ALROSA Diamonds

Client’s Registration Data[1]

Section 1. General information about the Applicant
  1. Full company name of the Applicant

  1. Registration Date, Place, Registration number of the company and Authoritythat effected the registration

  1. Registered address

  1. Postal address (address for postal correspondence)

  1. Head of the Company
(full name, citizenship, date of birth, place of birth (country and city), passport details (number and issue date), registration address, personal tax reference number)
  1. Applicant’s contact person

  1. Phone

  1. Fax

  1. Web-site

  1. E-mail

Section 2. Details of shareholders and share capital
  1. Paid-up capital:

  1. Composition of the company’s management bodies: sole and/or collegial executive body, board of directors/ supervisory board (full name, positions).

  1. Persons or/and legal entities (members, shareholders) whose shareholding in the Applicant’s authorized capital stock (or number of voting shares) is 25% and more (for legal entities indicate full name and registered, state registration number and the authority of incorporation; for individuals indicate their full name and address)

  1. Bank details
/ Bank (name and address)
Account No.
Correspondent account
Tel. of the Bank:
Contact person at the bank:
Section 3 Information on Beneficiary
  1. An individual which up front or intermediately (through third parties) controls (has overriding participation in more than 25% of capital) a client (a legal entity) or has capability to control client’s operations (full name, citizenship, date of birth, place of birth(country and city), passport details (number and issue date), registration address, immigration card details: series, card number, date of the beginning of the residence duration, date of the residence expiration, document details acknowledging foreign citizen right or individual without nationality in residence (habitation) on the Russian Federation Territory: series (if so), document number, date of the beginning of the residence duration (habitation), date of the residence expiration (habitation), personal tax reference number.

Section 4. Information on the Applicant’s production and commercial activities
  1. Applicant’s specialization

  1. Applicant’s own diamond cutting and polishing operations: location, production volumes (in value terms), size groups and quality characteristics of processed diamonds, diamond cut brands

  1. Sales of polished diamonds (in percentage break-down): to wholesalers and retailers, used for own jewellery manufacture needs; geographic spread of sales

  1. Own jewelry production capabilities: location of facilities, production volumes in terms of value, jewelry brands, geographic spread of sales

  1. Jewellery sales of: location of retail jewellery outlets, jewelry brands sold

  1. Desired diamonds categories (weight, color, clarity)

  1. Desired delivery volumes (cts, $/year)

______
(Signature, name and position of authorized person, date, stamp)

[1]Allfieldsare required