ANNEX B.

1- SWORN STATEMENT OF THE BUSINESS PARTNER

(LEGAL PERSON)

The information contained in this document has been required in order to comply with the requirements established in the "Law to
fight corruption, illicit enrichment and investigation of fortunes", ISO 37001:2016 Standard - "Anti-Bribery Management Systems",
Decree Supreme No. 24771 and the internal and external regulations applicable on the matter in Bolivia.

Business Partner is understood as customers, partners, suppliers, subcontractors or any company that has or intends to have a
contractual relationship with COSAPI SA SUCURSAL BOLIVIA .
By signing this Affidavit, I declare that the information contained therein is completely reliable. and that it must be treated with
absolute confidentiality.
I. CONTACT DETAILS OF THE BUSINESS PARTNER :

Denomination or social reason: TIN:

Address:

Corporate purpose or main activity:

Contact person: Email: Phone:

SHAREHOLDERS, DIRECTORS, MANAGERS AND LEGAL REPRESENTATIVES

(*) That have more than 25% of the social capital, contribution or participation of the legal entity.
participate _ Document type Nationality
Shareholders* Document No.
(%)

Note to the Business Partner : If you need additional space to complete the questions, you can attach pages indicating the title of the section and
the number of the question.

If the company has a Board of Directors, please complete:

Post Document type and Starting date in
directors Nationality
number office

President

Director

Director

Director

Director
Place the 5 most relevant positions

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 Post Document type Starting date in
Management Plan Nationality
and number office

General manager

Financial Manager

Post Document type Starting date in

Legal representative Nationality
and number office

Official who will sign documents with COSAPI SA SUCURSAL BOLIVIA

II. BACKGROUND

ASK YES NO
Indicates if any Shareholder, director, legal representative, general manager, main executives or the
legal person itself has been sentenced or is (are) part of an investigation for the crimes of criminal
activities, whether criminal or administrative, for improper use of goods and services public, undue
use of influence, illicit enrichment, illicit enrichment of individuals affecting the State, favoring illicit
enrichment, active bribery, active transnational bribery, passive transnational bribery, own passive
bribery, obstruction of justice and false affidavits of property and income, embezzlement,
embezzlement, undue use of influence, benefit by reason of the position, common disposition,
omission of declaration of property and income, negotiations incompatible with the exercise of
public functions, extortion, exactions, abuse of authority, resolutions contrary to the constitution and
laws, breach of duty, appointment illegal, reception, culpable embezzlement, negotiations
incompatible with the exercise of public functions, resolutions contrary to the constitution and laws,
breach of duties, others.

If your answer is affirmative, specify:

Status
Name Crime Year
(sentenced / investigated)

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III. POLITICALLY EXPOSED PERSON SWORN STATEMENT
Politically Exposed Persons (PEP) are natural persons, national or foreign, who are performing or in the last five (5) years performing or have performed
outstanding and prominent public functions in a country, by election or executive appointments; as well as individuals with a high public profile, either by
political affiliation or private activity linked to political power; also as being, Heads of State or a government, high-ranking politicians, high-ranking government,
judicial or military officials, senior executives of state companies, important officials of political parties.
They will also be considered direct family PEPs and any person with whom they maintain permanent or de facto affinity relationships, up to the third degree of
consanguinity, second degree of affinity or that derived from adoption ties.

By the persons mentioned in section I; I declare that the company I represent:

ASK YES NO
Have you fulfilled, in the last 5 years: i) public functions in a public body or ii ) prominent
functions in an international organization? o Have you been a direct collaborator of the
highest authority in said institutions?

In the event that the existence of a PEP is declared, please complete the following information for each of them:

Full name:

Identification document:

Position in the company:

Position in the public institution:

Institution:

Period of exercise in the position:

Full name:

Identification document:

Position in the company:

Position in the public institution:

Institution:

Period of exercise in the position:

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IV. SWORN STATEMENT OF CONFLICT OF INTEREST

I hereby declare that the company I represent:

YES NO
Has a relationship up to the third degree of consanguinity and/or second degree of affinity
with a COSAPI shareholder, director, executive director, manager, legal representative or
worker.

For these purposes, the aforementioned persons are in a situation of Conflict of Interest, when they have a family
relationship:
 Up to the second degree of consanguinity: spouse or partner, parents, children, grandparents, siblings and grandchildren
.
 Up to second degree of affinity: In-laws, son-in-law, daughter-in-law and brother-in-law.
 Up to the third degree of consanguinity: great-grandparents, uncles, nephews, great-grandchildren.

If the existence of a Conflict of Interest is declared, please complete the following information for each of them:

Name of person in a situation of

Conflict of Interest:
Position held at the client:

Name of Cosapi executive or

worker:

Position held at Cosapi:

Description of the situation that

generates the Conflict of Interest:

Name of person in a situation of

Conflict of Interest:
Position held at the client:

Name of Cosapi executive or

worker:

Position held at Cosapi:

Description of the situation that

generates the Conflict of Interest:

These situations must be duly declared for Cosapi to take the appropriate and appropriate measures.

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V. ETHICS AND COMPLIANCE
(SGAS: Anti-Bribery Management System, SPDLAFT: System for the Prevention and Detection of Money Laundering and Financing of Terrorism, SPD: Crime
Prevention System)

i. About the Crime Prevention System:

YES NO Description
A The entity has a Crime Prevention System and/or Anti-
Bribery Management System
The entity has a compliance function or area that
B monitors and supervises the operation of the Crime
Prevention Systems.

The entity has a procedure and/or guidelines for risk

C
identification, evaluation and mitigation.
The entity has internal controls for the
prevention, detection or correction of risks.
The entity has internal prevention, detection or
correction controls that allow it to deal with
facilitation payments, contributions to political
campaigns, gifts, sponsorships, trips, etc.

The entity has a periodic dissemination and training

D
plan for the crime prevention model.

E The entity has an internal audit person or area.

The entity has guidelines and/or mechanisms that

recognize and promote the communication of ethical
F
or illegal breaches or potential crimes (complaints
channel).
The entity has guidelines and/or procedures to
G
manage and/or interact with public officials.
The entity has procedures, policies or controls for the
h
treatment of conflicts of interest.
The entity has procedures or policies on gifts,
I
hospitality and presents.

J The entity has procedures or policies on donations.

The entity has sufficient policies and/or procedures to

k ensure an adequate practice for the knowledge of
Business Partners (Due Diligence).
The entity has some other document related to Ethics
L
or Anti-Corruption.

ii. Regarding the Prevention of Money Laundering and Terrorism Financing:

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 YES NO Description
The entity is considered as a Subject Obliged to inform
the Financial Analysis Unit in matters of asset
A
laundering and terrorist financing or the financial
intelligence agency of its country.
If your answer is affirmative, answer: If the answer was "NO" please go to section iii .

YES NO Description
The entity has a ML/FT Prevention Manual ( Attach )

The entity has a Code of Conduct for the Prevention of

ML/FT ( Attach ).
The entity has a Compliance Officer registered with the
FIU.
The Entity has guidelines and/or procedures to prevent or
detect unusual and/or suspicious operations.
The Entity carries out a review of its business partners to
verify if they are included in International Lists of persons
linked to ML/FT activities.
The Entity has implemented a training program in
accordance with the provisions of the current standard.
The Entity has established policies and procedures for
due diligence in the knowledge of directors and workers
and business partners.
The entity has ever been investigated, prosecuted or
sanctioned for non-compliance with the regulations on
ML/FT Prevention.

In case of not complying with any of the indicated aspects, I declare that I have been aware of the regulatory
requirement and, if applicable, I promise to regularize it in the shortest possible time.
iii. Regarding Anti-Corruption and Anti-Bribery Management:
YES NO Description
A. The entity has a Code of Ethics ( Attach ).
The entity has an Ethics and/or Anti-Bribery, Anti-
B.
Corruption and/or Crime Prevention Policy ( Attach ).
The entity periodically disseminates the
C.
aforementioned documents. Indicate the period.
The entity provides periodic training on ethics, anti-
D. corruption and/or anti-bribery issues. Indicate the
period.

ATTACH THE DOCUMENTS THAT SUPPORT THE PROCEDURES AND GUIDELINES INDICATED IN THIS
DOCUMENT.

I declare that:

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 1. The information contained in this Affidavit is true and in the event of detecting fraud and falsity in it or the omission of
requested information, I will be subject to the administrative sanctions established in the current legislation on the matter,
without prejudice to personal responsibility and / or penalty that corresponds to me for such infraction or the termination
of the contract.

As a sign of agreement, I affirm and ratify everything stated in this affidavit:

Full name:
C.I. _ / CE No .:
Post:

_____________________________
SIGNATURE
Legal representative

Date: / /

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