QUESTIONNAIRE FOR FOREIGN NATURAL PERSONS. In the process of establishing a business relationship or executing a transaction with a non resident customer the Bank of Georgia is obliged to apply the respective procedure based on which it is determined whether the customer is a Politically Exposed Person (in accordance with the law of Georgia on the facilitating the prevention of illicit income legalization).
1. Are You holding a senior public position (e.g. state president, prime minister, minister, deputy minister (or equivalent)) in your domicile state/state of permanent residence?
2. Are You a member of parliament/member of a legislature?
3. Are You a member of the Supreme Court, Constitutional Court or another high court?
4. Are You a member of the central (national) bank's council?
5. Are You an ambassador, consul or a high ranked military officer?
6. Are You a member of the managing or supervisory board of (majority) state-owned legal entities?
7. Are you a senior executive of political party (union)? If yes, please specify the name of the political party (union):
8. Are You the ultimate owner/beneficial owner of the banking accounts, which you will hold in Bank of Georgia? If no, please specify the name of ultimate beneficial owner: Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No
9. Are You an immediate family member of the person stated under 1-6:
1. spouse or brother or sister
2. common-law partner
3. child or spouse of the child or common-law partner of the child
4. parent
10. Are You a personal or professional associate of the mentioned person(s) who commonly benefits from the assets or from an established business relationship or from another form of close business contact with the upper stated person(s)?
11. If yes on 9-10 questions , please specify the name and position:
12. Has a time period of at least 12 months expired since the termination of any of the upper mentioned senior public position?
13. If You are a Politically Exposed Person please state: Yes No Yes No Yes No
a) the source of the assets or funds which are or will be the subject of the business relationship with Bank of Georgia:
b) Total estimated annual income in GEL ( tick as appropriate): Less than 30,000 Between 100,000 and 500,000 Between 30,000 and 100,000 More than 500,000
c) Total estimated net worth in GEL (liquid assets, investments, real property):
d) Purpose and Reasons for Opening of the Account(s):
e) The amount expected to be received on the accounts: Less than 30,000 Between 100,000 and 500,000 Bet...
