FORM – Legal Entity
Due to Act on Measures Against Money Laundering and Terrorist Financing /
  1. The Client – name, address etc.

Name: / Reg. No.:
Legal residence: / City and Country:
Tel.: / Fax: / E-mail:
  1. Is the Client listed on a regulated market?

NoYes (what?)

  1. Operations of the Client

What is the purpose of the Client / what operations does the Client have?

(Please provide a certificate froma competent national authority containing the Client’s purpose and the names of the board members (not more than 2 months old).)

  1. Individuals who are authorized to legally bind the Clientin its dealings with Arctica Finance hf.

Name: / Id. No.:
Legal residence: / City and Country:
Tel.: / E-mail:
Presented identification:
Passport / Passport number: / Issuing date:
Authority:
Procurator Power of Attorney Other (what?) / Signature example:
Name: / Id. No.:
Legal residence: / City and Country:
Tel.: / E-mail:
Presented identification:
Passport / Passport number: / Issuing date:
Authority:
Procurator Power of Attorney Other (what?) / Signature example:

(Procuration must be verified with a valid certificate. An original of a Power of Attorney must accompany this form.)

  1. Beneficial owner
  1. Is the Client conducting business on behalf of a third party?

NoYes (who?)

  1. If yes to a - What is the reason the Client intends to conduct business on behalf of a third party?
  1. Origin of financial resources
  1. What is the origin of the funds to be used in the business/transactions whereby Arctica Finance may be involved in?

SavingsTurnoverSales profitOther (what?)

  1. Where will the first transfer of funds come from (e.g. bank account) and who is the owner of those funds?
  1. Persons owning at least 25% in the Client

Provide information on those who own 25% or more in the Client, and if those parties are legal entities then information on those who own 25% or more in that party must also be provided etc., until information on the ultimate beneficial owner has been provided in accordance with item 4 in Article 3 in the Act no. 64/2006, on measures against money laundering and terrorist financing.

Name: / Reg. No. / Id. No.:
Legal residence: / City and Country:
Stake in %:
Name: / Reg. No. / Id. No.:
Legal residence: / City and Country:
Stake in %:
Name: / Reg. No. / Id. No.:
Legal residence: / City and Country:
Stake in %:
  1. Purpose and nature of the business
  1. What is the purpose/nature of the business the Client intends to conduct with or with the involvement of Arctica Finance?

Asset managementCorporate finance Securities brokerageOther (what?)

  1. Documents

The data listed below need to accompany this form:

  1. An original or a certified copy of a Certificate of Incorporationfrom a competent authority, e.g. a Companies Registry.A certificate may not be older than three months.
  2. An original or a certified copy of a certificate listing the board of directors of the Clientfrom a competent authority. A certificate may not be older than three months.
  3. Confirmation from the Client who are authorized to legally bind the Client, e.g. a procuration or a power of attorney.A confirmation may not be older than three months.
  4. Valid passports of the following individuals (they must in person present a valid passport to an employee of Arctica Finance, who in turn will take a photocopy,or confirmed by a notary public:

IBoard members

IIChief Executive Officers

IIIHolders of procuration

IVOthers who are to represent the Client towards Arctica Finance hf., i.a. legally bind the Client

  1. The Client’s Articles of Association.
  2. The latest audited account of the Client.
  3. Other documents as may be requested by Arctica Finance.

The Client confirms that all the information in this form and in the accompanying documents is true and correct.

(Place) / (Date) / (Signature)

Vers.: AML-0041/2