ECONOMIC PROFILE QUESTIONNAIRE

In accordance with the provisions of the Prevention and Suppression of Money Laundering Activities Law (hereafter the “Law”), Fiduserve
Management Limited must have valid and sufficient information for the economic profile of its clients. In case a client refuses to provide the
information requested in this Questionnaire, Fiduserve Management Limited, can terminate or reject the business relationship.

Notes to the Applicant:

• If you have any queries when completing this form, please contact Fiduserve Management Limited.
• This form should be completed by the Beneficial Owner of the Company and submitted together with the Application Form for a new company.
• No Question should be left unanswered. Where the Applicant believes that a question does not apply, the Applicant should write “Not
Applicable” or “N/A” and provide an explanation.
• Please make sure you have this form duly signed where indicated. Advance Electronic Signatures as defined under EU eIDAS Regulation are also
accepted.
• Please return this Questionnaire, completed and signed, to 9 Kafkasou Street, 4th Floor, CY 2112, Nicosia, Cyprus, or P.O. Box 27142, CY 1642,
Nicosia, Cyprus. Application forms bearing an Advanced Electronic Signature are exempt from posting the paper document.
• Fiduserve Management Limited and the Fiduserve Group of Companies are committed to ensuring client data is kept confidential and held in
accordance with data protection legislation and as such have a data protection policy based on the requirements of the EU General Data Protection
Regulation. Fiduserve Management Limited Privacy Statement is available at http://fiduserve.com/fiduserve-privacystatement and details how we
process data and the rights of individuals in respect of their data.

This Economic Profile Questionnaire must be completed by the Beneficial Owner of the Company. In case the
Beneficial Owners of the Company are more than one, each one must complete, execute and submit a
separate Economic Profile Questionnaire and provide their more up-to-date Curriculum Vitae (CV).

A) Personal Information:

Essential Information:
Name & Surname
Street Number/Address
Town/City
Postcode
Country
Nationality
Date of Birth
Passport Number
Passport Issue Date
Passport Expiry Date
Tax Residence Country
Tax Identification Number
Email
Telephone Number
Telephone (Mobile)
Website

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 B) Educational Background:

Academic Qualifications:
High School Diploma ☐
GCSE or other equivalent exam ☐
Foundation Diploma ☐
Bachelor’s Degree ☐
Master’s Degree ☐
Doctorate ☐

Please specify any degree(s), schools graduated and years of graduation:

Please specify your professional qualifications (if applicable):

C) Current Professional Status:

Please specify your current professional status by selecting one of the following:
Employed:☐ Self - Employed:☐ Retired:☐ Other:☐

If other please specify:

Please also complete the below table referring to your latest/ current employment status. Regarding your
previous employments please provide a CV providing your employment/ business history and career/
entrepreneurial development.

Company Name/Business
Organization/Employer
Employment start/end date
Line of Business/Industry
Website
Job/Position
Business Address
Telephone Number
Email
Annual Income/Wealth Generated
in the latest completed financial
year (Euro/€) (please provide your
latest tax return to support this)

Additional Information (If applicable):

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 D) Net Wealth Accumulation Timeline

Please provide below a timeline of how you have accumulated your current net wealth in chronological order.
Wealth accumulation may consist of employment income, service fees, dividends, interest, rental income,
capital gains from private equity or listed securities or real estate either realized or unrealized, gifts/ inheritance,
pension, etc. Net wealth is the total accumulated wealth after deducting loans and wealth consumed or lost.

We clarify that the request for such information is to ensure that we fully understand your economic profile to
ensure that it is in line with your business activity with us as well as to ensure that we provide you the best
possible services.

Period (start- Company/ Position/ Nature of Wealth generated Amount of

end date) Organisation/ Asset relationship with (employment income, service wealth
from which wealth the Company/ fees, dividends, interest, generated in
was generated & Organisation/ rental income, capital gains EUROs or
website Asset (employee/ from private equity or listed USDs
consultant/ securities or real estate either
shareholder/ realised or unrealised, gifts/
owner/ lender) inheritance, pension, etc)

Total Wealth Generated

Less current loans
Less Wealth consumed
Less Wealth Lost
Total Net Wealth in EUROs or USDs
Note: If there are more than eight entries then please continue on a separate sheet giving similar details.

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 Please select appropriate, in case you operate in one of the following high-risk sectors/industries or
geographical locations:

Animal Testing, Live Export of Animals ☐

Antiques Trading and Art Objects Dealing ☐
Building and Public Work Construction ☐
Environmental damage and Pollution Freight Forwarding ☐
Electronic Gambling, Casino and/or Internet Gaming ☐
Football Club Ownership ☐
Hunting and Fur Trade ☐
Mining and/or Trading Oil Minerals, Gems, Commodities, precious and non-precious Metals ☐
(Scrap Metal, Spare Parts)
Mining and/or Trading in Cryptocurrencies ☐
Money Transfer, Investment services or other regulated activity (fundsmanagement, ☐
lending, etc.)
Online Adult ☐
Pharmaceutical, Health Care and Narcotics ☐
Transacting with high – risk countries as indicated by EU and FAFT ☐

Additional Information (If applicable):

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 E) Net Wealth Breakdown:

Please provide below a breakdown of your current wealth by assets class (cash, private equity, listed
securities, real estate, loans receivable, etc.) Net wealth is the total market value of your assets after
deducting loans.
We clarify that the request for such information is to ensure that we fully understand your economic profile to
ensure that it is in line with your business activity with us as well as to ensure that we provide you the best
possible services.

Asset class Description Countries Estimated Current

(please specify/ list major assets for each Market Value
class) (EURO or USD)
Real estate

Private Equity
holdings

Listed securities
portfolio

Cash at bank

Loans receivable

Movable Assets
(i.e. Trademarks,
domains, etc.)

Crypto Currencies
Ownership

Other
(Luxury Assets, Jet,
Yacht, etc.)

Total Wealth
Less current loans
Total Net Wealth in EUROs or USDs
Note: If there are more entries then please continue on a separate sheet giving similar details.

Additional Information (If applicable):

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 F) Compliance Section
PEP and Sanction Declaration:
1) Are you connected in any way, directly or indirectly with any sanctioned Country/Legal Entity or Individual as defined
by EU, UN and OFAC?

2) Have you ever been classified as a Politically Exposed Person (PEP), or are you a close familymember of a PEP, or
are you a closed associate of a PEP.

Note: a PEP is defined as a natural person who is or who has been entrusted with prominent public functions in the Republic or
in another country, an immediate close relative of such person, as well as a person known to be a close associate of such person:
Provided that, for the purpose of the present definition, ‘prominent public function’ means any of the following public functions:
(a) heads of State, heads of government, ministers and deputy or assistant ministers,
(b) members of Parliament or of similar legislative bodies,
(c) members of governing bodies of political parties,
(d) members of Supreme courts, of constitutional courts or of other high-level judicial bodies, the decisions of which are not
subject to further appeal, except in exceptional circumstances,
(e) members of courts of auditors or of the boards of central banks,
(f) ambassadors charges d’ affaires and high ranking officers in the armed forces,
(g) members of the administrative, management or supervisory bodies of State-owned enterprises,
(h) directors, deputy directors and members of the board or equivalent function of an international organization,
(i) Mayors
No public function referred in points (a) to (i) shall be understood as covering middle-ranking or more junior officials.

Close relatives of a politically exposed person includes the following:

(a) The spouse, or a person considered to be equivalent to a spouse, of a PEP,
(b) The children and their spouses, or persons considered to be equivalent to a spouse, of a PEP,
(c) The parents of a PEP,

‘Persons known to be close associates of a politically exposed person’ means a natural person who:
(a) Is known to have joint beneficial ownership of legal entities or legal arrangements, or any other close business relations, with
a politically exposed person, or
(b) Has sole beneficial ownership of a legal entity or legal arrangement which is known to have been set up for the de facto
benefit of a politically exposed person.

Morals and Credibility:

3) Has your appointment as member of the board of directors or executive staff of a company ever been revoked, or
cancelled, or have you ever been dismissed, or asked to resign, or agreed to resign instead of being dismissed, or resigned
whilst under investigation, for reasons pertaining to the exercise of the duties assigned to you or organization (of public
or private law) following a court ruling or an administrative decision.

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4) Have you ever been involved in cases (include also pending cases), which were the object of an administrative or
disciplinary control or the imposition of administrative or disciplinary or other sanctions by competent or supervisory
authorities, previous employers or professional bodies and associations.

5) Have you ever been convicted or are any charges or investigation procedures pending against you?

6) Have you ever been declared bankrupt (include also pending cases) or have any of your assets been confiscated or were
you obliged to transfer any of your assets to your creditors or have you failed to fulfill your obligations arising from
verdict against you within one year from the issue of such verdict.

7) Have you or/and any of the corporate, partnership or unincorporated entities, with which you were associated, ever
been asked to close an account with or had account closed by a credit institution with which you or any of the above
mentioned cooperated with?

FATCA/CRS:
FATCA stands for The Foreign Account Tax Compliance Act (FATCA) which was enacted as part of the Hiring Incentives
to Restore Employment (HIRE) Act in the United States (U.S.) on March 18, 2010. In order to determine whether FATCA
is applicable in your situation and to ensure you are in compliance with the relevant provisions of FATCA, we ask you to
please answer below questions.

a) Are you currently in the possession of a U.S. passport (including one of dual passports)?
YES: ☐ NO: ☐

b) Are you currently in the possession of a U.S. Green Card?

YES: ☐ NO: ☐

c) Is your current place of residence in the U.S. (as resident alien)?

YES: ☐ NO: ☐

d) Do you (expect to) receive any U.S. source income (e.g. salary, interest, dividend, royalties, rent,sale or
disposition of real estate property)?
YES: ☐ NO: ☐

If the answer to any of the above questions is ‘yes’, please provide Fiduserve with a filled out and signed “Form W-9”
from the U.S. Department of the Treasury Internal Revenue Service (Request for Taxpayer Identification Number and
Certification), with details of your reported structures managed by Fiduserve.

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 Common Reporting Standard (CRS) The organisation for Economic Co-operation and Development (OECD) released a
model Competent Authority Agreement (CAA) and Common Reporting Standard (CRS) designed to create a global
standard for the automatic exchange of financial information. To satisfy the Standard for the automatic exchange of
financial account information between tax authorities worldwide and the Participating Jurisdictions, the Cyprus tax
authorities, must obtain certain information and exchange them with the partner countries annually. Based on that
Agreement, we are required to collect and review certain information in order to identify the tax residency or multiple
tax residencies of each Controlling person in a company or Trust managed by Fiduserve.

TAX Residency Details

Country/ies of Tax Residency Taxpayer Identification Number **

** The term ‘TIN’ means Taxpayer Identification Number or a functional equivalent in the absence of a TIN, some jurisdictions do not issue a TIN.
However, these jurisdictions often utilise some other high integrity number with an equivalent level of identification. Example of that type of number
include, for individuals, a social security/insurance number, citizen/personal identification/service code/number, and resident registration
number.

Note: If TIN is unavailable because the country of resident does not issue TINs to its residents please provide us with the name of
the country. Click to type

By providing these information, I permit disclosure of any required account information to the U.S. IRS, UK HMRC,
Cyprus IRD and/or any other tax authority, local revenue service or financial institution where and as applicable in
relation to FATCA/CRS compliance.

Consent for Personal Data Sharing and Processing:

Within the context of the EU General Data Protection Regulation I confirm that:

a) I have read and understood Fiduserve Management Limited Data Privacy Statement available on
http://fiduserve.com/fiduserve-privacy-statement .
b) I understand that Fiduserve Management Limited, in their capacity as a licensed Administrative Service Provider in
Cyprus and other regulated or not regulated companiesof the Fiduserve Group are required to collect, store, process
and share personal data of its clients (“Data Subjects”) in the manner set forth herein below.
c) I understand that the personal data, with respect to the context herein shall mean, any information relating to the
Data Subjects, with the help of which the Data Subjects, can be identified directly or indirectly, including name,
identification number, location data or online identifier etc. (“Personal Data”).
d) I understand, agree and consent that the Personal Data relating to me and my associated persons/entities may be
legally required to be processed for the following reasons, which isinclusive of:
i. Fulfilling Anti Money Laundering and Know Your Client regulatory compliance obligations
ii. Fiduserve Management Limited’s Internal Client Onboarding Procedures
iii. Provision of services as per the terms of the service agreement with FiduserveManagement Limited
iv. For marketing and promotion purposes
v. Conducting market or customer satisfaction research
vi. Operation of Fiduserve Management Limited’s websites

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 vii. Management of Fiduserve Management Limited’s communications systems
viii. Operation of IT security and IT security audits
ix. Financial Management
x. Detecting, investigating and preventing breaches of policy, and criminal offences, in accordance with
applicable law
xi. Compliance with our legal and regulatory obligations under applicable law
xii. Risk Management and quality review
xiii. Detecting, preventing and investigating fraud
e) I understand and agree that Fiduserve Management Limited may provide my Personal Datato its associates and
subsidiaries (“Fiduserve Group” including their directors, officers andemployees), Fiduserve Management Limited’s
agents, authorized service providers and relevant third parties, who may collect, store and process my Personal Data
in various jurisdictions in which they operate for the purposes of carrying out Fiduserve Management Limited’s
duties and obligations as mentioned under point no. 4 above.
f) I understand and agree that the sharing and transfer of Personal Data within Fiduserve Group is subject to Fiduserve
Group Privacy Policy and Fiduserve Group store, transfer and process Personal Data in accordance with data
protection requirements under the applicabledata protection laws and regulation of various countries, including EU
Data Protection Laws.
g) I understand and agree that Fiduserve Management Limited requires its third party service providers who collect,
store and process Personal Data on its behalf to adhere to applicable data protection laws and regulation of various
countries, including EU Data Protection Laws and Fiduserve Group’s Privacy Policy.
h) I understand and agree that Fiduserve Management Limited may also be required to disclose or process Personal Data
by law or by any court order or any governmental or regulatory proceedings or pursuant to the requests of any
regulatory agency having jurisdiction over me or my entities activities.
i) I understand that I have the right to access my Personal Data controlled by Fiduserve Management Limited. I can
request to access my Personal Data by sending an email request to Fiduserve Management Limited at
info@fiduserve.com .
j) I undertake to keep Fiduserve Management Limited informed if the Personal Data maintained with them is
incomplete or in the event of any changes to it, within 30 days from the occurrence of any change.
k) I understand and agree, that I have a right to withdraw my consent for processing my Personal Data at any point of
time by providing prior notice to Fiduserve Management Limited at info@fiduserve.com .
l) I understand that I have the right to be forgotten, and that I can request for my Personal datato be deleted from
Fiduserve Management Limited’s Database and Fiduserve Management Limited shall take all necessary action to
remove my Personal Data from its system, subject to applicable data retention laws and regulations governing
Fiduserve Management Limited.

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 G) Undertakings and Signature of Beneficial Owner:
I confirm that:
a) I have never been convicted of any criminal offence (other than a minor motoring offence) nor have
I ever been declared bankrupt or the subject of an investigation by a governmental, professional or
other regulatory or statutory body;

b) I have exercised all due diligence in ensuring that all the information included in this questionnaire
is correct, true and accurate;

c) I hereby confirm that I shall comply with the relevant requirements and obligations arising from the
Laws of the Republic of Cyprus;

d) I will notify Fiduserve Management Ltd, in writing without undue delay, of any new detail regarding
any person, which could affect the reputation of the Company and prudent management of
Company;

e) I acknowledge and accept that Fiduserve Management Ltd may reveal information in the discharge
of its duties, under circumstances defined by the Law.

NOTE: The provision of false, or misleading information or details or documents or forms, or the
withholding of material information from the current document is a criminal offence.

Signature

Name

Date

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