Due Diligence Form for Natural Persons / UBO

Please complete all sections accurately. Fields marked with * are mandatory under Cyprus AML Law.

This form must be completed by each natural person who is a client, director, shareholder, or Ultimate Beneficial Owner (UBO) of a corporate entity engaging the services of Yiannakis K. Thoma Law Firm LLC. The information requested is the minimum required under the Prevention and Suppression of Money Laundering and Terrorist Financing Law 188(I)/2007 (as amended). All information provided is treated as strictly confidential.

Section 1 of 10

Personal Information

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Personal Information

First Name(s) *

Surname *

Date of Birth *

Place of Birth

City and country of birth, as per passport.

Nationality *

Other Nationality (if applicable)

If you hold dual or multiple citizenship, please indicate all nationalities.

ID Card Number

Required if you hold Cyprus nationality.

Passport Number

Required for non-Cyprus nationals.

Passport Issuing Country

Passport Expiry Date

Country of Tax Residence *

Required for CRS/FATCA compliance.

Tax Identification Number (TIN)

Select your country of tax residence first.

Residential Address

Permanent Residential Address *

Full address including street, city, postal code, and country.

City *

Postal Code *

Country of Residence *

Correspondence Address (if different from above)

Dual or Temporary Residential Address (if applicable)

III

Education and Occupation

Highest Level of Education *

Current Occupation / Employment Status *

Current Employer / Company Name (if employed)

Job Title / Position

Employer Address

Brief description of professional background and experience

Contact Information

Email Address *

Mobile / Telephone Number *

Include country code, e.g. +357 99 123456

Alternative Telephone Number

Fax Number (if applicable)

Source of Income

Description of source(s) of income *

Please be specific. Generic terms such as Business or Investments are not acceptable. Describe the nature of your income, the sector, and the countries involved.

Approximate annual income range *

Countries from which income is received *

Select the primary country from which you receive income.

Source of Wealth

Source of wealth refers to the origin of the total net worth or assets of the individual, i.e., how the overall wealth was accumulated over time, as distinct from the current source of income.

Primary source of wealth *

Approximate total net worth

Please provide supporting details for each applicable source of wealth:

A. Employment / Salary

Employer name

Position held

Period of employment

Country

B. Business Ownership / Profits

Company name

Country of incorporation

Your shareholding (%)

Nature of business

C. Investments (dividends, capital gains, interest)

Type of investment(s)

Approximate value

Countries where investments are held

D. Inheritance / Gift

Name of deceased / donor

Relationship to you

Date of inheritance / gift

Approximate value

E. Sale of Real Estate / Property

Property location

Date of sale

Net proceeds from sale

VII

Contact Person (if different from above)

Full Name

Relationship to Client

Email Address

Telephone Number

Address

VIII

Existing Bank Accounts and Anticipated Transactions

Please list your existing bank account(s) and the country of the bank

Anticipated nature of transactions

Anticipated volume of transactions per month

PEP Declaration & Screening Consents

Section — Politically Exposed Person (PEP) Declaration

Mandatory under Cyprus AML Law 188(I)/2007, Article 61 — All questions must be answered

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. *

Document Upload

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

Valid Passport or National ID Card*

Upload a clear copy of your valid passport or national ID card.

Click to select files or drag and drop here

Accepted formats: PDF, JPG, PNG, DOCX — Maximum 10 MB per file · max 2

Proof of Residential Address (less than 3 months old)*

Upload a recent utility bill, bank statement, or official letter confirming your residential address.

Click to select files or drag and drop here

Accepted formats: PDF, JPG, PNG, DOCX — Maximum 10 MB per file · max 2

Bank Reference Letter or Professional Reference

Upload a reference letter from your bank, lawyer, or accountant.

Click to select files or drag and drop here

Accepted formats: PDF, JPG, PNG, DOCX — Maximum 10 MB per file · max 2

Additional Documents (Curriculum Vitae, Source of Wealth Evidence, etc.)

Upload any additional documents supporting your source of wealth or professional background.

Click to select files or drag and drop here

Accepted formats: PDF, JPG, PNG, DOCX — Maximum 10 MB per file · max 5

Mandatory Documents

The following documents must be submitted together with this form. This is the minimum required documentation; additional documents may be requested.

Copy of valid Passport or National ID Card (certified copy)
Proof of residential address (utility bill, bank statement, or government-issued document not older than 3 months)
Reference letter from a Bank, Lawyer, or Accountant (not older than 3 months)
Detailed Curriculum Vitae (CV) regarding financial status and professional background
For Source of Wealth — Employment: most recent payslips (last 3 months) or employment contract
For Source of Wealth — Business: company financial statements or dividend documentation
For Source of Wealth — Investment: investment account statements or portfolio summary
For Source of Wealth — Inheritance or Gift: copy of will, probate documents, or gift deed
For Source of Wealth — Real Estate: sale agreement or title deed transfer documentation
Tax Identification Number (TIN) documentation

Important Notice

• Each document must be an Original or a Certified Copy. Certified copies must be certified by a Certified Officer, Embassy, Consulate, High Commission, or Apostille.
• Documents must be in English or Greek. Otherwise, an official translation is required.
• Upon request, supporting documents (contracts, invoices, information on business partners, etc.) will be provided to justify the nature of the business and financial profile.

Declaration

By signing this form I confirm and declare that:

I am the person named in this form, and the information provided is true, accurate, and complete to the best of my knowledge.

I have not been engaged in or have not benefited from (a) criminal conduct and/or (b) funds which are wholly or partially, directly or indirectly, products of criminal conduct.

I undertake to promptly notify Yiannakis K. Thoma Law Firm LLC in writing within 14 days of any changes to the information provided in this form.

I acknowledge that Yiannakis K. Thoma Law Firm LLC is required by law to conduct ongoing monitoring of the business relationship and may request updated documentation periodically.

I understand that providing false or misleading information may constitute a criminal offence under Cyprus law.

Date

Electronic Signature *

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