Company Name

AML and CIP Certification

Company Name, Inc. acting solely in their capacity as discretionary investment advisor hereby certifies to

Company Name USA, Inc., that:

1) Anti money-laundering programs have been implemented by Company Name, Inc.

2) Company Name, Inc. has implemented and will maintain a customer identification program that contain the following elements:

• Procedures for verifying the identities of customers

• Procedures for maintaining records of the verification process

• Procedures for comparing customers with lists of known or suspected terrorists or terrorist organizations

• Procedures for providing customers with notice that information is being collected to verify their identities

Company Name, Inc. certifies that the above referenced programs have been applied to all customers for whom investment advisory services are presently performed, regardless of whether or not the customer may be referred to Company Name USA, Inc.

Company Name, Inc.

By:_______________________

Name: ____________________

Title: _______________________

Date:________________________

COMPANY NAME USA, INC.

123 Main Street, New York, NY 10003 General (212)123-4567 Trading (212) 891-2345 Fax (212) 612-2343

Member FINRA/SIPC