GENERAL INFORMATION

Company Name

Country of Establishment

Year of Incorporation

Beneficial Owner / Authorized Signatory No. 1:

Beneficial Owner / Authorized Signatory No. 2:

Beneficial Owner / Authorized Signatory No. 3:

Office Address

Telephone Number

Fax Number

Mobile Number

Email

Website

Do you have a company policy?

Source of Wealth by the company/firm

List of other business activities:

Bank Name

Bank Address

Year(s) of relationship with the bank:

Beneficiary Name

Beneficiary Address

Account Number

PERSONAL INFORMATION

Beneficial Owner / Authorized Signatory No. 1:

Title:

Complete Name:

Date of Birth

Nationality:

Current Home Address:

Mobile Number

Email Address

Source of Wealth (Net worth)

Beneficial Owner / Authorized Signatory No. 2:

Title:

Complete Name:

Date of Birth

Nationality:

Current Home Address:

Mobile Number

Email Address

Source of Wealth (Net worth)

Beneficial Owner / Authorized Signatory No. 3:

Title:

Complete Name:

Date of Birth

Nationality:

Current Home Address:

Mobile Number

Email Address

Source of Wealth (Net worth)

PROPOSED BUSINESS DETAILS

PHYSICAL BUSINESS

Country of Origin:

Expected Purity

Supplier’s Name:

Country:

Type of Delivery:

Expected Quantity per delivery/pickup:

Gold : Monthly/Weekly in kg
Silver:Monthly/Weekly in kg
Others:Monthly/Weekly in kg

List of previous companies you have deal with:

Company Name:
Country::

TRADING BUSINESS

SUPPLY CHAIN PROCEDURE

Please describe your supply chain procedure and/or policy for verifying the source of metal

What is your policy regarding Anti Money Laundering and Combating Financial Terrorism?

Do you keep records of companies that you usually buy metals from?

Source of Funds and Equities

The undersigned hereby warrants to Kaloti Precious Metals that the Metals/Funds to be delivered to Kaloti Precious
Metals for treatment or trading have been procured through legal means and have been acquired from legitimate
sources not involved in funding conflict or incompliance with any United Nations sanctions, resolutions, or human
rights violations. To the best of my knowledge, I the undersigned hereby guarantees that these Metals are conflict-
free, free from child labor, and have been sourced through proper channels.

Source of Metals

I the undersigned agree that all documents (actual invoice, custom’s paper, airway bill) regarding the origin of the
metal will be declared to Kaloti Precious Metals. This is part of the policies and procedures implemented by the
compliance department and in line with DMCC and OECD’s Guidance for Responsible Supply Chain. In case of
any future changes with the origin of my precious metal, I agree to advise the company beforehand and to provide
supporting documents prior to sending any delivery/shipment. Upon having my account, I will be responsible to
update my files and submit any documents that are necessary for the compliance team.