General Questionnaire for a potentiel investor
In connection with the proposed transaction concerning _Marlinspike Consulting Ltd (the "Company" and
the “Transaction”, respectively), please provide for our review the information and documents described
below.
Any reference made to “you” herein, shall be deemed to include any legal entity in which you have controlling
interest.
Please provide each applicable document or item requested and kindly indicate on a copy of this form its status
by using the following codes: “E” – Enclosed; “N” – None Exists; “N/A” – Not Applicable. If the questions so
require, please provide a Yes or No answer and include details where necessary.
Please type answers in the spaces provided. If required answers can be provided in separate
documents annexed to the questionnaire
I. PERSONAL INFO
1. Name: _Nathan Philip Engelbrecht
2. Address: 20-22, Wenlock Road, London, England, N1 7GU
3. Nationality: British Citizen, please attach a copy of your passport with number
4. I.D# 1083655274
5. Web page/Linkedin/Facebook: N/A
6. Address: ____________________
7. Phone # N/A ;
8. Email:
9. Occupation: Management Consultency. please attach your certified license
II. BUSINESS INFO
1. Have you been or are you currently a party to any investment transaction in other countries?
________________________________Realestate_________________________________________
2. If so – are any of the above third parties in which you invested in are engaging in a competitive field
with the Company?
_______________________________________N__________________________________
III. COMPLIANCE INFO
3. Are you a Public Official (See definition in Annex A below) or a close associate, immediate family
member, or household member of you? If so please provide all relevant details.
______________________________________N__________________________________________
____________________________________________________________________
4. Do you have any criminal record?
__________________________N______________________________________________________
_
5. Do you know or have any reason to believe that: N
5.1. Have you gave or promised to give anything of value, directly or indirectly, to any government
official for the purpose of influencing the official to obtain or retain business?
___________________________N_________________________________________________
_
5.2. Will you be required to obtain licenses, permits or discretionary approvals from government
authorities in order to close the proposed Transaction? Or after the Transaction closes?
_______________________________N_____________________________________________
_
IV. I HEREBY FURTHER CERTIFY:
that the information I have provided is true and complete to the best of my knowledge;
that I understand that you will rely on this information in deciding whether to enter into any
contractual agreement with me;
that I consent to your representatives making such inquiries as they may consider necessary to
verify this information and to process, store and transfer such information in accordance with your
policies; and
that in connection with my business with you, I have not given and will not give or attempt to give,
to anyone, directly or indirectly, anything of value for the purpose of obtaining or retaining any
business or gaining any improper advantage from a public official.
Neither I nor any company I own or control, its subsidiaries, branches, officers, directors, third
parties connected with performance of the Transactions are (a) listed on a Sanctions list
promulgated by Israel, the United States of America (“US”), the European Union (“EU”), United
Kingdom (“UK”), Canada or the United Nations (“UN”) or otherwise sanctioned under their
economic Sanctions legislation due to ownership or control by a person or entity listed on such a
Sanctions list; (b) an agency or instrumentality of, directly or indirectly owned or controlled by, a
government of a territory under Sanctions, or otherwise resident or located in, operating from, or
incorporated in or owned by or controlled by party located in or incorporated under the laws of a
territory under comprehensive Sanctions including but not limited to the following territories:
Crimea, Donetsk (DNR), Luhansk (LNR), Kherson, Zaporizhzhia, Cuba, Iran, North Korea,
Lebanon, Russia, Belarus, or Syria; (c) otherwise a target of Sanctions and/or restricted from trade
under Sanctions. Reference to ‘Sanction/s’ in this document includes financial , economic, or trade
sanctions, prohibitions, guidance, directions and/or orders by any government or similar authority
that issues, imposes , administers or enforces financial economic or trade restrictions, including
not limited to, the Israeli Ministry of Defense, Israeli Ministry of Finance U.S Department of
Treasury (OFAC), U.S. Department of Commerce Bureau of Industry and Security (BIS) and the
U.S. Department of State, the U.K Office of Sanctions Implementation (OFSI), the Council of the
European Union, the United Nations Security Council .
______________
Date: _______________
Annex A
“Public official” means any:
(A) An employee of any governmental unit, including national, district or local unit
(“government”) and any person holding a public office or exercising a public function
on behalf of a government; including in the legislative, executive or judiciary branch of
the government, whether by appointment, by election or by agreement;
(B) A person holding a public office or exercising a public function on behalf of a public
body constituted by an enactment of a government, or of a body over which the
government, directly or indirectly, has control;
(C) official, officer, employee or representative of any national, state, local or municipal
government, department, agency, institute or instrumentality thereof, inter alia, the
army, the public educational system, public health system, social security agencies,
religious councils, national and stated banks and reserves, national workers unions and
arbitrators;
(D) official, officer, employee, agent or representative of any government-owned or
government-controlled corporation, inter alia, any factory, institution, foundation or
other entity that the government participates in its administration, including
participation on the board of directors or on the management of these entities;
(E) official, officer, employee or representative of a Public International Organization, and
any person holding a public office or exercising a public function for a Public
International Organization;
(F) any person acting in an official capacity for or on behalf of any such government or
department, agency, instrumentality, corporation or a public international organization;
(G) Any political party or any official, officer, employee or representative of a political party
or any candidate for political office;
(H) Any employee of an entity providing a public service; or
(I) Any outside consultancy group engaged by any of the above.
