Know Your Client - EMA Group

1. Full Legal Name of the Company:

2. Operational Complete address:

3. Company Website:

4. Email Address:

5. Telephone Number:

6. Registration Number (License Number):

7. Company Date of Incorporation:

8. Latest Renewal Date for Company:

9. Company Representative Name:

10. Nationality:

11. Email address:

12. Mobile No. :

12-1. Work No. :

13. Method of Representation Power of Attorney Board Resolution Other If other kindly specify:

14. Passport No.:

14-1. Passport No.:

15. National No.:

15-1. National No.:

16. Address:

17. Company Shareholding Structure:

Individuals Corporate Both

18. Senior Management:

Director Manager Other

If Other, Please Specify

19. List the member(s) of the Board of Directors

A. Name:

Nationality:

B. Name:

Nationality:

C. Name:

Nationality:

20. List the Members of the Management:

A. Name:

Designation:

Nationality:

B. Name:

Designation:

Nationality:

C. Name:

Designation:

Nationality:

21. Approximate number of employees

LIST ALL OTHER NAMES UNDER WHICH THE COMPANY HAS CONDUCTED BUSINESS PLUS TIME PERIOD FOR EACH

22 Name:

From to dates:

23 Name:

From to dates:

24 Name:

From to dates:

25. Vessel Name:

26. Vessel Location & Coordinates:

27. Ullage Report:

28. Certificate of Origin:

29. Certificate of Quality:

30. Certificate of Quantity:

31. Last Audited Financial Statement:

32. Bank Name:

33. Bank Address:

34. IBAN No. USD:

35. IBAN No. JOD:

37. Bank Swift Code:

38. Special Wire Instructions:

39. Is the company's shareholder or Senior Management a Member of a Royal Family or Senior Politician, a Senior Government Official, a Senior Judicial, Military or Law Enforcement Official, a Member of Board of Central Bank or similar Regulator, Senior Executive Manager of State-Owner Corporations, an Ambassador or a Charge d/affaires, either local or foreign?

Yes No

IF YES Please provide details:

40. Is your company listed by either the UN, US, EU or Switzerland as being involved in terrorist or money-laundering activities?

Yes No

1. Declaration: We (Representative) hereby declare that the information furnished by the Company is true and correct and you are entitled to verify the same. We, understand that if anyof the a bove information is found to be false, untrue, misleading, or misrepresenting, we shall be held liable for it

2. Consent We (Representative) agree that you (Supplier) can disclose as applicable, any information contained therein, other related confidential information and transactions in this application and on accounts linked to the same to law enforcement and regulatory authorities.

Representative’s Name :

Representative’s Signature:

By checking the box below, you agree to the terms and conditions stated above

1. Memorandum/Articles of Association

2. Copy of Company’s License

3. Power of Attorney (if proposed signatory is not listed in the Document above

4. Copy of Representative’s valid passport

5. Copy of National ID

6. Reference Letter from a Bank

7. Notarised Copy of English Translated Documents in Case of Foreign Language

All the Preliminary Documents Submitted by the Client Shall be Validated as True Copies

Representative Name:

Date:

Representative’s Signature:

By checking the box below, you agree to the authenticity of the documents uploaded above