Controller Detail. As appropriate to this account, please insert below the details of all Directors / Trustees / Partners / Committee Members or Controlling person(s). Name Residential Address Date of Birth Occupation Ultimate Beneficial Owner Detail 1 As appropriate to this account, please insert below the details of the natural person(s) who ultimately benefit from this investment regardless of how the account is registered. Name Residential Address Date of Birth Occupation PEP Y/N ² ¹ Ultimate Beneficial Owner - Where no beneficial ownership information is provided, it will be assumed no beneficiary holds 25% or more of the assets of the entity. ² Politically Exposed Person - Is the ultimate beneficial owner a senior government, political or military official, or an immediate family member or close associate of such a person? From above, where there is PEP associated with this account, please provide the following two confirmations: Please insert below the details of the individual PEP’s Source of Wealth, being confirmation of the economic activity which has generated the net worth of the individual Please insert below details of the origin of the particular funds which are the subject of this investment and how they were acquired
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Samples: Subscription Agreement, Subscription Agreement, Subscription Agreement