Note 4

Know Your Customer
[!IJbank. Required Information Collection Form
To help the United States government fght the funding of terrorism and prevent money laundering activities, U.S. Federal law requires
all fnancial institutions to obtain, verify, and record information that identifes each person (individual, corporation, partnership, trust,
estate, or any other entity recognized as a legal person) who opens an account. U.S. Bank will ask for the legal name, address, tax
identifcation number, and other identifying information that will assist us in completing the review of your contract/application. We may
also ask for copies of certifed articles of incorporation, an unexpired government-issued business license, a partnership agreement, or
other documents that indicate the existence and standing of the entity. U.S. Federal law also requires fnancial institutions to conduct
ongoing customer due diligence, verify the identity of benefcial owners of certain legal entities, and comply with U.S. Economic
Sanctions. U.S. Bank may require identifcation information on Customer, its Affliates, Related Parties, or Cardholders, if applicable,
to allow U.S. Bank to remain in compliance with U.S. Federal law or U.S. Bank policy. Customer agrees to promptly provide such
identifcation information to U.S. Bank, and Customer shall cause its Affliates, Related Parties or Cardholders, if applicable, to provide
identifcation information to U.S. Bank.
How to complete this form:

Answer all questions completely and thoroughly, reviewing the requirements of each section. Do not leave any section blank unless
you qualify under Section B. Provide the First, middle (if applicable), and last name for all individuals supplied on this form. Missing
information will cause delays in processing. Abbreviations or acronyms are not acceptable. Post Offce Boxes or Personal Mailboxes
are not acceptable, please provide physical address for any addresses provided. You must notify U.S. Bank if any information contained
in the form changes.
Section A: Customer Information

Company Name:
(Provide the full legal name of the customer as it is captured on formation documents, this does not include DBA/
Trade names or Operating As names (Examples: Articles of Incorporation, Partnership Agreements, etc.). If the entity
is a Sole Proprietorship, provide the full legal name of the Owner.)
Company Information
Identifcation number:
• (TIN / EIN; SSN / ITIN)
Legal Physical Address:
(Where your business is located. Do not provide your mailing address)
Does your company have a Trade Name / Doing Business As  Yes  No
(DBA) name(s)?
If Yes, provide only the DBA(s) or trade name(s) that are applicable to your
relationship with U.S. Bank:
Provide the DBA address(es) if it is different than the company
address:
Section B: Exempt Entities – Do any of the below business types apply to your business?
• If yes, check the boxes below that apply. Then complete Sections C and Section D only.
• If no, supply formation documents, if available and complete the entire form.
 Is your business a U.S. Department or Agency, including Indian Tribal Government, or was it formed under in interstate compact between
two or more states?
 U.S. Political Subdivision (Local Government Entity)
 Financial institution that is regulated by a Federal or State Regulator:
 Any entity established under an interstate compact, including Indian Tribal Governmental Entities
 An entity that is listed on the New York, NYSE Market LLC or NASDAQ stock exchanges – this only applies to U.S. operations
 Subsidiary of a Publicly Traded parent listed on NYSE, NYSE MKT LLC, or NASDAQ stock exchanges*. This only applies to U.S.
operations and U.S entities where equity of 51% or more is held by a U.S. listed entity. *Excludes subsidiaries and entities listed under
“NASDAQ Capital Market (Nasdaq-CM) Companies”
Name of Exchange: Ticker Symbol:
Page 1 of 2
Section C: Standard Due Diligence Questions – This section is required to be completed by all applicants
1 What is the nature of your business?
(What products or services do you supply?)
• Include NAICS if known
2 Does your business operate in the hemp industry?  Yes  No
(If yes supply USDA License, or State/Tribal Government License along
with this form)
3 What is the legal structure of your business?
(e.g., Corporation, Limited Partnership/LLP, Not-for-Proft Organization,
LLC, Single Member LLC, Partnership, Sole Proprietor, Government)
4 What is the company’s country of formation?
5 What is the country of primary business operations for the company?
6 Does the company provide any of the following services to your customers?
If Yes, which service?
check cashing services  Yes  No
issue or cash travelers checks or money orders  Yes  No
provide money transmission or foreign exchange services  Yes  No
offer prepaid cards  Yes  No
7 What is the company’s estimated or projected annual revenue/budget $
(USD)?
(If none, please indicate with $0. None and N/A are not allowed.)
8 What is the purpose of this account?
Section D: Related Parties –One individual is required to be listed. Additional individuals are optional.
Full Name Provide one of the following items: Authorized Signer –
is the individual(s),
(First, Middle, Last) Date of Birth (mm/dd/yyyy),
who signs the
OR OR U.S. Bank
Full Legal Name Physical Residential Address (preferred) OR Business Address contract or
Application
OR
SSN
1 Authorized Signer
 No middle name
2 Authorized Signer
 No middle name
[!I1bank.
© 2022 U.S. Bank. All trademarks are the property of their respective owners. U.S. Bank Customer Confdential
Know Your Customer: Required Information Collection Form Page 2 of 2 08-0011-01-USX-CAL (Rev. 03/22) CAT-18928336

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Know Your Customer

[!IJbank. Required Information Collection Form

How to complete this form:

Section A: Customer Information

Name of Exchange: Ticker Symbol:

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