- The State (national) banks of a foreign state or an interstate banking;
- Bank-nonresident (except for the bank, which is the state (national) banks of foreign states or interstate bank)
(Underline whatever applicable)
General Information	
1. Name	Full		
		Example: Limited Liability Company "Daisy"	
	Short		
		For example: LLC "Daisy"	
	In a foreign language		
		If you have it	
2. Legal form		
	For example: LLC	
3. Code of foreign
Organisation	

Enter the code of a foreign organization to a non-resident	
4. Information about state registration	Number of the certificate of accreditation of the branch or representative office of a foreign legal entity, or		

Indicate the registration number	
	Number of the registration authority	

Indicate the registration number	
	Date of state registration		
		For example: 28 June 2011	
	Name of registering authority		
		For example: Inspectorate of the Federal Tax Service № 14 for Moscow	
	Place of registration		

		For example: Moscow	
5. Basic details	S.W.I.F.T.	
If you have it	
	ТЕЛЕКС	
If you have it	
	REUTERS	
If you have it	
6. Location address	According to the registration		
		For example:  of. 64, b. 10, str. Kedrov, Moscow, 107123	
	Actual address		
		For example:  of. 13, b. 8, st. Vavilov, Moscow, 122123	
	Mailing address	

If you have it	
7. E-mail address		
	
For example:  hello@romashka.ru	
8. Information about the license for the right activities subject to licensing

* To be completed if your activities are licensed
	type of license		
	number		
	date of issue		
	name of the authority		
	period of validity		
	list of licensed activities		
9. The main activities		
		
10. Authorized capital	the value of the registered authorized (equity) capital or the amount of the authorized fund, property		
		For example: 10 000 USD	
	the value of the paid authorized (share) capital or the amount of the authorized fund, property	

		For example: 10 000 USD	
11. Contact numbers	Phone	
	
		For example: +7 (916) 777-45-32; +7 (495) 777-45-33	
	Fax	
	
		For example: +7 (495) 777-45-33 (111)	
Information about the management bodies 	
12. The structure (composition)	Full name	Position	Term of office	

				
	To be filled by line	
For example: Ivan Ivanov - General Director - Indefinitely, in the absence of filled "no"
The information is filled separately for each person on the form of the NCO questionnaire	
13. Information on participants (shareholders)		
	For example: Ivanov Ivan Ivanovich, LLC “Patron”
The information is filled separately for each person on the form of the NCO questionnaire	
14. Information about the beneficial owners		
14.1. 
The ownership structure does not imply the existence of beneficial ownership and (or) the sole executive body (director) (Leave the correct version) (mark the correct option)
	- correctly
(Structure does not imply any beneficial owner and (or) the sole executive body)

- incorrectly
(Structure presupposes the beneficial owner and (or) the sole executive body)	
15. Information about other persons who are entitled to act on behalf of an organization without power of attorney		
	Full name. For example: Ivanov Ivan Ivanovich
The information is filled separately for each person on the form of the NCO questionnaire
	
16. The sole executive body

If you have it	Full name	Position	Term of office	

	For example: Ivan Ivanov - General Director - Indefinitely, in the absence of filled "no"
The information is filled separately for each person on the form of the NCO questionnaire	
The points 12,13,14,15,16 - You must provide an original or a copy of the documents attesting their identity	
Purpose and Intended Nature of the Business Relationship with the NCO	
17. For information about the purposes and intended nature of the business relationship with the NCO (characteristic of future operations)

	
	For example: Receiving online payments	
18. Information about the purposes of financial and economic activity	the main counterparties
For example: The tax authorities	
- Tax authorities
- Shareholders (participants)
- Other organizations (provide details)
- Additional Information (указать при  наличии)	
			
	Planned payers and recipients of operations in funds	- Legal entities
- Natural persons
- Additional information (provide details)
For example: Legal entities

- Tax authorities
- Shareholders (participants) of the legal entity
- Other organizations (provide details)
- Additional Information	
			
19. Information about the basic correspondent banks
	List of basic correspondent banks	

For example: "Alfa-Bank"	
	You are working with non-resident banks (the availability and use of accounts) in respect of which there is information that: their accounts are used by banks that do not have on the territories of the states in which they are registered, constantly acting governing bodies and (or) registered on the territory of the state, which does not comply with the recommendations of the FATF?		

For example: YES, set / No, not installed	
20. Availability of customers:
- Have no permanent management bodies at the place of registration;
- Registered in offshore zones		
Information about the financial situation	
21. Financial condition of the organization.
Additionally, you can provide supporting documentation.*	- stable
- unstable
- crisis
- other 

Information on the Business Reputation of the Organization	
22. Business reputation of the organization 
Additionally, you can provide supporting documentation.	- positive
- unavailable
- negative information is present
- other 	
		
23. Experience in the market.
History, market sector and competition	

		
24. Official website of the credit institution  	
	
	If you have it	
25. Divisions of the credit institution	

For example: Category 1	
The origin of funds and (or) other property	
26. The origin of funds and (or) other property 	- income from ongoing activities

- income from supplementary activities
__________________________________________________ 
(please specify)
- other_______________________________________________ 
_____________________________________________________
(provide details)	
Beneficiaries
 (persons not involved in the operations, but for the benefit of which the Client performs banking operations and other transactions, incl. on the basis of the agency agreement, commission and trust management contract) 
(please underline: YES or NO)	
27. Beneficiaries
Credit institution does not operate under the suretyship, commission, trust management, agency agreements or other commercial agreements in favor of third parties, that is, all transactions are made to its own benefit and at its own expense.     	
- correctly
(all transactions, payments are made for your own comfort and at your own expense)
- incorrectly
(beneficiaries)
	
	If you have of beneficiaries, you should fill out a form for each of a natural person for each  beneficiary.	
Activities of credit institutions on counteraction to legalization (laundering) of proceeds of criminal proceeds and financing of terrorism	
28. Measures taken by the credit institution to counter money laundering and terrorism finance (availability and use of the internal control rules for AML/CTF, specifics and regularity of implementation of the AML/CTF procedures, etc.)	

	
29. Employee responsible for a complex of measures on counteraction to legalization (laundering) of proceeds from crime and financing of terrorism
(Name, phone, e-mail)	

	
Information about the presence or absence of a credit institution and its permanent management body or the persons who have the right to act on its behalf without a power of attorney at their location.	
		
_______________________________________________________________________ hereby
                                      (name of the credit institution)                          
confirms that the permanent governing body (other body or person authorized to act on behalf of the credit institution without a Power of Attorney) is present at the address: ___________________________________________________________________________________ 
                                     (actual location address)	
For client:
I confirm the completeness and reliability of the above information.
I commit notify the LLC RNCO " Yedinaia kassa" all changes in the financial - economic activity of the credit institution by forwarding a notice or this amended Questionnaire.   
Head of the credit institution/
Authorized person                ____________________    ________________________
                                                                        (signature)                            (full name)

 L.S.                                     _________________________ 
                                                   (date)	

For the employee responsible NCO:

The information that is provided by the client, tested and confirmed:

             Full name of the employee responsible NCO:

			(Signature)   		           (date)	
*
*Section 1
1.copy of annual financial statements (balance sheet, statement of financial performance) and/or;  
2.copy of annual (or quarterly) tax return marked by a taxation body as "accepted" (or without such a mark but with an enclosed copy of a receipt for sending a registered letter with a list of attachments, if it was sent by mail, or copy of the sending confirmation in paper, if it was sent electronically) and/or;      
3. a copy of the audit report on the annual statement for the past year, which confirms the reliability of the financial (accounting) statements and compliance of the accounting procedures with the accounting legislation of the Russian Federation and/or; 
4. a receipt confirming that the taxpayer has paid taxes, fees, fines, penalties issued by the tax authority and/or; 
5. information on absence of insolvency (bankruptcy) proceedings, any effective court ruling declaring it insolvent (bankrupt), liquidation proceedings as at the date of submitting the documents to the NBCI, arrears in budget payments and/or;     
6. information confirming that there is no default of financial obligations due to insufficient funds on the bank accounts; 
7. your rating on an official website (website adress to be provided) of the global rating agencies ("Standard & Poor's", "Fitch-Ratings", "Moody's Investors Service") and national rating agencies, if available. 
IMPORTANT: organizations with the period of operations less than 3 months from the date of their registration shall submit the following supporting documents at the time of application: 

Section 2 :
1. copies of monthly financial statements: balance sheet, profit and loss statement (Form No.1 and No.3) and/or;
2. statements of cash flow on Client's accounts from other credit institutions providing services to the Client and/or; 
3. information on absence of insolvency (bankruptcy) proceedings against the Client, any effective court ruling declaring the Client insolvent (bankrupt), liquidation proceedings as at the date of submitting the documents to the credit institution, information confirming that there is no default of the Client's financial obligations due to insufficient funds on the bank accounts or arrears in budget payments;     
The Client applying to the NBCI without the set of the required data set out in Section 1 shall provide the specified data as it becomes available/generates. According to FZ No.115 "On Countering Money Laundering and Terrorism Financing", an NBCI has a right to refuse to fulfil a client's instruction to perform an operation (except for crediting funds to an account) and terminate a bank account agreement, denying the service to the persons, who have not provided the requested data as required by the Federal Law.

Documents supporting business reputation:
Business reputation may be confirmed by: assessment of your business reputation by other credit institutions, which provided you with the services earlier, address of the website with information on your business reputation or any other disclosure of information on your business reputation.