General Company Information
Name of the Company
Type of legal entity
Date of Formation of Company
What is the relationship between the Company and any of the various local or regional governmental or political party bodies (in particular do any financial or business relationships exist)?
If so, who?
If so, who?
Names of shareholders up to the level of the beneficial owner and board members of the Company
If yes, please provide details (role, name, nationality, date of birth)
If yes, please provide details below
Agents & Intermediaries
“Agent” means a person or third party who on a continuing basis promotes the Company business and provides related services in a certain territory or towards a certain group of customers, thereby promoting the conclusion of contracts between the Company and a third party.
“Intermediary” means such a person or third party who provides the above-mentioned services for a specific project by project basis.
If so, who?
If so, who?
If so, who?
How have payments to Agents or Intermediary been made (i.e. cash or bank transfer)?
How does the Company evaluate its Agents or Intermediaries and ensure that they follow relevant laws?
Business and Regulatory Concerns
If so, please describe.
Company Certification
To be completed by an Officer or Principal of Company
I hereby agree that this questionnaire and the information provided herein is accurate and complete and agree that the information provided may be processed by yourselves and/or your Affiliates for purposes of compliance with relevant laws and regulations. I hereby certify that the Company has reviewed and made aware of your policies and procedures and confirms and warrants its full compliance thereof and into the future.
I further hereby confirm the following:
I am a duly authorized representative of the Company and I have personal knowledge of the information requested;
The information provided herein is true, complete and correct;
I understand that you will rely on this information, in part, for deciding whether to enter into any contractual agreement with the Company
I consent to yourselves making such inquiries as they may consider necessary to verify this information, and to collect, process, store and transfer such information in accordance with your policies;
I understand that you take compliance with Anti-Corruption Laws (including but not limited to the FCPA and the UKBA) and other anti-corruption and Sanctions related laws and regulations as a very serious matter and require all its business partners to take appropriate actions necessary to ensure compliance with such laws;
Company will abide by all laws, treaties and regulations, including the FCPA and the UKBA and all local anti-corruption laws that forbid bribery or improper payments to government officials, commercial entities or other persons. That any violation of the FCPA, the UKBA, the Brazil Anti-Corruption Laws, or other anti-bribery laws will not be tolerated and may be grounds for termination;
Company will not make or permit any off-the-books accounts, inadequately identified transactions, recording of non-existent expenditures, entry of liabilities with incorrect identification of their object or the use of false documents;
I understand that prior to performing services we will sign an Agreement or Engagement Letter, as appropriate, acceptable to yourselves;
I hereby represent and warrant that the Company, nor any shareholders, shareholder nominees, Ultimate Beneficial Owners or their nominees, directors, director nominees, officers, or employees of the Company, or any agent, affiliate or other person acting on behalf of the Company, is the subject or the target of any U.S. sanctions administered by the Office of Foreign Assets Control of the U.S. Department of the Treasury or the U.S. Department of State, the United Nations Security Council, the European Union, Her Majesty’s Treasury of the United Kingdom, or other relevant sanctions authority (collectively, “Sanctions”); nor is the Company located, organized or resident in a country or territory that is the subject or target of Sanctions, including, without limitation, Crimea, Cuba, Iran, North Korea, and Syria.
Since its inception, the Company has not knowingly engaged in and is not now knowingly engaged in any dealings or transactions with any person that at the time of the dealing or transaction is or was the subject or the target of Sanctions or with any sanctioned country.
Name
Title
Date
Email
Documents for delivery
Provide the following information via email to contact@loamont.com.mx
Provide a structure chart of the Company including all ultimate beneficial owners, parent companies and subsidiaries.
Memorandum and Articles of Incorporation, Incorporation Certificate and Certificates of Goodstanding for all companies that are part of the corporate structure.
Certificates of Directors, Officers, Shareholders and Registered Address for all companies that are part of the corporate structure.
Copies of passport documents of shareholders and/or beneficial owners.
Copies of recent (not older than three months) utility bills of the directors, officers and ultimate beneficial owners of the Company.
Send