised Signatories 2
(State capacity)
3
4 - -
5 - -
 page 2

CREDIT AGENCY RATING DATE GRANTED

Credit Rating (if applicable)

Regulating Agency or
Government Authority

Address of Regulator

Activities Covered by Regulator

CONTACT INFORMATION
DEPARTMENT CONTACT PHONE E-MAIL

BANK REFERENCES
BANK CONTACT PHONE E-MAIL

COMMERCIAL REFERENCES

COMPANY CONTACT PHONE E-MAIL

Information provided shall be treated as Confidential, and strictly for our KYC purposes

Date Submitted Name / Position Signature / Stamp

** Kindly submit Form and supporting documents by e-mail to : marketing@eezdee.intrade.com.my

COUNTERPARTY APPROVAL

Remarks Documentation complete

Finance Dept. Review

Registration Date Approved by :

KYC-EEZ-2023/12