Due Diligence Form for Charity / Foundation / Club / Society

Cyprus Bar Association — AML/KYC Compliance | Law 188(I)/2007

Section 1 of 9

Entity Details

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This form must be completed by a Director, Trustee, Officer, or authorised signatory of the entity. All fields marked with an asterisk (*) are mandatory under Cyprus Anti-Money Laundering legislation. Please complete all sections accurately and attach the required supporting documents.

Entity Details

Full Name of Entity *

Type of Entity

Registration Number *

Date of Registration

Country of Registration *

Regulatory / Supervisory Authority (if any)

Registered Address *

Principal Place of Operations (if different)

Contact Telephone

Contact Email

Website (if applicable)

Tax Identification Number (TIN)

VAT Registration Number (if applicable)

Purpose and Objectives

Primary Purpose / Category

Detailed Purpose of Creation and Objectives *

Potential or Known Beneficiaries

Countries / Regions of Operation

III

Governance and Control

Under Cyprus AML Law, you are required to identify all persons who exercise control over the entity, including Board Members, Trustees, Officers, and any other person with significant influence.

Full Names and Roles of Persons who Exercise Control *

Governance Structure

Number of Members / Registered Members

Financial Information

Primary Source of Funds *

Description of Source of Funds

Estimated Annual Budget / Income (EUR)

Estimated Annual Expenditure (EUR)

Bank Account(s) — Bank Name(s)

Country of Bank Account(s)

Does the entity receive funds from foreign sources (outside Cyprus)?

YesNo

If yes, please identify the foreign funding sources

Services Requested from the Firm

Description of Matter / Purpose of Engagement

Estimated Transaction Value (if applicable, EUR)

Anticipated Transaction Frequency

PEP Declaration & Screening Consents

PEP Declaration — Officers, Directors and Trustees

The following PEP declaration must be completed by the person signing this form and applies to all persons who exercise control over the entity.

Definition: A Politically Exposed Person (PEP) is an individual who holds or has held a prominent public function, including Heads of State or Government, senior politicians, senior government, judicial or military officials, senior executives of state-owned enterprises, and senior officials of political parties. It also includes members of the governing bodies of international organisations.

1. Do you currently hold or have you previously held a prominent public function (i.e., are you a PEP)?*

YesNo

2. Are you an immediate family member of a PEP? (spouse, partner, children, parents, or siblings)*

YesNo

3. Are you a known close associate of a PEP? (a person known to have joint beneficial ownership, close business relations, or to be the sole beneficial owner of a legal entity set up for the benefit of a PEP)*

YesNo

I consent to the processing of my personal data by Yiannakis K. Thoma Law Firm LLC for AML/KYC compliance purposes, as required under Cyprus AML Law 188(I)/2007 and the EU General Data Protection Regulation (GDPR). I understand that my data will be retained for a minimum of five (5) years from the end of the business relationship, as required by law. *I acknowledge that Yiannakis K. Thoma Law Firm LLC is required to conduct screening against EU, UN, OFAC, and other applicable sanctions lists, as well as adverse media checks, as part of its AML/KYC obligations. *

VII

Additional Compliance Information

Is the entity or any of its officers subject to any current or pending criminal investigation, prosecution, or regulatory sanction?

YesNo

If yes, please provide details

Is the entity or any of its officers subject to any international sanctions (UN, EU, US OFAC, UK, or other)?

YesNo

If yes, please provide details

Has the entity or any of its officers been involved in any money laundering or terrorist financing investigation?

YesNo

VIII

Document Upload

Please upload the required supporting documents. Accepted formats: PDF, JPG, PNG, DOCX (max 10 MB each).

Certificate of Registration*

Upload the official certificate of registration of the entity.