I, the undersigned hereby:

• Confirm that all the information provided by me is correct and up-to-date;
• Undertake to immediately inform you, as the service provider, of any material changes in writing;
• Agree to provide any required documentation in relation to myself, the person I am representing (if applicable) and any relevant transactions upon your request as a service provider;
• Understand and consent to having the information I have provided in this form and the relative supporting documentation, disclosed to third parties engaged by yourself to carry out due diligence, in satisfaction of the applicable legal and regulatory obligations.
• Understand and consent to having the information I have provided in this form and the relative supporting documentation, disclosed to judicial, law enforcement and regulatory authorities, where such disclosure is mandated by the law.

I, the undersigned declare that the initial and any future ensuing additions of funds or property held by me have not originated and will not originate from Activities or Transactions which are a Criminal Offence in Malta or which, if carried out in Malta, would be such an offence, or comprises property the receipt, ownership or control of which would be such an offence.

I, the undersigned declare that I have never been:

• Convicted of any offence other than minor traffic offences;
• Adjudged bankrupt;
• The subject of an investigation by a governmental, professional or other regulatory or statutory body;
• A director, shareholder or manager of a business entity which has been the subject of an investigation as aforesaid, or which has been adjudged bankrupt, compulsorily wound up or has made any compromise or arrangement with its creditors.