ࡱ> jliqXbjbjzLzL4t&\&\ r r (((8`<(w%jppppp$$$$$$$$&)$Q$ppH1%pp$$:n#,#p GF # $G%0w%#R*PZ*#*#$$w%*r h :@8410==O V=25=B0@N 4;O >@30=V70FVW >A2VB=L>3> ?@>F5AC ?@>D5AV9=>-?@0:B8G=>W ?V43>B>2:8 73V4=> 45@602=8E AB0=40@BV2 70 ?@>D5AVTN CE0@; >=48B5@>40B>: 6 4> " "/QUESTIONNAIRE , !"   .// GENERAL INFORMATION ABOUT THE COMPANY10720 :><?0=VW // Name of the company2@0W=0 @5TAB@0FVW // Country of incorporation3 5TAB@0FV9=89 =><5@ B0 40B0 @5TAB@0FVW // Number and date of registration48:>=02G89 >@30= (=09<5=C20==O, A:;04: .../ V<5=0 G;5=V2 28:>=02G>3> >@30=C, :@0W=0 3@><04O=AB20) // Executive Body (name, composition: names of the Executive Body members, their citizenship)5>=B0:B=0 V=D>@<0FVO :><?0=VW (251A09B, :>=B0:B=V =><5@8 B5;5D>=V2, e-mail) // Contact information (website, telephone numbers, e-mail)6A=>2=V 2848 4VO;L=>ABV Main activities7'8 1C;0 :><?0=VO @5>@30=V7>20=0, 284V;5=0, ?5@59<5=>20=0; G8 T :><?0=VO ?@02>=0ABC?=8:>< V=H>W N@848G=>W >A>18? Has the company been reorganized, spun off, renamed; whether the company is the successor of another legal entity?=V B0: (1C4L ;0A:0 CB>G=VBL) // No Yes (please clarify)8'8 7<V=N20;8AO 70 >AB0==V 420 @>:8 CG0A=8:8 (2V4 0%) G8 0:FV>=5@8 (2V4 10%), 48@5:B>@8, G;5=8 =03;O4>2>W @048? Have the participants (from 0%) or shareholders (from 10%), directors, members of the Supervisory Board changed over the past two years?=V B0: (1C4L ;0A:0 CB>G=VBL) // No Yes (please clarify)9'8 ?@0FNT :><?0=VO C B0:8E :@0W=0E/@53V>=0E: !C40=; V2VO; @0:; 0:8AB0=; D30=VAB0=; @0=; V15@VO; >@40=VO; @>AV9AL:0 D545@0FVO; 1V;>@CAL; !(; =5?V4:>=B@>;L=0 B5@8B>@VO #:@0W=8 // Is the company active in these countries/regions: Sudan Libya Iraq Pakistan Afghanistan Iran Liberia Jordan russian federation belarus USA uncontrolled territory of Ukraine =V B0: (1C4L ;0A:0 CB>G=VBL) // No Yes (please clarify)!  " " & $&  ! (UBO) // COMPOSITION OF THE COUNTERPARTY S ASSETS ULTIMATE BENEFICIARY OWNER (UBO)10>2=5 V< O UBO B0 :@0W=0 3@><04O=AB20 // Full name of UBO, citizenship11... B0 :@0W=0 3@><04O=AB20 4>2V@G>3> :5@CNG>3> (O:I> :V=F5289 2;0A=8: T =><V=0;L=8< 2;0A=8:><) // Full name and citizenship of the trustee (if the ultimate owner is a nominal holder)12... CG0A=8:V2 01> 0:FV>=5@V2, O:V 2>;>4VNBL 10% V 1V;LH5 0:FV9, :@0W=0 WE 3@><04O=AB20 // Full names of the participants or shareholders owning 10% or more shares, their country of citizenship13$ D R l n * P R T V ŵ|mZGm@mZ hhO$hhOCJOJQJaJmH sH $hh&CJOJQJaJmH sH hhOCJOJQJaJ hhSq"hh&56CJOJQJaJhh5CJOJQJaJhhSq5CJOJQJaJh_hU5CJOJQJaJh&h&5CJOJQJaJhx* 5CJOJQJaJh"h"CJOJQJaJh+Fh+FCJOJQJaJD n  * R T vhhhhd$Ifgdhkd$$Ifl1%% t0644 layt$d$Ifa$gd$a$gdSq$a$gd"T V Z oaaaad$Ifgdkdu$$Ifl`F1%N t06    44 layt  P R T V * p r t | 0NPRT468dhjx˱˱ڞڞˋxˋڋˋ$hhnbCJOJQJaJmHsH$hhnbCJOJQJaJmH sH $hhOCJOJQJaJmHsH$hh&CJOJQJaJmH sH  hhOhhOCJOJQJaJ$hhOCJOJQJaJmH sH $hh@YCJOJQJaJmH sH *  R T oaaaad$Ifgdkd $$Ifl`F1%N t06    44 laytT V Z * oaaaad$Ifgdkd$$IflF1%N t06    44 layt oaaaad$Ifgdkd4$$IflF1%N t06    44 layt 0PRoaaaad$Ifgdkd$$IflF1%N t06    44 laytRTX8$`bdjoaaaaaaaaad$Ifgdkd^$$Ifl`F1%N t06    44 layt xoaaaaaaaaad$Ifgdkd$$IflF1%N t06    44 layt |z|6:<fh&8|ıӎzjZFZ'hh~5CJOJQJaJmH sH hh~5CJOJQJaJhh6CJOJQJaJ'hhia5CJOJQJaJmH sH hhia5CJOJQJaJ$hhCJOJQJaJmH sH $hh@YCJOJQJaJmH sH hhOCJOJQJaJ hhO$hhOCJOJQJaJmH sH $hh~CJOJQJaJmH sH ^lzoaaOOOOOO & Fd$Ifgdd$Ifgdkd$$IflF1%N t06    44 layt $0v|,6FTz & Fd$Ifgdd$Ifgdhd$If^hgd & Fd$Ifgd "$&(*,.0246<fd$Ifgdfh<~o^^^$d$Ifa$gdkd$$Ifl1F1%N t06    44 layt|~V"$&(.DEEE&F(F*F,FPFXFFFF@HJJ\J`Jկ¨կըկըզկըscկկhhY^5CJOJQJaJhh5CJOJQJaJhhia5CJOJQJaJ$hhBECJOJQJaJmH sH U hhO$hhY^CJOJQJaJmH sH $hhOCJOJQJaJmH sH hhOCJOJQJaJ hhia'hhia5CJOJQJaJmHsH&~d$Ifgdhkd$$Ifl1%% t0644 laytoaaaad$Ifgdkd'$$IflF1%N t06    44 laytV$&oaaaad$Ifgdkd$$IflF1%N t06    44 layt&(.E(F*Foaaaad$IfgdkdQ$$IflF1%N t06    44 layt0B5@8=AL:0/E>;48=3>20 :><?0=VO/>A=>2=0 :><?0=VO 3@C?8, G0AB8=>N O:>W T 20H0 :><?0=VO (=0720, :@0W=0 @5TAB@0FVW, @5TAB@0FV9=89 =><5@) // Parent / holding company / main company of the group of which your company is a part (name, country of incorporation, registration number)  !& // INTERNATIONAL SANCTIONS14'8 70AB>A>2C20;8AL O:VAL <V6=0@>4=V/C:@0W=AL:V A0=:FVW 4> :><?0=VW, C B><C G8A;V 4> 1C4L-O:>W :><?0=VW E>;48=3C/3@C?8 :><?0=V9, 4> O:>W 2E>48BL 20H0 :><?0=VO, WW ?>A04>28E >AV1 (70 25AL G0A 4VO;L=>ABV :><?0=VW)? // Have any international/Ukrainian sanctions been applied against the company, including against any company of the holding/group of companies that includes your company, its officials (for the entire time of the company's activity)?=V B0: (1C4L ;0A:0, CB>G=VBL) // No Yes (please clarify)15'8 1C;> 70AB>A>20=> 1C4L-O:V <V6=0@>4=V/C:@0W=AL:V A0=:FVW 4> UBO? // Have any international/Ukrainian sanctions been applied against UBO?=V B0: (1C4L ;0A:0, CB>G=VBL) // No Yes (please clarify)16'8 A?V2?@0FNT :><?0=VO/ UBO 7 1C4L-O:8<8 >A>10<8, I>4> O:8E 70AB>A>20=V <V6=0@>4=V/C:@0W=AL:V A0=:FVW, C B><C G8A;V SDN, non-SDN (4>3>2V@=V 2V4=>A8=8, C B><C G8A;V 4>3>2V@ ?@> A?V;L=C 4VO;L=VABL, CG0ABL C =5:><5@FV9=8E >@30=V70FVOE, A?V;L=5 ?V4?@8T<AB2>, B>20@8AB2>, A?V;L=0 CG0ABL C 1V7=5AV (2;0A=VABL V=H8E N@848G=8E >AV1), 1C4L-O:V D>@<8 DV=0=AC20==O, AC4>2V AC?5@5G:8, >A>18ABV 2V4=>A8=8)? // Does the company / UBO cooperate with any persons against whom international / Ukrainian sanctions are applied, including SDN, non-SDN (contractual relations, including a joint activity agreement, participation in non-profit organizations, joint venture, society, joint participation in business (ownership of other legal entities), any form of funding, litigation, personal relationships)?=V B0: (1C4L ;0A:0, CB>G=VBL) // No Yes (please clarify) #" // DOCUMENTS1>?VO G8==8E CAB0=>2G8E 4>:C<5=BV2 // Copy of valid constituent documents2>?VW 4>:C<5=BV2, I> ?V4B25@46CNBL ?>2=>2065==O ?@54AB02=8:0 (70 =0O2=>ABV) // Copies of documents confirming the authority of the representative (if any)3@0DVG=0 AB@C:BC@0 2;0A=>ABV :><?0=VW 4> UBO (?>G8=0NG8 7 5%) V7 707=0G5==O< G0AB:8 (?V4?8ACTBLAO 48@5:B>@>< :><?0=VW/:>=B@>;5@>< 01> V=H>N C?>2=>2065=>N >A>1>N) // Graphical structure of the company's ownership to UBO (starting from 5%) indicating the share (signed by the director of the company / inspector or other authorized person) V4?8A C?>2=>2065=>W >A>18 // Signature of authorized person ... 28:>=02FO, B5;. // Full name of an executor, tel.     *F,FFo^$d$Ifa$gdkd$$Ifl F1%N t06    44 laytFFF@HJJRJTJVJXJZJ\JbJJd$Ifgdhkd{$$Ifl1%% t0644 layt `JbJJJKK"KKKKKK L"LXL^LMMM M"M(MDOPRRRRRRRRRRRRııııӖzjhhl76CJOJQJaJhh_5CJOJQJaJhl7CJOJQJaJhSqCJOJQJaJhh""CJOJQJaJ$hh""CJOJQJaJmH sH hhOCJOJQJaJ hhO$hhY^CJOJQJaJmH sH $hhOCJOJQJaJmH sH !JJJ"KKKKK Loaaaaaaad$Ifgdkd$$Iflb F1%N t06    44 layt L"L(LDORRXRRRRRRRoaaaaaaaaaad$Ifgdkd $$IflF1%N t06    44 layt RRRRRRRRRRRa\\gdSqkd $$Ifl/F1%N t06    44 laytd$Ifgd RRSSSbSSSssssd$Ifgdhkd $$Ifl1%% t0644 layt$d$Ifa$gdgdSqRSSSbSjSlSpSrS|S~SSSSSSPTTTTT:VWWWWWWWXymyZ$h""h""CJOJQJaJmH sH hl7CJOJQJaJh_CJOJQJaJ$hhOCJOJQJaJmH sH  hhOhh""CJOJQJaJ$hh""CJOJQJaJmH sH hhOCJOJQJaJ hh_'hh_5CJOJQJaJmH sH 'hh""5CJOJQJaJmH sH SSSPTTToaaaad$Ifgdkd$ $$Ifl`F1%N t06    44 laytTTT:VWWoaaaad$Ifgdkd $$IflF1%N t06    44 laytWWWWWXXXNXXXojjjjjjjj` dgdgdSqkdN $$Ifl7F1%N t06    44 layt XXFXLXNXlXnXXXXXXXXXXXXX²£hljhlUh""hl7CJOJQJaJh""h""CJOJQJaJhCJOJQJaJmH sH $h""h""CJOJQJaJmH sH hl7CJOJQJaJh_CJOJQJaJ$h""hl7CJOJQJaJmH sH XXXXXXXXXXgdSq dgd 21h:pl. 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