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Contract analysis / lender-kyc-ofac-certificate-form.docx
lender-kyc-ofac-certificate-form.docx
1043-00001 · 7 clauses
High · 0 Medium · 1 Standard · 0
1. Is the Lender organized in or a tax resident of a jurisdiction outside the United State
1. Is the Lender organized in or a tax resident of a jurisdiction outside the United States? If yes, identify the jurisdiction(s): Response: ________
2. Is the Lender regulated by a non-US financial regulatory authority? If yes, identify th
2. Is the Lender regulated by a non-US financial regulatory authority? If yes, identify the authority and provide the applicable license or registration number: Regulatory Authority: ________ License / Registration Number: ________
3. Is the Lender, or any of its directors, officers, or Beneficial Owners, a "UK person" (
3. Is the Lender, or any of its directors, officers, or Beneficial Owners, a "UK person" (i.e., a UK national, UK resident, or entity incorporated in the United Kingdom or a British Overseas Territory)? Yes No If yes, provide details (including name, nationality/jurisdiction, and nature of relationship to the Lender): ________________________________________ ________________________________________
4. Is the Lender a fund vehicle, CLO, managed account, or similar pooled investment entity
4. Is the Lender a fund vehicle, CLO, managed account, or similar pooled investment entity? Yes No If yes, identify the fund manager or CLO manager and its jurisdiction of organization: Fund Manager / CLO Manager Name: ________ Jurisdiction of Organization: ________
5. Does the Lender have any investors, limited partners, or noteholders who are Sanctioned
5. Does the Lender have any investors, limited partners, or noteholders who are Sanctioned Persons or who are located, organized, or resident in a Sanctioned Country? Yes No If yes, provide details (including name, jurisdiction, and nature of interest): ________________________________________ ________________________________________
6. Does the Lender participate in the EUR Sub-Tranche?
6. Does the Lender participate in the EUR Sub-Tranche? Yes No If yes, confirm that EU Sanctions and BaFin/GwG screening has been completed for the Lender and its Beneficial Owners: Confirmed — EU Sanctions and BaFin/GwG screening completed. Not Yet Completed — Expected completion date: ________
7. Has the Lender made all required filings with the German Transparenzregister (to the ex Medium
⚑ Assignment / subcontracting
7. Has the Lender made all required filings with the German Transparenzregister (to the extent applicable)? Yes No Not Applicable If yes, provide filing reference number: ________ IN WITNESS WHEREOF, the undersigned Lender has caused this Supplemental Questionnaire (Annex B) to be executed and delivered by its duly authorized officer as of the date set forth below. [NAME OF LENDER] By: ________ Name: ________ Title: