Business Account Application Form

Client Entity Name

Date

SH Financial Consultant

In accordance with legislation of the Republic of Lithuania regarding prevention of money laundering and terrorist financing, also to
implement “Know Your Customer” principle, other requirements of legal acts of European Union and the Republic of Lithuania UAB Stanhope
Financial is required to collect information about a client before entering or proceeding with business relations with the client. UAB Stanhope
Financial ensures that the information provided is deemed to be confidential and will be protected as required by the laws.
 Notes on completion of corporate entity’s
application form

This account opening application form incorporates all the Parts you
need to complete in order for you to become a client of SH Financial
and to open an account with us.
This application form is for completion by applicants who are
corporate entities. For convenience we refer to the applicant in this
document as “you” or the “applicant”.
Before completing this application form, please make sure that you
have read and understood our Services Terms and Conditions (the
Terms).

The completed, dated and signed form should be returned

by e-mail to your SH Financial consultant.
 Documents required

Please provide the documents listed below:

Act/Agreement of Incorporation of the Company

Articles of Association of the Company

Extract from Legal Entities Register confirming the incorporation of the Company (the extract shall
indicate the incorporation date, assigned legal entity’s/registration number, the appointed direct
manager(s), shareholders, etc.) [Shall not be older than 6 months, legalized by Apostille]

Bank statement (not older than 3 months) from which the funds to SH Financial will come
Organizational structure of Company/Company’s Group (if Company belongs to group) indicating all the
shareholders and ultimate beneficial owners with percentage of the shares/votes – signed by Company’s
CEO

Up to date Company’s shareholders registry – signed by CEO

UBO’s: copy of passport (colorful)

List of managers who have the signatory rights and their copies of passports (colorful)

Last financial audit report (if audit is mandatory) or the last period income tax declaration submitted to
tax authorities

License

The completed, dated and signed form should be returned

by e-mail to your SH Financial consultant.
 Part A – Company profile

Full registered company name

Type of business/legal entity

Trading name (if applicable)

Company registration number

Registered address

Actual business address

Telephone

Email

Website

VAT code

USA TIN number (if applicable)

Country and code of tax

residence
Are the securities of the
business listed on a regulated
securities market (stock
exchange)?

ISIN code (if applicable)

Name of the regulated

securities market (stock
exchange)

Number of employees
 Part B – Business requirements

Please describe the business in a

few sentences
Country (s) of operations. Please list ALL
countries for incoming/outgoing payments
Any operations in preferential tax zones?
(e.g. The Cayman Islands, Bermuda, the
British Virgin Islands)

Size of current beneficiaries database

Top 5 beneficiaries (name+country)

Top 5 creditors (name+country)

Services related to the business activity

Purchase / sale of antiques Gambling, games of chance, casino

Charity Sales of alcohol, tobacco, or drug products online

Retail sale of art in specialized stores, art Retail sale of coins and stamps in specialized
gallery activities stores
Activities of auctioning (in internet or
Political organization
action houses)
Sale of weapons and ammunition Transportation of cash

Mediation of currency and or payments Purchase/sale of precious metals and jewelry

Legal assistance,establishment of organizations Intermediation in real estate transactions

Financial institution Company is not providing listed services

Currencies required

Reasons for currency requirements

Are there any possible hits of negative

news/adverse media about your company
or your clients? If yes - how do you mitigate
this risk?

Account opening reasons (1-2 sentences)

 Part C – Operational requirements

Relevant license (if applicable)

Current banking providers

Funding account number

Current bank location

Current liquidity provider(s), if relevant

Last year turnover

This year planned turnover

Reasons for currency requirements

Source of incoming funds

What percentage of working capital is cash?

Forecast Payments Profile – Monthly Payments Flow in EUR

Payment Number of incoming Number of outgoing Average value per

Type payments per month payments per month transaction

SEPA
Cross
border
 Maximum Volumes / Payment Values

Monthly Incoming

Monthly Outgoing
Total volume per month (EUR equivalent)
Maximum value of single incoming
payment (EUR equivalent)
Maximum value of single outgoing
payment (EUR equivalent)
 Part D – Foreign exchange requirements

Monthly currency conversion based on current flow - Please list the currencies you will convert from and to the
volume for each pair
Converting from (currency) Converting to (currency) EUR equivalent volume/month
 Part E – Shareholders and UBOs
• Immediate shareholders (holders of other property rights)

Does the company have immediate shareholders whose holding is at least 10%?

Is the immediate shareholder a private person or a legal person?

If the customer is directly controlled by another legal person, below please draw the management

structure.
First name, surname / Full name

ID code / Registry code

Citizenship / Country of registration

Holding in shares or voting rights (%):

Does this immediate shareholder have an
owner who has at least 10% of shares/
voting rights?*
*Fill this question only if the company has legal immediate shareholders. Immediate shareholder’s owner is a private or legal person who
is holding at least 10% of the shares, participations or voting rights in your company’s legal shareholder.

• Ownership structure

If the company is owned or controlled by another legal entity, please:

 draw a complete ownership structure below or;

 provide the ownership structure as an attachment (picture, presentation,
etc.).
Please provide mandatory information about all layers of ownership (all legal entities and private individuals, who
own at least 10% of the shares or voting rights):

 business name / first name and surname;

 country of registration / residence;
 registration code / personal ID-code or date of birth;
 holding in shares or voting rights (%).

Ownership structure provided as the attachment

 • Please list all UBO's holding 10 or more percent of the company

Directly Directly Directly

Beneficial ownership
Through another legal Through another legal Through another legal
management type
entity Through the Trust entity Through the Trust entity Through the Trust

Shares/voting rights holder Shares/voting rights holder Shares/voting rights holder

Holding in shares or Holding in shares or Holding in shares or
voting rights(%): voting rights(%): voting rights(%):
CEO/Senior manager CEO/Senior manager CEO/Senior manager
Control in another way Control in another way Control in another way

Ultimate Founder Founder Founder

beneficial owner The trustee The trustee The trustee
type
Counsel Counsel Counsel
Beneficiary Beneficiary Beneficiary
Any other natural Any other natural Any other natural
person excersising person excersising person excersising
effective control of the trust effective control of the trust effective control of the trust

First name, surname

Date of birth

Country of birth

Personal ID-code

Country of residence
Address of
residence (city,
street, house or flat
number)
Citizenship
Country of tax
residence
Code of tax residence

USA TIN number

Number of
identity document

National identity National identity National identity card

card Passport card Passport Passport
Type of document
Driver‘s license Other Driver‘s license Other Driver‘s license Other

Country of issue

Validity of document
Is the ultimate
beneficial owner a
tax resident in
several countries?
Country of tax
residence
Code of tax residence

Is the ultimate NO NO NO
beneficial owner, their
UBO is PEP UBO is PEP UBO is PEP
close family member
or a close associate a Their close family member Their close family member Their close family member
is PEP is PEP is PEP
politically exposed
person PEP*? Their close associate is PEP Their close associate is PEP Their close associate is PEP

• Position of politically exposed person

Head of the State, Head of the Government, Minister, Vice Minister or Deputy Minister, Secretary of State,
Chancellor of the Parliamet, the Government or any Ministry

Member of the Parliament

Member of the Supreme Courts, the Constitutional Courts or any other judicial authority, against whose decisions
there is no judicial remedy

Mayor of the municipality, municipality administration director

A member of the management body of the Supreme State Audit and Control Office or the Central Bank
Chairman, Deputy Chairman or a member of the Management Board

an Ambassador, Chargés d’affaires ad interim, The Chief of Defense of the Republic of Lithuania, Commanders of
the armed forces and units, Chief of Defense Staff or Senior Officer of Armed Forces of Foreign Countries

A member of the management or supervisory body of the company managed by the state or municipality

Director, deputy director or member of the management or supervisory body of the international
intergovernmental organization

Head, deputy head or member of the management body of political party

Other (specify)

• Information of politically exposed person

First name and surname Personal ID - code

Document type Date of birth Country of residence

First name and surname Personal ID - code

Document type Date of birth Country of residence

First name and surname Personal ID - code

Document type Date of birth Country of residence

 Part F – Authorized signatories

Authorized signatories - The following persons shall be authorized to give instruction to SHP for the services
provided by SHP

Full name Full name Full name

Position Position Position

Phone number Phone number Phone number

Email Email Email

Specimen Specimen Specimen

signature signature signature

Copy of ID Copy of ID Copy of ID

Are you a PEP? If Are you a PEP? If Are you a PEP? If

YES, please fill in YES, please fill in YES, please fill in
PEP questionnaire PEP questionnaire PEP questionnaire

Full name Full name Full name

Position Position Position

Phone number Phone number Phone number

Email Email Email

Specimen Specimen Specimen

signature signature signature

Copy of ID Copy of ID Copy of ID

Are you a PEP? If Are you a PEP? If Are you a PEP? If

YES, please fill in YES, please fill in YES, please fill in
PEP questionnaire PEP questionnaire PEP questionnaire
 Part G – Declaration of applicant

Please mark if SH Financial can send you offers*

*This is to confirm that we are willing to receive all messages, proposals, various news, and other important information from
SH Financial at the contact details.
I am informed that any time I may refuse of direct marketing proposals to be sent by SH Financial by submitting a written
application via Internet bank or by email.

I do confirm that the information provided in the present questionnaire is true and correct
and I do undertake to forthwith notify in writing of any changes in the information provided.
I am aware that all or part of information submitted in this questionnaire can be transferred
to official institution of the Republic of Lithuania. I confirm that I will use the services of UAB
Stanhope Financial only for the legitimate purposes and understand that in such case
if identified that information provided in this form is incorrect or misleading, the
law enforcement institutions of the Republic of Lithuania may be informed about it and
this could lead to unilateral termination of business relations.

Signed (Authorized
Name
signatory)

Position
Date
 Appendix A - Definitions
*Politically exposed person – a natural person who is or was during the past 18 months, entrusted with prominent public
functions in the Republic of Lithuania, the European Union, international or foreign state institutions as well as close members or
close assistants of such person:

1) Head of State, Heads of Government, minister, vice minister and deputy minister, secretary of the State, chancellor of
Parliament, Government or Ministry

2) Member of the Parliament

3) Member of the Supreme Courts, the Constitutional Courts or any other judicial authority, against whose decisions there is
no judicial remedy

4) Mayor of the municipality, municipality administration director

5) A member of the management body of the Supreme State Audit and Control Office or the Central Bank Chairman, Deputy
Chairman or a member of the Management Board

6) an Ambassador, Chargés d‘affaires ad interim, The Chief of Defense of the Republic of Lithuania, Commanders of the armed
forces and units, Chief of Defense Staff or Senior Officer of Armed Forces of Foreign Countries

7) A member of the management or supervisory body of the company managed by the state or municipality

8) Leaders or deputies of an international intergovernmental organizations, Member of the Management or Supervisory body
(international intergovernmental organizations could be United Nations, Council of Europe, Institution of European Union,
Organization for Security and Co-operation in Europe, Organization of American States, NATO and others)

9) Head, deputy head or member of the management body of political party

Close family member – the spouse, the person with whom partnership has been registered (hereinafter referred to as
the “cohabitant”), parents, brothers, sisters, children and children’s spouses, children’s cohabitants.

Close associate:

1) a natural person who, together with the person who is/was entrusted with the above mentioned prominent public
functions, participates in the same legal entity or maintains other business relations;

2) a natural person who is the only owner of the legal entity set up or operating de facto with the aim of acquiring property or
another personal benefit for the person who is/was entrusted with the above mentioned prominent public functions.

Payment types:

SEPA - EUR payments in the SEPA region

EUR non SEPA - EUR payments in non SEPA region

Cross border payment - International payments in any currency outside Europe

The completed, dated and signed form should be returned

by e-mail to your SH Financial consultant.