Addition information №1
ADDITION INFORMATION ABOUT THE LEGAL ENTITY FOR THE MAIN CLIENT PROFILE FOR
 WALLET ONE 

*  By Client’s Wallet one profile ________________________________________________________________________________________

□ Shareholder
□ Founder
(participant)	□ representative of the client	□ Counterparty	□ other:
___________________________ 
(indicate)

	General Information	
1. Name	Full name

	*	

Example: Limited Liability Company "Daisy"	
	Abbreviated
	*	
		
For example: LLC "Daisy"	
	In a foreign language		
		
Укажите наименование при наличии	
2. Form of incorporation	*	
	For example: LLC, JSC	
3. Individual Taxpayer Identification Number	*	
		
4. Infromation on state registration	Tax identification number	*	
		
Indicate the registration number (13 digits, for example 1234567890123)	
	Date of 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	
		For a non-resident of the Russian Federation	
	Number of certificate of accreditation of the branch or representative office of a foreign legal entity	

if there are not, indicate "I'm a resident of the Russian Federation"	
	Registration number of the legal entity at the place of the institution and registration - for a non-resident	

if there are not, indicate "I'm a resident of the Russian Federation"	
5. Location address	In accordance with organization chart	*
	
		For example: 107123, Moscow, st. Kedrov, 10, of. 64	
	Factual	*

For example: 122123, Moscow, st. Vavilov, 8, of. 13	
6. E-mail
Field is required only for the categories: Beneficiary, the client representative. In other cases, filling NOT REQUIRED	

For example: email@mail.com	
7. Information about the license for the right activity subject to licensing
(Choose the correct option)

Field is required only for the categories: Beneficiary, the client representative. In other cases, filling NOT REQUIRED	*
 - there is a license (s)
	view license		
		number		
		date of issue		
		name of the issuing authority		
		validity		
		list of licensed activities		
	*
 - no license	
8. In fact carried activities (list, or you can specify codes from OKVED (All-Russian Classifier of Types of Economic Activity))

Field is required only for the categories: Beneficiary, the client representative. In other cases, filling NOT REQUIRED	For example: 51.53, 51.54, 52.23	
9. Authorized capital
Field is required only for the categories: Beneficiary, the client representative. In other cases, filling NOT REQUIRED	the value of the registered authorized (equity) capital or the value of the statutory fund, property	

For example: 10 000 RUB	
	the value of the paid authorized (equity) capital or the value of the statutory fund, property		

For example: 10 000 RUB	
10. Contact numbers	Phone	*	
	Fax		
Information about the management bodies	
11. The structure (composition)
Field is required only for the categories: Beneficiary, the client representative. In other cases, filling NOT REQUIRED

	Full name	Position	Term of office	
	*	*	*	

				

				
			
	For example, Ivan Ivanovich Ivanov, LLC "Patron", indefinite		
12. Information about the participants 
(shareholders)

Field is required only for the categories: Beneficiary, the client representative. In other cases, filling NOT REQUIRED

If a participant (shareholder) is:
- A legal person - to fill in additional information number 1;
- A natural person - to fill in additional information number 2	Full name	Position	Share,%	
	*	*	*	

				

				

	For example, Ivan Ivanovich Ivanov, LLC "Patron", 80%	
ATTENTION:
Paragraphs 12-13 - further request our expert, you must provide the original or a copy of the document proving the identity of these individuals	
Purpose and intended nature of the business relationship with RNKO	
13. Information about the purpose of establishing and intended nature of the business relationship with RNKO

Field is required only for the categories: Beneficiary	

For example: Receive online payments	
14. Information about the purposes of financial and economic activity
(Leave the correct version)
Field is required only for the categories: Beneficiary	main contractors
For example: The tax authorities	*
- tax authorities
- Shareholders (participants) of the person
- Other organizations (provide details)
- additional information (specify if any)
For example: The tax authorities	
	Planned payers and recipients of operations with cash	*
- Legal entities
- Individuals
- additional information (provide details)
For example: Legal entities	
15. The organization is not provided for the conclusion of contracts and cooperation with contractors, which are:	1. The organizations established outside the territory of the Russian Federation (including non-resident of the Russian Federation)	*
That's right, is not provided
(No contracts with counterparties referred to in paragraph 1, 2)

False ; provided
(Contracts with counterparties are set forth in claim 1, 2)

For example: there is not provided, or yes, provided
	
	2. The non-profit organizations registered in an order different from the order established by the legislation of the Russian Federation.		
15.1 The organization does not belong to the list of Russian residents - participants of foreign trade activities, before non-residents of the Russian Federation that have debts on contracts	- Right
(The organization does not belong to the list of RF-resident participants of foreign trade activities, with arrears of non-residents of the Russian Federation under contracts)

- Not true
(The organization refers to the list of RF-resident participants of foreign trade activities, with arrears of non-residents of the Russian Federation under contracts)	
For information about financial situation	
16. The financial situation of the organization
Additionally, you can provide supporting documentation
Field is required only for the categories: Beneficiary	*
- sustainable
- unstable
- crisis
- Other (please specify in detail)
For example: stable, unstable, crisis, other	
Details about business reputation	
17. Goodwill
Additionally, you can provide supporting documentation
Field is required only for the categories: Beneficiary	*
- positive
- missing
- The availability of negative information
- Other (please specify in detail)
For example: positive	
18. Official site	*

In the presence of. For example: site.ru, if not indicate word NO	
Sources of funds and (or) other property	
19. The sources of origin of the funds and (or) other property are
Field is required only for the categories: Beneficiary	*
- Income from ongoing activities

- Income from additional activities

_____________________________________________________
(Please specify)
- Other _______________________________________________
 _____________________________________________________
(Provide details)
Select your preferred option.
If the sources of origin of funds are revenues from the implementation of additional activities, indicate its views and provide details.	
For client:
I confirm the accuracy and completeness of the above information.
All changes in the financial - economic activity, I undertake to notify the Wallet one by means of the direction of this newsletter or questionnaire in a new edition	
*
Customer data:
Client Name: __________________________________________________________________
Head of the organization/
Authorised Person of organization

           _______________________                                 ______________                                                                               ___________________
               (Full name)                                                                 (signature)                                                                                         (Date of completion)
Stamp