Customer Due Diligence Form: Individuals and Sole Proprietors

The purpose of this Customer Due Diligence Form is to assist Malta precious Metals refinery (“MPM”) to comply with its obligations under applicable anti-money laundering (AML) and counter-terrorism financing laws and regulations. Any agreement entered into between MPM and the Customer is subject to the submission of a Customer Due Diligence Form deemed satisfactory by MPM, failing which MPM shall not be under any the obligation to provide any services under such agreement.

1. General Information on the Customer

2. Accredited Investor

Total income (p.a.) in the preceding 12 months Exceeding S$ 300’000 (or its equivalent in a foreign currency)

YesNo

Estimated total assets Exceeding S$ 2 million (or its equivalent in a foreign currency)

YesNo

3. Origin of Assets

Gift/inheritance

Life time earnings/salary

Sale of real estate

Investments profits

Sale of business

Winnings (lottery)

Others

4. Politically Exposed Persons (PEP)

A PEP is an individual who is or has been entrusted with a prominent public function in a foreign country (for example: head of state or of government, senior politician, senior government, judicial or military officials, senior executives of state owned corporations, important political party officials)

Is the Customer considered a PEP?

NoYes, please specify:

5. Contact Information

6. Customer Declaration

The Customer hereby represents and warrants that:

he/she is the beneficial owner of the funds used to transact with MPM and of the assets held in storage with MPM (“the Customer’s Assets”).the Customer’s Assets do not represent the proceeds of and are not intended to finance or be used in connection with any act which may constitute drug trafficking or criminal conduct or any terrorist act or tax evasion in any country in which he/she is subject to tax.

7. Supporting Documents

Unless otherwise specified, all non-original documents must be certified by a suitable certifier (which includes professionals such as a lawyer, a notary public, an accountant, a government official or a senior manager at a regulated financial institution).

Certified copy of valid Passport or National ID Card (bearing photo and signature).Proof of residential address, e.g. utility bill or bank statement (originals or certified copy).Bank Reference Letter from the bank from which the Purchase Amount will be transferred to MPMBusiness Registration Certificate (if a Sole Proprietor).

The Customer represents that the information provided in this Customer Due Diligence Form is true, accurate and complete, and undertakes to inform immediately Malta Precious Metals refinery about any changes in the above.

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