Quarterly Global Banking AMLJNCA Assessment Form
Entity Name:
New Client Adoption Dab.: CIP Complete Date:
Physical Address:
Date of Birth (For an Individual):
EIN / TIN: Applied for TIN/EIN: rlycs 110 nia
Entity Type:
CIP Notification: E Eno yes OFAC: yes Ono PCR: Dyes Eno
Documentary: D yes Eno Control Person review yesill no Na
O Certificate of Incorporation O By-laws
O Certificate of Registration O Prospectus
O Registered Articles of Incorporation or O Offering Memorandum
Association O Plan/Subscription Agreement
O Government Issued Business License ci Other
❑ Statutes
Non-Documentary yes
n°
O Dunn & Bradstreet O S&P Directory
O Lexis/Nexis O Other
EDD 0 yesill no Onta
PEP
ElYesEllE High Risk Industry yesE no High Risk Country yes E no D
Foreign Financial Institution in a designated country Dyes D no
Qualitative Review of Alert Escalations (PCR/RDC:)
PCR O yesEL
RDC O yesIlk
Comments:
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0066441
CONFIDENTIAL SDNY GM_00212625
EFTA01372649