VTB Bank (PJSC)

Questionnaire

for individual entrepreneurs, individuals, engagedinprivatepracticeinthemannerprescribedbylegislationoftheRussianFederation

Dear customer,

VTB Bank (PJSC) paysgreatattentiontoimprovingqualityofcustomerserviceandiswillingtomeetyourexpectationsandrequirementsthatyouset when you inquire with us.

Toprovidetopqualityservices, ourBankinvitesyoutoanswerthefollowingquestionsbyfillingoutthequestionnairelegiblybyhandorbyusingtechnicalmeans.

1.Last name, first name and (if any) middle name
2.Date of birth
3.Place of birth
4.Citizenship
5.Permanent (registration) address
6.Residence address
7.Permanent (registration) address specified in the Unified State Register of Individual Entrepreneurs
8.DetailsoftheID(name, series(ifany)andnumber, dateofissue, nameoftheissuingauthority, issuingauthoritycode(ifany))
9.Taxpayer identification number
10.Contact information(such asphone number, fax number,email address, mailing address (if any))
11.Migrationcarddata(forforeigncitizensandstatelesspersons) (cardnumber, start dateandexpirationdateoftheperiodofstay)
12.Detailsofthedocumentconfirmingtherightofaforeigncitizenorstatelesspersontostay (reside) intheRussianFederation(series(ifany) andnumberofthedocument, startdateandexpirationdateofresidence (stay))
13.Information on registrationas an individual entrepreneur
Primary State Registration Number of Individual Entrepreneur (OGRNIP)
place of state registration
date of state registration
14.Information about thelicense foractivities subject to licensing(type, number, date of issue ofthe license, issuing body; expiry date;list of thelicensed activities)
15.Insurancenumberof the individualaccountof the insured personin the system ofcompulsory pension insurance(if any)

16.Certify that you are a U.S. tax resident?

No, I am not a U.S. tax resident

Yes, I am a U.S. tax resident

If “Yes”, provide the following information:

SSN/ITIN[1] / SSN / Номер
ITIN
Family name, first name and (if any) middle name in the English language as in ID issued by the U.S. authorities

17.What type of bank services would you like to receive? Please, tick the boxes below[2]:

receiving ruble and foreign currency deposits

opening ruble and foreign currency accounts

purchase/sale of foreign currency

depository services

brokerage servicesat securities market

performing transactions with bank cards

accepting cheques in foreign currency for collection(includingtravelers cheques) and paying cheque refunds

lending

performing transactions with VTB Bank (PJSC) securities

remote banking services

proceeds collection

accepting payments to be credited to the accounts of the organization

transactions with precious metals

renting safety deposit boxes

providing information and consultations

other (please, specify)

18.Tick this box if you intend to carry out transactions under foreign trade agreements (contracts) entered into with the entities, which are non-residents of the Republic of Belarus and the Republic of Kazakhstan acting in their own interests or on behalf of third parties, under which the import of goods, previously acquired from residents of the Republic of Belarus and the Republic of Kazakhstan respectively, is carried out from the territory of the Republic of Belarus and the Republic of Kazakhstan, and you will submit shipping documents (accompanying documents for the goods) to the Bank as the supporting documents, which shall be executed by shippers of Republic of Belarus or the Republic of Kazakhstan.

19. Please, provide information on your primary income sources:

Income source

Average amount per year (RUB)

Salary/wages
Pension
Income from entrepreneurship
Inheritance
Depositinterests, dividends
Savings
Other income (please specify)

20. Frequency and amount of planned transactions[3]:

Transaction type / Average number of transactions per month / Average amount of transactions in rubles per month
Incoming ruble payments
Outgoing ruble payments
Incoming currency payments
Outgoing currency payments
Cash deposit
Cash withdrawal
Other operations (please, specify)

21.Whoareyourmajorcounterpartiesandbusinesspartners, payersandrecipientsundertransactionswithfundsontheaccount?[4]

Name of the counterparty, business partner, payer, recipient

TIN (if any)

Residence (country, city)

Name of the bank providing services to the counterparty, business partner, payer, recipient

Residence (country, city) of the bank providing services to the counterparty, business partner, payer, recipient

22. Please, specify the type of agreements (contracts) under which you are planning to make settlements at the Bank.[5]

23.Please, answer the following questions:

23.1.Areyouthepersonholdingorhavingpreviouslyheldthepositionslistedbelow?

YES (proceed to Item 23.2)

NO (proceed to Item 23.5)

Head of state (regardless of form of government)

Person holding (filling) a position in the administration of the Head of State

Plenipotentiary Representative ofthe Head of State

Headof executive(administrative) power of the state or its deputy

Headof executive(administrative) power of a constituent entityof the Russian Federation or its deputy

Minister or its deputy

Head of authority or organization under the Government of the Russian Federation

General(state) prosecutor or its deputy

Headoflegislativebodyofthestateoritsdeputy

Head, itsdeputy, amemberofparliamentorotherlegislativebody

Head, itsdeputy, amemberofhighestjudicialbody

Judge of thefederaljudicial bodyof the Russian Federation

Prosecutor Generalof the Russian Federation

Chairmanof the Investigative Committeeof the Russian Federation

Secretaryof theRussianFederationSecurity Council

Human Rights Ombudsmanof the Russian Federation

Head, itsdeputy, auditor of the Accounts Chamberof the Russian Federation

Head ofthe highest military stateauthorityof the state or its deputy

Leaderofan officiallyregisteredpoliticalpartyandmovement or itsdeputy

Head of state corporation or its deputy

Head of organizationestablished in accordancewith the Federal Lawof the Russian Federation

Directorormember of theboard of directors ofthe Bank of Russia

Head ofthe embassyof a foreign statein the Russian Federation

Diplomaticrepresentative ofthe Russian Federation,Ambassador Extraordinary and Plenipotentiaryof the Russian Federation, Permanent Representative of (permanent observer) of the Russian Federationto foreign statesand international organizations

Head, deputy head or an international civil servant of an international organization (the United Nations and its umbrella organizations, the European Parliament, the Council of Europe, the World Bank, the International Olympic Committee, the Organization for Security and Co-operation in Europe, NATO, the International Maritime Organization, the World Trade Organization, the Association of Southeast Asian Nations and others) and a person authorized to act on behalf of the organization

Head or member of an international judicial body

23.2. Please, specify the position held (title, rank):

23.3.Please, provide name and address of your employer:

23.4.Please, provideinformation on thepropertyowned byyouand the sources ofits origin:

Property

Property name

Source of property origin (documents of title)

Real estate
Vehicle
Securities, incl. shares
Stakesand stocksin the authorized(share) capitalof the Russian and(or) foreign organizations
Other

23.5. Are you related to the persons holding positions specified above?

YES (proceed to Item 23.6)

NO (proceed to Item 23.8)

23.6.Please, specify full name and the position (title, rank) held of the person you are related to:

23.7.Please, specify the degree of relationship:

spouse
father (mother)
son (daughter)
grandfather (grandmother)
grandson (granddaughter)
brother/sister (incl. half-blooded)
stepson (stepdaughter)
stepfather (stepmother)

23.8.Do you plan tocarry out transactionson behalf of thepersons referred toin paragraph23.1, and (or)spouses,close relatives ofthe persons mentioned inparagraph 23.1?

YES (proceed to Item 23.9)

NO (proceed to Item 24)

23.9. Please, specify full name, position (title, rank) of a person referredto in Item23.1/ name ofthe spouse, a close relative ofa person referredto in Item23.1, on whose behalfyou are planningto carry outthe transactions:

24.Pleaseprovideinformationonthebeneficialowner(individual, who is directlyorindirectlyabletocontrolyouractions and is in position todefinethedecisionstakenbyyou) ortick the box below ifthereisnosuchperson:

There is no beneficial owner.

Information on beneficial owner[6]:

Last name, first name and (if any) middle name
Date of birth
Place of birth
Citizenship
DetailsoftheID(name, series(ifany)andnumber, dateofissue, nameoftheissuingauthority, issuingauthoritycode(ifany))
Migrationcarddata(forforeigncitizensandstatelesspersons) (cardnumber, startdateandexpirationdateoftheperiodofstay)
Detailsofthedocumentconfirmingtherightofaforeigncitizenorstatelesspersontostay (reside) intheRussianFederation(series(ifany) andnumberofthedocument, startdateandexpirationdateofresidence (stay))
Permanent (registration) address
Residence address
TIN (if any)
Contact information(such asphone number, fax number,email address, mailing address (if any))

24.1.

25. Check the box, if you are a paying subagent and indicate the payment processors, which you have entered into an agreement with to receive payments from individuals:

Name

TIN (if any)

26.Please attach to this Questionnaire:

- information (documents) on your financial standing (please, tick one of the following boxes to specify which information (documents) you are attaching to this Questionnaire):

a copy of the annual financial statements(balance sheet, statement of financial performance), and (or)a copy ofthe annual(or quarterly)income tax returnwith the registration stamp of a tax authorityor without it,or acopy of a registered letterreceiptwith alist of enclosures(ifsent by mail) or a copy of sendingconfirmation in hard copy(in transmitted in electronic form);

and (or)

a copy of an audit opinion on the annual report for the previous year, which confirms the accuracy of the financial (accounting) reports and complianceofaccountingprocedureswiththelegislationoftheRussianFederation;

and (or)

a certificate issued by a tax authority stating, that as a taxpayer you have performed your obligations (levy payer, tax agent) on paying taxes, levies, penalties, fine;

and (or)

information on absence of insolvency proceedings (bankruptcy) against you, final court decisions declaring you insolvent (bankrupt), any liquidation procedures as at the date of submitting documents to the Bank;

and (or)

information on absence of failure to perform your monetary obligations due to insufficient funds on bank accounts;

and (or)

information on your rating in the Internet and on websites of international rating agencies ("Standard & Poor's", "Fitch-Ratings", "Moody's Investors Service" , etc.) and national rating agencies);

and (or)

a free-form letter of guarantee with client’s liabilitiesregistered less than 3 months before its submission to the Bank, submit to the Bank a copy of annual accounting report (balance sheet, statement of financial performance) and (or) a copy of annual (or quarterly) tax return not later than 10 days following:

- the date of receipt of a document acceptance mark made by a tax authority (the copies of documents with document acceptance marks of a taxation body are submitted to the Bank);

- the date when post office receipt onsendingdocumentsbyregisteredletterwithalistofcontentswithacopyofthisreceipt was received;

- thedateofsubmittingthereportsinelectronicformwithanattachedprintedcopyofthedocumentconfirmingsuchsubmission

- opinions about you (in any written form) (please tick the opinions you attach to this Questionnaire):

of other customers of VTB Bank (PJSC) having business relationship with you

(if there is no possibility to obtain such opinions, please tick the following box:

there is no possibility to obtain opinions of other customers of VTB Bank (PJSC));

and (or)

of other credit institutions you were provided services at and assessment of your goodwill by these credit institutions

(if there is no possibility to obtain such opinions, please tick the following box:

there is no possibility to obtain opinions from other credit institutions I was provided services at).

26.1. If it is found impossible to receive reviews from other VTB Bank customers, your business partners, and from other financial institutions where you previously kept accounts open, so, please, stick  whether the following statements are true or false with respect to you:

- at least one financial institution refused you in bank/deposit account opening:

FALSE

TRUE

- at least one financial institution dissolved the bank/deposit account contract with you at its own initiative:

FALSE

TRUE

- at least one financial institution declined your transaction:

FALSE

TRUE

- for the last 12 months you had credit loan arrears:

FALSE

TRUE

- you were held liable for a tax offence:

FALSE

TRUE

27.Additional information (any other information you want to notify the Bank of):

Information received for the purposes of meeting the requirements of Chapter 201 of the Tax Code of the Russian Federation
Are you a tax resident of a foreign country / several foreign countries?

YES NO

I AM NOT A TAX RESIDENT OF ANY STATE / ANY TERRITORY

28.2. Is your beneficiary owner (an individual who ultimately directly or indirectly (through third parties) has the ability to control your actions) a tax resident of a foreign country / several foreign countries (to be filled in if you specified this person in paragraph 19 of the Questionnaire)?

YES NO

BENEFICIARY OWNER IS NOT A TAX RESIDENT OF ANY STATE / ANY TERRITORY

28.3. Is the person (beneficiary) for the benefit of which you act in establishing legal relations with the Bank, a tax resident of a foreign country / several foreign countries (to be filled in if you stated that you act for the benefit of a third person when concluding a contract)?

YES NO

BENEFICIARY IS NOT A TAX RESIDENT OF ANY STATE / ANY TERRITORY (this option is possible for filling only for the beneficiary - an individual)

If you indicated «YES» in response to any of these questions and (or) you indicated that you and (or) your beneficiary owner and (or) beneficiary (individual) are not tax residents of any state (territory), we ask you to answer additional questions in the form provided by the Bank for the purposes of meeting the requirements of Chapter 201 of the Tax Code of the Russian Federation.

I certify that the information stated herein is correct.

I am well aware of the liability for providing false or deliberately misleading information about myself in compliance with the applicable legislation.

(signature) / (Full name of the customer/ authorized person)
Date of completion (DDMMYYYY): / . / .

[1] “SSN” means Social Security Number of a U.S. citizen. If you do not have any, provide your ITIN (Individual Taxpayer Identification Number).

[2]To be filled when accepted for services.

[3]To be filled when accepted for services.

[4]To be filled when accepted for services.

[5]To be filled when accepted for services.

[6]If there are several persons of this kind, the information on the other persons shall be provided in Item 24.1 of this Questionnaire.