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/ , / QUESTIONNAIRE OF ...

/

, /

QUESTIONNAIRE OF CUSTOMER

SELF-EMPLOYED ENTREPRENEUR/

INDIVIDUAL ENGAGED IN PRIVATE PRACTICE DEFINED BY RUSSIAN LAW

( / All fields are to be filled in obligatorily and clearly)

, ( ) /

SURNAME, NAME AND PATRONYMIC (unless otherwise follows from law or national custom) FORMTEXT

/gender FORMCHECKBOX /MALE FORMCHECKBOX /FEMALE

/

native country FORMTEXT

/

date and place of birth FORMTEXT

/citizenship FORMCHECKBOX /RUSSIA FORMCHECKBOX ( )/

OTHER (name all countries) FORMTEXT

?/

tax residency FORMCHECKBOX /RUSSIA FORMCHECKBOX 2 ( )/

OTHER2 (name all countries) FORMTEXT

( )/

INN (obligatory for self-employed entrepreneur) FORMTEXT

(, , , , , ( ))/

ID DOCUMENT (series, number, date of issue, issuing authority, division code if any) /DOCUMENT TYPE FORMTEXT

/DOCUMENT DETAILS FORMTEXT

( )/

migration card (for non-residents or aliens) /SERIES FORMTEXT /NUMBER FORMTEXT

/DURATION OF STAY FROM: FORMTEXT

/DURATION OF STAY TO: FORMTEXT

, () /

stay or residence permit in russia (for non-residents or aliens) /DOCUMENT TYPE FORMTEXT

( )SERIES (if any) FORMTEXT /number FORMTEXT

()/date of issuance FORMTEXT

()/date of expiration FORMTEXT

/

registered address in russia /zip code FORMTEXT , , , /republic, territory, region, district FORMTEXT

/name of locality FORMTEXT

/STREET FORMTEXT /HOUSE FORMTEXT /BUILDING FORMTEXT ()/APARTMENT (OFFICE) FORMTEXT

/

actual address in russia FORMCHECKBOX /SAME AS THE REGISTERED ADDRESS IN rUSSIA

FORMCHECKBOX ()/OTHER (indicate): FORMTEXT

( )/





DOMICILE OUTSIDE OF RUSSIA (for non-residents of Russia) /COUNTRY FORMTEXT /ZIP CODE FORMTEXT

, , , /REPUBLIC, TERRITORY, REGION, DISTRICT FORMTEXT

/NAME OF LOCALITY FORMTEXT

/STREET FORMTEXT /HOUSE FORMTEXT /BUILDING FORMTEXT ()/APARTMENT (OFFICE) FORMTEXT

/

postal address FORMCHECKBOX /SAME AS THE REGISTERED ADDRESS IN rUSSIA

FORMCHECKBOX /SAME AS THE ACTUAL ADDRESS IN rUSSIA

FORMCHECKBOX /SAME AS the DOMICILE OUTSIDE OF RUSSIA

FORMCHECKBOX ()/OTHER (indicate): /COUNTRY FORMTEXT /ZIP CODE FORMTEXT

, , , /REPUBLIC, TERRITORY, REGION, DISTRICT FORMTEXT

/NAME OF LOCALITY FORMTEXT

/STREET FORMTEXT /HOUSE FORMTEXT /BUILDING FORMTEXT ()/APARTMENT (OFFICE) FORMTEXT

, /

ANY BUSINESS TO BE LICENSED? FORMCHECKBOX /YES FORMCHECKBOX /NO

3?/

DO YOU ACT AS A PAYMENT AGENT 3? FORMCHECKBOX /YES FORMCHECKBOX /NO

CORE BUSINESSES /OKVED code /NAME OF THE CORE BUSINESS

FORMTEXT FORMTEXT

FORMTEXT FORMTEXT

4?/

ARE YOU A PEP4? FORMCHECKBOX ( )/

YES (fill in Appendix Information about politically exposed person)

FORMCHECKBOX /

no

, 5?/

are you a person related to/associated with a pep5? FORMCHECKBOX ( )/

YES (fill in Appendix Information about politically exposed person)

FORMCHECKBOX /

no

, - /

THE PURPOSES OF ESTABLISHING AND THE INTENDED NATURE OF YOUR BUSINESS RELATIONS WITH THE BANK; THE PURPOSES OF YOUR FINANCIAL AND BUSINESS OPERATIONS

FORMCHECKBOX - /

CASH AND SETTLEMENT SERVICES FORMCHECKBOX /

REMOTE ACCOUNT MANAGEMENT

FORMCHECKBOX /

SALARY PAYMENT USING BANK CARDS FORMCHECKBOX /

PAYMENT CARDS

FORMCHECKBOX /

SECURITY TRANSACTIONS FORMCHECKBOX

TRADE FINANCE

FORMCHECKBOX /

LOANS FORMCHECKBOX /

DEPOSITS

FORMCHECKBOX /

CASH COLLECTION FORMCHECKBOX ()/OTHER (indicate): FORMTEXT

20.1. ?/DO you plan any foreign trade OPERATIONS?

FORMCHECKBOX /NO FORMCHECKBOX /YES ( 1, 2 , /indicate 1,2 types of agreements, contracts):

FORMCHECKBOX /IMPORT OF GOODS FORMCHECKBOX /EXPORT OF GOODS FORMCHECKBOX /IMPORT OF SERVICES

FORMCHECKBOX /EXPORT OF SERVICES FORMCHECKBOX /AGENCY AGREEMENT FORMCHECKBOX /COMMISSION AGREEMENT

FORMCHECKBOX ()/OTHER (indicate): FORMTEXT

20.2. , , , ?/DO you plan to pay in favor of third persons LOCATED in other JURISDICTIONS FOR goods imported from belorussia and kazakhstan?

FORMCHECKBOX /NO FORMCHECKBOX /YES

20.3. / /- ?/

DO YOU PLAN TO SEND/RECEIVE MONEY TO/FROM ABROAD under other types of FUNDS transfer?

FORMCHECKBOX /NO

FORMCHECKBOX ( )/YES (tick the appropriate box and indicate a relevant country): FORMCHECKBOX /OWN FUNDS TRANSFER FORMTEXT FORMCHECKBOX ()/OTHER (indicate): FORMTEXT

20.4. /information about planned account transactions per month

/ TYPE OF TRANSACTION / PLANNED NUMBER OF TRANSACTIONS ( )

MAX. TURNOVER PLANNED (RUB)

, /

CASHLESS TRANSFERS, UNLESS FOR FOREIGN TRADE PURPOSES / Incoming FORMCHECKBOX /up to 100 FORMCHECKBOX /up to 500 FORMCHECKBOX /over 500 FORMTEXT

/

Outgoing FORMCHECKBOX /up to 100 FORMCHECKBOX /up to 500 FORMCHECKBOX /over 500 FORMTEXT

/

CASHLESS TRANSFERS FOR FOREIGN TRADE PURPOSES /

Incoming FORMCHECKBOX /up to 100 FORMCHECKBOX /up to 500 FORMCHECKBOX /over 500 FORMTEXT

/

Outgoing FORMCHECKBOX /up to 100 FORMCHECKBOX /up to 500 FORMCHECKBOX /over 500 FORMTEXT

FORMCHECKBOX /NO CASHLESS TURNOVER IS PLANNED

/CASH TRANSACTIONS /

Deposit

FORMCHECKBOX /up to 100 FORMCHECKBOX /up to 500 FORMCHECKBOX /over 500 FORMTEXT

/

Withdrawal FORMCHECKBOX /up to 100 FORMCHECKBOX /up to 500 FORMCHECKBOX /over 500 FORMTEXT

FORMCHECKBOX /NO CASH TURNOVER IS PLANNED

20.5. /INFORMATION ABOUT KEY COUNTERPARTIES

/

FULL OR SHORT OFFICIAL NAMES

( )/

INN or KIO

(if any) /LOCATION

/COUNTRY /CITY

FORMTEXT FORMTEXT FORMTEXT FORMTEXT

FORMTEXT FORMTEXT FORMTEXT FORMTEXT

()/ i CONFIRM MY FINANCIALS WITH THE FOLLOWING INFORMATION (DOCUMENTS) FORMCHECKBOX 3-/TAX RETURN IN 3-NDFL FORM

FORMCHECKBOX , , , /NO OUTSTANDING TAXES, LEVIES, PENALTIES AND FINES

FORMCHECKBOX ()6/OTHER (indicate)6 FORMTEXT

( )/

THE REASON FOR ESTABLISHING RELATIONS WITH THE BANK IN RUSSIA (for non-residents of Russia) FORMCHECKBOX /OPERATIONS IN RUSSIA

FORMCHECKBOX ( )/OTHER (indicate why else) FORMTEXT

/

source of wealth and source of funds FORMCHECKBOX /

core business FORMCHECKBOX /

RENTING OWN REAL ESTATE

FORMCHECKBOX /

FINANCIAL TRANSACTIONS FORMCHECKBOX ()/OTHER (indicate) FORMTEXT

, ( / ANY ACCOUNTS WITH OTHER CREDIT INSTITUTIONS?

(including foreign banks) FORMCHECKBOX /no

FORMCHECKBOX ( )/YES (fill in the table below):

/

BANK NAME /

LOCATION , /SERVICES USED /

CUSTOMER SINCE

FORMTEXT FORMTEXT FORMTEXT FORMTEXT

FORMTEXT FORMTEXT FORMTEXT FORMTEXT

/

INFORMATION ABOUT BUSINESS REPUTATION FORMCHECKBOX /

NO INFORMATION THAT YOU HAVE BEEN INVOLVED IN ANY DISPUTE/LITIGATION

FORMCHECKBOX /

POSITIVE MEDIA COVERAGE

FORMCHECKBOX /

POSITIVE FEEDBACK

FORMCHECKBOX ()/OTHER (indicate) FORMTEXT

7/

any beneficiaries?7 FORMCHECKBOX ( )/

yes (fill in Appendix Information about beneficiary for each beneficiary separately)

FORMCHECKBOX /

NO

8/

any beneficiary owners8 FORMCHECKBOX ( - )/

YES (fill in Appendix Information about beneficiary owner (individual) for each beneficiary owner separately)

FORMCHECKBOX / i am acting for my own benefit and in my own interests

/

contact details ( )/

telephones (including country and city code) ( )/

fax (including country and city code) e-mail ( )/(if any) ( )website (if any)

, , , . , , 5 /

I HEREBY CONFIRM THAT THE HEREIN CONTAINED INFORMATION IS TRUE AND ACCURATE AS OF THE DATE HEREOF. IF THERE IS ANY CHANGE IN SUCH INFORMATION, i UNDERTAKE TO NOTIFY THE BANK THEREOF WITHIN 5 BUSINESS DAYS.

FORMTEXT

( , )/

(full name of self-employed entrepreneur or person engaged in private practice FORMTEXT

/signature

..( /seal (if any) FORMTEXT FORMTEXT FORMTEXT

/date

1 , 183 12 ( 2 207 )./

Russian tax residents mean individuals who have been physically present in Russia for at least 183 calendar days during 12 consecutive months (clause 2, article 207 of the Russian Tax Code.

2 , , . , , : ) ( I-551 (Green Card)); ) 31 183 3 , . , , , : (i) 1 (.. , ); (ii) 1/3 (iii) 1/6. ./

Note that tax residency criteria are set by the laws of a relevant country and may differ from those set by the Russian legislation.

E.g. under the common law an US tax resident is a person: a) permitted to stay in USA on a permanent basis (form I-551 (Green Card)); b) staying in USA at least 31 days during a current calendar year and at least 183 days over the period of 3 years, including a current year and two preceding years. However, the number of days, which is spent by the person on US territory within a current year and two preceding years, is multiplied by the applicable coefficient: (i) the coefficient for a current year is equal to 1 (i.e. including all days the person has stayed during a current year); (ii) the coefficient for a preceding year is equal to 1/3 and (iii) coefficient for a penultimate year is equal to 1/6. If you have any doubts, please contact your tax advisor.

3 - , , (, ), , (, )./Payment agent means a legal entity that accepts funds sent by individuals as payment for goods (works, services), residential premises and utilities in accordance with the Russian Housing Code, as well as subsequently settles accounts with the supplier of goods (works, services).

4 :

- , ( ) , , , , , , , , ;

- , ( : , , , , , , , , ..); , () , , , , , , , , , ./

PEP (Politically Exposed Person) means:

a foreign functionary, a person vested (or used to be vested) with a public function in his/her country, e.g. heads of states or governments, prominent politicians, top-ranking government officials, judicial officials (e.g. judges and etc.), top-ranking military officials, CEOs of state corporations, political party leaders;

an international public organization functionary, a person entrusted or used to be entrusted with prominent functions in an international organization (e.g. UN, International Maritime Organization, Council of Europe, EU institutions, Organization for Security and Cooperation in Europe (OSCE), Organization of American States, NATO, WTO, ASEAN and etc.);

a Russian functionary, a person who holds (substitutes) a public office in Russia or another post in governmental agencies or state companies (e.g. Board of Directors of the Central Bank of Russia (CBR), federal civil service where Russian President or Government appoints or dismisses candidates, CBR, state corporations or other organizations set up by Russian Government pursuant to a federal law), as well as included into the list of posts defined by Russian President.

5, , , ( ( , , ), ( ) , ) , / , ; , ./

Person related to/associated with a PEP means his/her spouse, next of kin (parents and children), grandparents and grandchildren, siblings and half-siblings (having a common parent), adoptive parent and child, or a person effecting transactions and/or deals on behalf of such person (if he/she is serviced by the Bank), as well as people constituting the inner circle of a PEP, including his/her business partners and associates.

6: ; , , , ./

E.g.: confirmation that there have been no cases of a self-employed entrepreneurs inability to discharge his/her obligations due to the lack of funds on his/her bank accounts; information that he/she has not been involved in any judicial, administrative, tax and other proceedings which are capable of affecting his/her financials.

7 , , , , , ./

Beneficiary means a person to whose benefit you will act as a customer of the Bank, including under an agency agreement, commission agreement, fee and trust management agreement in connection with monetary and other property transactions.

8 - , ./

Beneficiary owner means an individual capable of controlling the actions which you carry out as an self-employed entrepreneur.

(* , (), , ( ) , , , , ( , ( , ..), ; , , , )./(*Controlling person means an individual who has a right (possibility), including by virtue of an agreement with customer, to directly and indirectly (via third persons) exert a material influence on the decisions made by customer, to exercise powers in order to influence the size of customers income; an individual capable of influencing customers decisions about deals (including those associated with a credit risk (on the issuance of loans, guarantees and etc.), as well as about financial transactions); an individual who is customers parent or adoptive parent, a guardian, trustee or etc.)




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