BASIC INFORMATION

Company name

Registration country, registration number

1. Country of tax residence

Registration date

Legal address

Phone number

E-mail, Skype

WEB address

INFORMATION ON TAX RESIDENCY*

(TIN)/its functional equivalentNo Yes (if Yes, specify)

:

INFORMATION ON COMPANY’S BUSINESS ACTIVITIES

I hereby certify that the company is not a tax resident in any jurisdiction

I hereby certify that the company is not a tax resident in any countries other than the stated above in this questionnaire

CLIENT - CORPORATE ENTITY QUESTIONNAIRECLIENT’S CODE

Company is: 1 p 2

a

mining and quarrying

manufacturing

electricity,gas,steam and air conditioning supply

2. Country of tax residence(TIN)/its functional equivalent

No Yes (if Yes, specify)

water supply, sewerage, waste management and remediation activities construction

wholesale and retail trade; repair of motor vehicles and motorcycles

transportation and storage

accommodation and food service activities

information and communication

nancial and insurance activities

real estate a ctivities

professional,

administrative and support service activities

other service activities (specify)

activities of households as employers;

activities of households for own use

Type of activity and NACE code (if it is known)

Type of activity edoc ECAN

Legal address Other (specify)

* If the company does not know or is not sure whether it is a tax resident of any particular country, it should contact this co

public administration and defence;

114.11.2016AS "Meridian Trade Bank", 57 Elizabetes str., Riga, LV-1772, Latvia, Reg. Nr. 40003194988

Ph.: +371 67019393, E-mail: info@mtbank.eu, www.mtbank.eu

Activities of Extraterritorial Organizations and Bodies (U)

How long has the company been operating in the main business area?

Please tick if the company is engaged in any of the listed activities:

Is the company's business seasonal?

Does the company’s business require licensing?

No Yes (specify)

No Yes (explain, justify the purposes of cash transactions)

Are the company's main business activities associated with governmental and municipal procurements?

Do cash transactions occupy an important role in the company's main activity?

Please describe in more detail the company’s main activity and business structure (in a written and/or graphic form, using additional sheets, if necessary)

Does the company have subsidiaries or parent companies, or any associated companies?

No YesDoes the company (non-resident of Latvia) have an obligation to

Less than 5 More than 20 Number of employees:

Name Registration country Country of business activity Main directions of partner's business activities

Form of cooperation (seller, buyer, client, contractor, etc.)

A start-up Less than a year 1 to 3 years More than 3 years

arrangement of gambling

provision of cash collection services

trading in precious metals and precious stones

intermediation in transactions with real estate

trading in arms and ammunition

provision of reinsurance services

provision of money service

intermediation in currency trading

advertising and/or marketing services

delivery and support of IT solutions

investment services

No Yes (specify periods)

No Yes (provide a license copy)

No Yes (specify)

No Yes (specify sources)

INFORMATION ON MAIN BUSINESS PARTNERS WITH REGARD TO ACCOUNT TRANSACTIONS

2

payments associated with business (payments for goods/services, taxes, operational expenses etc.)

(loan, investment deal, deposit etc.)

other (specify)

No Yes (state the purpose and amount in EUR)

The account will be used for:

Planned amounts of transactions

What is the amount of funds you expect to receive in your company’s account (s) in wire transfers per month?

If the company performs cash transactions, incl. by using payment cards, where amounts of such transactions exceed EUR 15, 000 a month, please provide explanation of the necessity of cash transactions:

Expected number of account transactions per month:

If the company is a non-resident of Latvia, please specify the reason for account opening in Latvia:

INFORMATION ON THE INTENDED USE OF THE ACCOUNT AND CASH FLOW

What is the amount of funds you expect to transfer from your company’s account (s) per month?

What is the expected maximum amount of a single payment in wire transfers?

What is the amount of cash you expect to deposit into your company’s account(s) per month?

What is the amount of cash you expect to withdraw from your company’s account(s) per month?

EUR

EUR

EUR

EUR

EUR

(loan, deposit, property sale, etc.)?

less than 20 more than 20 (specify the number) incoming

less than 20 more than 20 (specify the number) outgoing

Bank's services that the company intends to use:

money transfers

payment cards ( less than 20, more than20)

deposits

credits

other (specify)

e-commerce services

Does the company have accounts with other credit institutions?

No Yes (specify credit institutions)

person is associated with Latvia

activities are associated with the EU and the company needs an account in a EU country

partners are associated with Latvia or have accounts in Latvia

associated companies or persons have accounts in Latvia

service is provided in a well known language

deposit guarantee system in Latvia as a member state of EU

terms of service are more favourable compared to other countries

other (specify)

3

Signature of Bank’s employee, printed name

Signature of Client’s representative, printed name

Date of completion

(Signature) (Name, Surname)

TO BE COMPLETED BY THE BANK

To be completed by the Bank: Resident Non-resident

- the information provided in this questionnaire is true and complete;- it undertakes to notify the Bank of any change in the information provided in this questionnaire within 30 days after the change occurs;- it is aware that the relationship between the Bank and the Client is governed by the applicable legislation of the Republic of Latvia and General Business Terms and Conditions of

the Bank, which the Client has read and understands, and is fully aware of its obligations;- it agrees that the Bank for the determination and implementation of legal relationship between the Bank and the Client and enforcement of the provisions of laws and regulations,

applies processing of Client’s data pursuant to the legislation of the Republic of Latvia, including may request such data from any third parties according to the procedure prescribed in the laws and regulations of the Republic of Latvia;

- it is informed that the information provided herein on Client’s tax residency may be used for reporting purposes according to the legislation of the Republic of Latvia, and to the extent necessary for the Bank in order to comply with the above obligations. The Bank may process the provided information and submit it to the State Revenue Service of the Republic of Latvia under the procedure and for the purpose stated in Section XII of the Law On Taxes and Fees of the Republic of Latvia and the Law on the Implementation of Agreement between the Government of the United States of America and the Government of the Republic of Latvia to Improve International Tax Compliance and to Implement FATCA. It undertakes at the Bank’s request to provide the Bank with information and documents that are necessary for the enforcement of the above laws and regulations;

- the funds to be credited to the Client’s accounts with the Bank are of legal origin, the account and services provided by the Bank will not be used for any illegal purposes, including

(Signature) (Name, Surname)

1

that produce or are held for the production of passive income;

on an established securities market;

or an Entity wholly owned by one or more of the foregoing;

acquire or fund companies and then hold interests in those companies as capital assets for investment purposes.

-cial entity;

institution;

2

that is operating in a non-participating CRS jurisdiction. 3Passive income

CONFIRMATION

Date

4