Questionnaire for financial institution

QUESTIONNAIRE FOR FINANCIAL INSTITUTION

1. Basic Information

1.1.	Company name (full official name and short name)
1.2.	Form of incorporation
1.3.	Number of State Registration
1.4.	Date of State Registration
1.5.	Name of the registering body
1.6.	Place of State Registration
1.7.	Taxpayer Identification Number (if a non-resident company does not have Taxpayer Identification Number, please specify the Foreign Organization Code)
1.8.	Type of banking transactions license
1.9.	License number
1.10.	Date of the issue of the license
1.11.	Authority which issued the license
1.12.	Term of validity of the license
1.13.	Legal address (if the counterparty is a branch of financial institution, please specify the location of the head office)
1.14.	Location address (if the counterparty is a branch of financial institution, please specify the location address of the branch)
1.15.	Post address
1.16.	Contact person (title, telephone number, fax and e-mail)

2. Shareholders

2.1.

Information about shareholders (full name, citizenship, official address, participation share)

3. Management

3.1.	Board of Directors (full name, title)
3.2.	Executive Committee (full name, title)

4. Subsidiaries

4.1.	Number of domestic subsidiaries
4.2.	Number of foreign subsidiaries
4.3.	Number of domestic branches
4.4.	Number of foreign branches

5. Financial data

5.1.	Capital
5.2.	Total assets
5.3.	Audit Company
5.4.	Date of the last audit

6. Correspondent banks

6.1.

List of correspondent banks (Nostro accounts)

7. History and Ratings

7.1.	History, reputation market sector and competition
7.2.	Ratings

8. Anti-Money Laundering

8.1.	Has your country established laws designed to prevent money laundering and terrorist financing?	YES / NO
8.2.	Is your institution subject to and fully compliant with such laws?	YES / NO
8.3.	Do the laws and regulations in your country prohibit your institution from opening anonymous accounts?	YES / NO
8.4.	Does your institution have a written policy, controls and procedures reasonably designed to prevent and detect money laundering/terrorism financing activities?	YES / NO
8.5.	Do you comply with FATF SR VII[*]?	YES / NO
8.6.	Does your institution have policies or practices to reasonably ensure that they will not conduct transactions with or on behalf of shell banks through any of its accounts or products?	YES / NO
8.7.	Does your institution have an officer responsible for anti-money laundering?	YES / NO
	If yes, please provide the contact information	Name: Title: Address: Telephone number: Fax: E-mail:
8.8.	Does your institution have periodic anti-money laundering training program?	YES / NO

I confirm that the information given above is true and complete and undertake to inform you about any change in these data.

_________________________	_________________________	_________________________
(Signature)	(Name of signatory)	(Date)

(Seal)

Note: in case of any change of the data specified in the questionnaire, an updated questionnaire should be presented to OTP Bank (Russia).

[*] The financial Action Task Force Special Recommendation on Terrorist Financing (FATF SR VII). VII. Wire transfers

Countries should take measures to require financial institutions, including money remitters, to include accurate and meaningful originator information (name, address and account number) on funds transfers and related messages that are sent, and the information should remain with the transfer or related message through the payment chain.

Countries should take measures to ensure that financial institutions, including money remitters, conduct enhanced scrutiny of and monitor for suspicious activity funds transfers which do not contain complete originator information (name, address and account number).