COUNTERPARTY SURVEY

The counterparty (supplier/contractor/processor) _____________________ notifies about the

relevance and completeness of the information in the submitted documents from the date of their
submission and at the time of issuing this letter, and also confirms the relevance of information
about shareholders/ultimate beneficiaries (participants).

Details about
Item Description
organization

1 Organizational and legal form and name

2 Legal address of the organization

3 Physical address of the organization

4 Mailing address of the organization

5 Website (if any)

6 Code of Ethics and Compliance (available/not available)

7 Incorporation Certificate (date, number, issued by)

8 ID No.

Position and full name of the person elected (appointed) to

9
the position of the sole executive body of a legal entity

Full names of other persons authorized to act on behalf of

the organization and having the signature right of legal
10
entities with the attachment of a document confirming the
powers

11 Phone No. of the head of the organization

12 Authorized capital amount

Ownership structure up to the ultimate beneficiary (full

13
name, place of registration, % of interest/shares)

Bank details (name and address of the bank, Account No.,

14
Phone No. and other details of the bank)

15 Types of activity (summary)

16 List of licenses (if Number, date, issued by, validity

applicable) term

Types of activity

Number, date, issued by, validity

term

Types of activity
 Location
17 Subsidiaries, affiliates
Types of activity

The organization's income and expenses for the last

18
reporting period

Income and expenses of the organization for the same period

19
of the previous year

List of works performed by the organization over the past

20
three years (works similar to those declared)

Details of customers which could characterize the work

21
performed by the organization

Number and qualifications of personnel in the declared

22
activities of the organization

23 List of hardware and/or software for work performance

Information about legal proceedings involving the

24
organization

The counterparty (supplier/contractor/processor) ) ________________________________

confirms that he/she has read and understood the Code of Corporate Ethics and Compliance of
EM Earth Materials and agrees with the “Anti-corruption” section/provision of the contract and
compliance with the norms of anti-corruption law.

Head of the
organization__________________________________________________________________
(position, signature, seal, full name, date of completion)