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Ultimate Beneficial Ownership & Bearer Shares Declaration<ON THE LETTER HEAD OF THE COMPANY>

[Date]

Citibank, N.A. Singapore8, Marina View#17-01 Asia Square Tower 1Singapore 018960

Dear Sirs,

Re: <Company's name>;<Company’s registered address><Company Registration No.___________________>

A. Ownership / Shareholding StructureProvide an organization chart from a duly authorized representative of the customer e.g. corporate secretary or company director and for high-risk corporateneed to be certified by registered lawyer, auditor or accountant (in-house are acceptable, but must be registered with relevant professional body andregistration must be verified (e.g., license number provided).Include the details of the shareholding of the individual(s) / entity(s) who owns >=10% of the Company, directly or indirectly. See Appendix A for example.

[Insert organization chart] *Please provide domicile address & country of incorporation for all entity(s)

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B. Declaration of Ultimate Beneficial Ownership1 (Tick as appropriate)

The details of natural persons who are the ultimate beneficial owners who directly and/or indirectly hold = > 10% ownership in the Company or whoexercise control over the company are as follows:

No

Name Number ofsharesowned

% ofHolding in

theCompany

Date of Birth NationalityCompany

Title /Occupation

Residential Address andCountry of ResidenceFirst Name Middle

Name Last Name

1

2

3

4

*Add rows if required

We have also enclosed the valid “copy of passport” or “photo national identification equivalent document” of the aforementioned individual ultimate beneficialowners.

We declare that there is no natural person / individual who is ultimately holding > =10% beneficial ownership interest directly / indirectly in the Company.

C. Bearer Shares Notice and Declaration

1 See Definitions

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Please be advised that Citi policy prohibits doing business with companies who issue bearer shares or have beneficial owners* who issue bearer shares. Ifany portion of your company ownership is held in bearer shares, or it is your intent to issue bearer shares, you are obligated to notify Citi immediately throughyour Banker or Relationship Manager. Similarly, if any of your beneficial owners are corporate entities that have issued bearer shares, or intend to issuebearer shares, you are also required to notify Citi immediately. Your continued usage of Citi services constitutes your acknowledgment of, adherence to, andcompliance with this Citi policy.*A Beneficial Owner in this instance owns 10% or more of the company.

Question Yes/No

Does your company explicitly permit the issuance of bearer shares or bearer warrants?

Does your company have 10% or more of company ownership in bearer shares outstanding?

For each Beneficial Owner, please provide responses to each question.

Beneficial Owner Name: _______________________________________________________

Question Yes/No

Does the Beneficial Owner explicitly permit the issuance of bearer shares or bearer warrants?

Does the Beneficial Owner have 10% or more of its own company ownership in bearer shares outstanding?

If Yes, what is their percentage outstanding? %

If Yes, what is their percentage ownership of the Citi entity? %

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Beneficial Owner Name: _______________________________________________________

Question Yes/No

Does the Beneficial Owner explicitly permit the issuance of bearer shares or bearer warrants?

Does the Beneficial Owner have 10% or more of its own company ownership in bearer shares outstanding?

If Yes, what is their percentage outstanding? %

If Yes, what is their percentage ownership of the Citi entity? %

D. Declaration of the List of Directors and Senior Management (CEO, CFO, Chairman or equivalent)

We declare that the details of the Company’s Directors and/or Senior Management are as follows:

No

Name Designation(Director(s) and/or other seniormanagement positions (if any)e.g. CEO, CFO, Chairman or

equivalent)

ID Number /PassportNumber

Nationality DOBResidential Address

and Country ofResidence

LastName

MiddleName

FirstName

1

2

3

*Add rows if required

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We declare that the company only has director(s) listed above and company does not have any other Senior Management positions such as CEO, CFO,Chairman or equivalent.

We have also enclosed the valid CTC “copy of passport” or “photo national identification equivalent document” of the aforementioned individual Directorsand/or Senior Management; for minimum 2 individuals.

THE UNDERSIGNED CERTIFIES, REPRESENTS, WARRANTS AND UNDERTAKES THAT:

That I/we will promptly provide written notification to Citibank N.A., Singapore of any changes in ownership of said Company.

The Company undertakes to inform Bank of any change in the information provided in this declaration, promptly.

We hereby agree to the contents of this declaration and confirm all details provided therein are complete, true and correct.

Yours faithfully,

__________________________<Name><Title>

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Definition:

Ultimate Beneficial Owner:

The ultimate beneficial owner of an account is the natural person with actual or effective control over the account. Effective control may be derived from anindividual’s role with respect to the account or the accountholder entity, or from a level of ownership in the account assets or accountholder entity that conferssuch control. This is included to mean any natural person who:

Exercise actual control over the account or the accountholder entity, or; Exercises effective control through a formal mandate of authority over the account or the accountholder entity, or; Exercises effective control through authority of 10% or more of the account assets or the accountholder entity either directly or indirectly, or; Exercises effective control through influence and other indirect means.

Control:

Control shall include through a formal mandate of authority over the account or the accountholder entity or through influence and other indirect means.

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Appendix A

Co XYZ -new client

Co ABC (40%owner of XYZ

Country of Incorp:Domicile address:

IndvB

(90%)

Indv C(10%)

Co PQR (43%owner of XYZCountry of Incorp:Domicile address:

Indv D (60%voting

Control)

Public Co 123(30% voting

control)Country of Incorp:Domicile address:

Indv E (10%voting

control)

Indv C (7%owner of XYZ)

Indv R (10%owner of XYZ)

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