Reference:

CUSTOMER PAYMENT INSTRUCTION

Ordering customer details

Name or Trade name : ..............................................................................................................

Account number to be debited : ......... .................. ...... ............ ............ . Currency : .........................

Amount and currency to be remitted

Currency and amount in figures : ................................................................................................

Currency and amount in words : .................................................................................................

Charges 1 : SHA (shared) BEN (beneficiary to pay ail charges) OUR (customer to pay all charges)
Ben(!_ficiary details

Name or Trade name : .............................................................................................................

FullAddress 2 : ... •••.••..•••. •..••..••..••..•••..••..••..••••.•••.......••..••..••..••••..•..••••.•••...••.•••.••••.•...••.••..•.

Account number to be credited : .................................................................................................

OrIBAN 3:

B ene:ficiary's bank: ................................................................................................................

(address or branch) .................................................................................................................
(code BIC/SWIFT) .................................................................................................................
Correspondent bank (optional) : ..................................................................................................
(code BIC/SWIFT) .................................................................................................................
Reference, payment details

Transfer purpose 2 : ..••..••..•. ..........•••...•...••..........••....•...•..•....•.......•........•..•...••..• ...•.....•........ ....

I /We confinn under my/our full responsibility the trueness ofthe declared reasons for payment.
1/We agree that the Bank may disclose to any party directly or indirectly involved in this transfer, without reverting to me/us, "any KYC
infonnation, under the domestic and international Anti-Money Laundering regulation".
It is clearly acknowledged that Banque Banorient France has accepted to execute this transfer on the express condition that none ofits direct
or indirect constituents and/or parties and/or elements and/or documents and/or links ofwhatsoever nature (ship, port, airline) fall or would
fall at any phase ofthis transfer or any other related subsequent transfers, under US, UN or EU sanctions or any other sanction.
It is further understood and clear that Banque Banorient France will be discharged towards ail parties of any responsibility and liability
of whatever nature and for whatsoever reason if it or any other party fails or delays to perfonn the transaction as a result of actual or
apparent breach ofsuch sanctions.
1/we also take upon to obtain a similar undertaking from the beneficiary ofthis transfer confinning that the purchased goods do not fall under
US, UN or EU sanctions or any other sanction and that their shipment will not be done through sanctioned carrier, being ship or airline, and
that the ship or carrier will not pass through sanctioned countries such as North Korea, Iran, Sudan, etc.
Furthennore, 1/we am/are fully aware that it is your sole judgment to reject the execution of this transfer or any other related subsequent
transfers to our complete discharge without any risk and/or responsibility on your part nor liability for any loss, damage, cost, expense,
charge or delay arising therefrom.

Place ..... . ...... ... ... ... ......... . ........... . ............... Date ......................................................

SIGNATURE:

1
Tick appropriate charges 2 Mandatory 1
Mandatory for Euro payments and in Europe countries