1. Full Legal Corporate Name
2. Registered Office Address
7. List any other names by which the Company is known (ie. Trading Names) 8. Is your Company duly authorised and regulated by a government or other authority in your country? YesNo
9. Source of Wealth
10. Source of Funds
11. Is the company wholly owned or partially owned by an Exchange Traded entity? YesNo
12. Does the ownership structure include any Bearer Shares? YesNo
13. Please provide details of the individuals or corporations that are the ultimate beneficial owners
14. Main Place of Business
15. Telephone Number at this location
16. Please provide the address, telephone number and email address of your operations department. Include the contact details of individuals responsible for physical contracts, demurrage and LC’s
17. Please provide the name and contact details of your relationship manager at your bank
18. Please provide the name and contact details for your legal counsel
19. Please provide the names of all persons authorised to trade on behalf of the Company
20. Please state the directors and provide source where these can be verified
By signing this document, I am hereby certifying and declaring that all of the information provided above is true, accurate, complete and not misleading by error, omission or otherwise. I confirm that I am a duly authorised representative of the Company and I have the authority to sign on behalf of the Company. We undertake to promptly inform Kimura Capital LLP, as permitted by law, of any civil or criminal penalties imposed on the Company that relate to a failing of our AML/CTF responsibilities and obligations. Additionally, we undertake to promptly inform Kimura Capital LLP upon the identification of any blocked persons, individuals or entities, or any beneficial owners relating to any business placed with Kimura. Finally, we undertake to inform Kimura of any other material changes to the information provided within this document. We expressly recognise the right of Kimura to terminate any business or contractual relationship maintained with the Company in view of a Sanction breach or failure to provide information or documentation that may be required by regulatory or legal obligation.
Your full name
Your email
Position
Your company
Signature