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Establishment of the beneficial owner’s identity

(Form A according to § 2.2, Art. 30 ff. SRO VFQ-Reglement)

Contracting party

The undersigned herewith declares:

( X ) That the contracting party is the beneficial owner of the assets involved

( ) That the following person / company is the beneficial owner of the assets involved

Name / Firstname
Date of Birth
Nationality
Address
State

The contracting partner shall immediately inform the financial intermediary of his own accord aboutany changes

The contracting party takes notice that the identity of the beneficial owner will be made known to the financial institution concerned, should the administration of the above mentioned file require the opening of a bank account or bank deposit.

If the undersigned intentionally provides wrong or incorrect information, or falsifies this document, this might be subject to the Swiss Penal Code. (Art. 251 Swiss Penal Code).

Place : Bern

Date : 04-12-2023

Signature of the counter party

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