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Appendix No. 1

CUSTOMER INFORMATION SHEETLEGAL ENTITY OR ENTREPRENEUR

Personal data collected through this Questionnaire will be processed for the purpose of customer due dilligence, in accordance with the Law on the Prevention of Money Laundering and the Financing of Terrorism and referent regulations. The Customer must provide, all the necessary and updated information, to allow toperform the Customer due diligence and the identification of the beneficial owners.

The Bank is obliged to identify and verify customers who carry out transactions in the amount equal to or higher than EUR 15,000.00:

- made in the context of a business relationship on behalf of third parties that are not identified before and during the established business relationship;

- when carrying out occasional transactions that the client can perform on their own behalf, and on behalf of third parties;The customer must provide in writing all the information necessary for its identification, and the identification of the beneficial owner of the transaction

If the Bank cannot respect, for any reasons, the Customer due diligence obligations' it must not start business relationship or carry out operations and it also must close any relationship in place

Code: BIB.(1.11.0.0).PC.005-OBR.01 Version: (III)/(08.06.2016) /11

Appendix No. 1

Customer data:Company Name: ________________________________________________________________________

Corporate ID number: __________________________ VAT Number: _____________________________

Date of incorporation: ___________________________ Country of registration: ____________________

Place of incorporation: _____________________

Registered Office:Address: ____________________________________________________________________________

Town: _________________________ Postal code: _______________ Country: ___________________

Business Activity: ______________________________________________________________________

Phone: __________________________________ Fax: ___________________________________

E-mail address: ______________________________________________________________________

Additional information on the legal entity:The customer performs as:• Foreign non-resident private company • Trust • Special purpose entity

• Foundation • Charity (More information at the end of the Questionnaire)

Type of beneficiary (only for non-profit organization):• Social assistance • Healthcare assistance

• Education and training • Scientific research and social interest

• Safeguard of civil rights • Amateur sport

• Conservation, promotion e valorization of artistic, historic and cultural patrimony

• Conservation and valorization of nature, environment and territory

• General charities • Other activity /other beneficiaries

Country where the main business is carried out: _____________________________________

Countries with which the customer does business significantly?1. ________________________ 2. _________________________ 3.___________________________

The purpose of business relationship:• Domestic and international payments • Payment based on the lines of credit released;

• Domestic commercial credit disinvesting • Foreign commercial credit disinvesting ;

• Corporate treasury managent • Foreign transactions management;

• Supply management • Employees salary management;

• Investments • Other _________________________________________

Type of business relationship: • Current account • Saving account • Credit card

• Pledge policies • Security and/or bond deposit • Safe box/Safe deposit

• Loan • Insurance • Internet card

• Asset management • Other


Appendix No. 1

Type of transactions that will be processed through the account: • Cash transactions • Domestic currency wire transaction • International payments

• Term deposit and investment • Loans, guarantees, letter of credit • Financial instruments

• Other: _______________________________________________________________________

Customers who works in sectors benefiting from public funds, including EU funds (e.g. public contracts, healthcare, collection and disposal of waste, renewable energy production): • YES • NO

Please specify the expected average level of in-payments to the account: • Up to 100,000 Euros annualy • Up to 500,000 Euros annualy

• Up to 1,000,000 Euros annualy • Up to 1,000,000 Euros annualy

What are the expected sources of funds:• Main activity • Sales of financial assets • Sales of real estate

• Reimbursement • Return of Capital from Abroad • Donation

• Winnings • Sales • Self-financing

• Grants from sponsors, partners etc. • Other :

Annual amount of expected other income: ________________________________________________

Will the transactions on behalf of third persons be carried out through the account? If YES, please specify the beneficial owner of the funds and its country of origin:_________________________________________________________________________________Please specify the Customer’s main counter-parties to which the largest turnover is expected (name or description):A. Suppliers:• __________________________________________________________________________• __________________________________________________________________________• __________________________________________________________________________

B. Customers:• __________________________________________________________________________• __________________________________________________________________________• __________________________________________________________________________

Client cooperates with business partners who are engaged in the following activities:• Real Estate Agencies and Brokers • Amateur Sports Associations• Road transportation • Auctions and Art Galleries• Wholesalers of Oil and Wheat • Dealers of Car, Accessories and Parts• Dealers of High Tech Products (ex. PC, mobile phone, etc.)• Trading of Precious Metals • Cash-for-Gold shops• Advisory and Advertising • Custody and transportation of cash• Building Industry • Foundations• Foreign Trust Companies • Gambling• Cosmetics • Money Transfer• Earthmoving and Construction machinery/activities• Renewable Energy Production • Production and sales of ferrous materials• Cleaning and maintenance • Waste Collection and Disposal• Credit Collection Agency • Healthcare• IT trading of services and rights • Awards of Public Contracts• Trust • Other


Appendix No. 1

DATA ON THE REPRESENTATIVE 1 :First name, Last name:___________________________________________________________________Personal ID Number: _____________________________ Date of birth: __________________Place of birth: _____________________________ Country of birth: ____________________________Citizenship: _________________________________ Gender: M F

Residence (from the ID Document):Address: ____________________________________________________________________________Place: __________________________Postal code: _________________Country: __________________Domicile (if different from residence):Address: __________________________________________________________________________Place: ________________________Postal code : _________________Country:___________________ID Document:Type: ______________________________ Number: ____________________________________Issuer: ______________________________ Date of release: ____________________________Place of release: ____________________________Phone: _________________________ Fax: _________________________Employment status: 1) Employee 2) Freelancer 3) Executive 4) Entrepeneur 5) Self-employed 6) Retiree 7) Student 8) House wife 9) Unemployed 10) Other

Additional information on the Representative 1:

Has the Representative or his/her close relative held at any time during last 12 months a public office, or has he/she been close associate of such person:• Domestic Politically Exposed Person: YES NO• Foreign Politically Exposed Person: YES NOIf you give positive answer to any of the questions bove, please answer the following:

Term of the public Office specify above: from _____________ to _____________Please briefly describe the public office specify above: _______________________________________Type of business relationship with person who held a public office above (if that is a case):______________________________________________________________________________________Please specify the origin of funds and property underlying the customers business relationship with the Bank or trnsactions through the Bank:__________________________________________________Country where the main business is carried out: _________________________________________Power for representation of the Account Holder: • Statutory Representative • Trust


Appendix No. 1

• Trustee • Special Power of Atorney The relationship between a person who acts for the account of the client and the client:• Managing Director • Member of Corporate Bodies • Employee• Bankruptcy Trustee • Other

DATA ON THE REPRESENTATIVE 2:First name, Last name:___________________________________________________________________Personal ID Number: _____________________________ Date of birth: __________________Place of birth: _____________________________ Country of birth: ____________________________Citizenship: _________________________________ Gender: M FResidence (from the ID Document):Address: ____________________________________________________________________________Place: __________________________ Postal code: _________________ Country: __________________ Domicile (if different from residence):Address: __________________________________________________________________________Place: ________________________ Postal code: _________________ Country:___________________ID Document: Type: __________________________________ Number: ____________________________________Issuer: ______________________________ Date of release: ____________________________Place of release: ____________________________Phone: _________________________ Fax: _________________________Employment status: 1) Employee 2) Freelancer 3) Executive 4) Entrepeneur 5) Self-employed 6) Retired 7) Student 8) House wife 9) Unemployed 10) Other

Additional information on the Representative 2:

Has the Representative or his/her close relative held at any time during last 12 months a public office, or has he/she been close associate of such person:• Domestic Politically Exposed Person: YES NO• Foreign Politically Exposed Person: YES NOIf you give positive answer to any of the questions bove, please answer the following:

Term of the public Office specify above: from _____________ to _____________Please briefly describe the public office specify above: _______________________________________Type of business relationship with person who held a public office above (if that is a case):______________________________________________________________________________________Please specify the origin of funds and property underlying the customers business relationship with the Bank or transactions through the Bank:__________________________________________________

Country where the main business is carried out: _________________________________________Power for representation of the Account Holder: • Statutory Representative • Trust• Trustee • Special Power of Atorney The relationship between a person who acts for the account of the client and the client:• Managing Director • Member of Corporate Bodies • Employee• Bankruptcy Trustee • Other


Appendix No. 1

DATA ON OWNERSHIP STRUCTURE:

Business entity is in the majority ownership of the state, local and regional self-government unit, public agency, public institution, public fund or chamber • YES • NOIf YES, please specify the name and the seat of the administration/institution:_______________________________________________________________________Securities issued by the Customer’s majority owner are included in an reputable stock exchange: • YES • NOIf YES, please specify the name of the owner and the stock exchange:_______________________________________________________________________

ULTIMATE BENEFICIAL OWNER 1 (physical person):First name, Last name:___________________________________________________________________Personal ID Number: _____________________________ Date of birth: __________________Place of birth: _____________________________ Country of birth: ____________________________Citizenship: _________________________________ Gender: M FResidence (from the ID Document):Address: ____________________________________________________________________________Place: __________________________ Postal code: _________________ Country: __________________ Domicile (if different from residence):Address: __________________________________________________________________________Place: ________________________ Postal code: _________________ Country:___________________ID Document: Type: __________________________________ Number: ____________________________________Issuer: ______________________________ Date of release: ____________________________Place of release: ____________________________

Additional information on the Beneficial Owner 1:Percentage of ownership: ________%Person is a direct owner of the Customer: YES NOIf NO, please specify the name and seat of a legal entity which is a direct owner:_________________________________________________________________________________Has the Beneficial Owner or his/her close relative held at any time during last 12 months a public office, or has he/she been close associate of such person:• Domestic Politically Exposed Person: YES NO• Foreign Politically Exposed Person: YES NOIf you give positive answer to any of the questions bove, please answer the following:


Appendix No. 1


Country where the main business is carried out: _________________________________________The type of connection between the Customer and Beneficial Owner:• Shareholder with more tha 25% of the company shares or rights of vote • Founder• Managing Director /Chief Executive Officer • “De facto” controller• Trustee • Beneficiary of the trust• Settlor of the trust• Protector of the trust• Beneficiary or Holder of more than the 25% of the capital of association, foundation or Non Profit Organization• Person in whose interest is established the Non profit organization


Additional information on the Beneficial Owner 2:Percentage of ownership: ________%Person is a direct owner of the Customer: YES NOIf NO, please specify the name and seat of a legal entity which is a direct owner:_________________________________________________________________________________Has the Beneficial Owner or his/her close relative held at any time during last 12 months a public office, or has he/she been close associate of such person:• Domestic Politically Exposed Person: YES NO


Appendix No. 1

• Foreign Politically Exposed Person: YES NOIf you give positive answer to any of the questions bove, please answer the following:



ULTIMATE BENEFICIAL OWNER 3 (physical person):First name, Last name:___________________________________________________________________Personal ID Number: __________________________ Date of birth: __________________Place of birth: _____________________________ Country of birth: ____________________________Citizenship: _________________________________ Gender: M FResidence (from the ID Document):Address: ____________________________________________________________________________Place: __________________________ Postal code: _________________ Country: __________________ Domicile (if different from residence):Address: __________________________________________________________________________Place: ________________________ Postal code: _________________ Country:___________________ID Document: Type: __________________________________ Number: ____________________________________Issuer: ______________________________ Date of release: ____________________________Place of release: ____________________________

Additional information on the Beneficial Owner 2:Percentage of ownership: ________%Person is a direct owner of the Customer: YES NOIf NO, please specify the name and seat of a legal entity which is a direct owner:_________________________________________________________________________________Has the Beneficial Owner or his/her close relative held at any time during last 12 months a public office, or has he/she been close associate of such person:• Domestic Politically Exposed Person: YES NO• Foreign Politically Exposed Person: YES NO


Appendix No. 1

If you give positive answer to any of the questions bove, please answer the following:




Additional information on the Beneficial Owner 4:Percentage of ownership: ________%Person is a direct owner of the Customer: YES NOIf NO, please specify the name and seat of a legal entity which is a direct owner:_________________________________________________________________________________Has the Beneficial Owner or his/her close relative held at any time during last 12 months a public office, or has he/she been close associate of such person:


Appendix No. 1

• Domestic Politically Exposed Person: YES NO• Foreign Politically Exposed Person: YES NO

If you give positive answer to any of the questions bove, please answer the following:

Term of the public Office specify above: from _____________ to _____________Please briefly describe the public office specify above: _______________________________________Type of business relationship with person who held a public office above (if that is a case):______________________________________________________________________________________Please specify the origin of funds and property underlying the customers business relationship with the Bank or trnsactions through the Bank:__________________________________________________


Hereby I confirm that all data given in this document are true and I am in full agreement with the Bank's right to check them. I will promptly inform the Bank on any change regarding the data given above. Hereby I give the consent to the processing of personal data mentioned in this questionnaire,including particularly sensitive data. This consent is valid until revoked. Also, I confirm that the Bank inform me on the the possibility to check the details on mentioned processing of data in the Central Data File Register maintained by the Commissioner for Information of Public Importance and Personal Data Protection, available at Web address: http://registar.poverenik.rs .

___________________, ______________ _____________________________________Place and date Signature of the Representative

Bank’s employee:First name, Last name:

_________________________________________________________________Organisational unit:

_________________________________________________________________

______________________________ _________________________________ Place and date Signature

ADDITIONAL INFORMATION:

1. Foreign non-resident private company is a foreign entity in private ownership whose shares / shares are not traded on the open market, regardless of the size of the company, or there is no publicly available information about the company balance sheets, audit reports).


Appendix No. 1

2. Special purpose entity is a company established to accomplish a clear and well defined objective.

3. Trust is a company that is engaged in providing for another person of the registered office / business addresses , management or secretarial services, etc. service, presenting as a designated shareholder / founder

4. Politically Exposed Person” or “PEP”: a natural person who holds or who held in the past year a public office in a foreign country or international organisation, including:

a. Heads of State and/or heads of government, members of government and their deputies or assistants;

b. Elected representatives of legislative bodies;c. Judges of the supreme and the constitutional courts or of other high-level judicial

bodies whose judgments are not subject to further regular or extraordinary legal remedies, save in exceptional cases;

d. Members of courts of auditors or of the boards of central banks;e. Ambassadors, chargés d'affaires and high-ranking officers in the armed forces;f. Members of the managing or supervisory bodies of legal entities whose majority

owner is the State.5. “PEP’s Close Associate”: any natural person who has benefit from a joint ownership or from

business relations or who has any other close business relations with a PEP.6. “PEP’s Close Family Member”: a PEP’s spouse or extra-marital partner, the parents, the

brothers and sisters, the children and their spouses or extra-marital partners7. „Ultimate beneficial owner“ has the following meaning:

a) With respect to legal entities, representative offices , branches and other entities subject to the following national and foreign regulations applicable rules for the legal entity:

- natural person who is ultimately beneficial owner of the entity- natural person who has control over a legal person by directly or indirectly

owns at least 25 % of the capital of such legal person or- natural person who otherwise exercises control over the management

bodies of the legal entity or- natural person who performs a significant impact on the business and

financial decisions of the organs management of such legal entity through rights acquired indirectly through the provision of means that legal entity ;

b) In terms of the foreign law , such as foundations and trusts: - natural person who is the beneficial owner of at least 25 % of the property

which is the subject- natural person who has a direct or indirect beneficiary of at least 25 % of

assets under management , if certain future users or- natural person or group of persons in whose interest is the face of foreign

law established or operates , provided that such person or group of persons or determinable

- natural person who directly or indirectly exercise control over at least 25 % of the assets of the face.


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