* Required fields:
Questionnaire of the client
Sole trader in private practice in the established order
Customer representative, to customer questionnaire: __________________________________________________
Beneficiary, to customer questionnaire: ______________________________________________________________
Other_________________________________________________________________________________________

General Information	
1. Name	*	
	
For example: Ivanov Ivan S.	
2. Citizenship	*	
	
For example: the Russian Federation	
3. Date and place of birth	*	
	In accordance with passport data
For example: 02.24.1987, Kirov region, Kirov	
4. Details of the document proving the identity 

* Further request our expert, you must submit the original (ly) or copy (s) of the document (s) certifying (them) the person (s)	Name	*	
		For example: passport	
	Series, number	*	
		For example: 5468 646424	
	Date of issue	*	
		For example: 24 September 1986	
	Name of the authority issuing the document	*	
		For example: 76 police department	
	Unit code (if any)	*	
		For example: 782-276	
5. Address	Place of residence (registration)	*	
		For example: 107123, Moscow, st. Kedrov, 10, of. 64	
	The actual place of residence	*	
		For example: 122123, Moscow, st. Vavilov, 8, of. 13	
	Postal address (if available)		
6. Individual Taxpayer Identification Number	*	
	If any	
7. SNILS  (Insurance Number of Individual Ledger)	*	
	Be sure to specify, for example: 120-198-064-23
If you have not received SNILS select NO	
8. Other additional documents (eg OMC policy number	
	
	If any	
9. Contact phone number	*	
	For example: +7 (916) 324-23-34; +7 (495) 545-51-10	
10. E-mail address	*	
	For example: hello@mail.com	
11. For citizens - non-residents of the Russian Federation	Information about the migration card
(Card number, date of commencement of the period of stay and expiration date of your stay)	

	Data on the document confirming the right of a foreign citizen or stateless person to stay (reside) in the Russian Federation
(Series (if available), and number of the document, the date of commencement of the residence rights (residence), date of expiry of the right of residence (stay))	

	
12. Attitude to "public officials" category 
(Persons -ispolnyayuschie important state functions, or are (were not more than 1 year ago) persons in positions of public trust 	*
 It is not TDL
 TDL    	
	In the case related to the category of TDL (RPDL, MPDL, FPO) must specify the job title, the name and address of the employer.
 In the case of kinship with PEPs must specify the degree of relationship or the status of your (spouse) in relation to PEPs, full name and position of TDL.	
13. Information on registration as sole trader	date of registration	*	
		For example: 24 September 2014	
	Primary State Registration Number of the Sole Proprietor	*	
		For example: 313556358912548 	
	Registration Authority. Place of registration	*	
		For example: Inspectorate of the Federal Tax Service for the city of Pavlovsky Posad, Moscow region	
14. Information about the license for activities subject to licensing
(Choose the correct option)	*
- has a license (s)

If your activity licensed - to fill	view license		
		number		
		date of issue		
		name of the		
		issuing authority		
		validity		
		list of licensed activities		
	*
  - no license	
15 Information on the beneficial owner (Specify a valid option)
Client-only
In the presence of beneficial (s) of the owner (s) - to fill in additional information number 2	* 	

For example: Ivan Ivanov	
16. Data on other persons who are entitled to act on behalf of a sole trader without power of attorney In the presence of these individuals, to fill additional information number 2	* 
	
Purpose and intended nature of the business relationship with RNKO	
17. 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	
	main counterparties
For example: The tax authorities	*
- tax authorities
- Shareholders (participants) of the legal entity
- Other organizations (provide details)
- Additional info (specify if any)
	
		For example, the tax authorities	
	planned payers	*
- Legal entities
- Natural persons
- Additional info (provide details)
	
		For example: Legal entities	
18. Persons are not entitled conclusion of contracts and cooperation with contractors, which are:
	1. 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)

Not right, it provided
(Contracts with counterparties are set forth in claim 1, 2)	
	2. non-profit organizations registered in an order different from the order established by the RF legislation.		
		For example: there is not provided, or yes, provided	
18.1. A person does not belong to the list of Russian residents - participants of foreign trade activities, be before which the non-residents of the Russian Federation debt contracts	- Right
(sole trader does not belong to the list of Russian residents - participants of foreign trade activities, be before which the non-residents of the Russian Federation debt contracts)

- Not true
(sole trader refers to the list of Russian residents - participants of foreign trade activities, be before which the non-residents of the Russian Federation debt contracts)	

For information about financial position of sole trader	
19. Financial position
Additionally, you can provide the supporting documentation	*
- sustainable
- unstable
- crisis
- Other (please specify in detail)	
	For example: stable	

Information about the goodwill of sole trader	
20. Business reputation.
Additionally, you can provide the supporting documentation	*
- positive
- missing
- The availability of negative information
- Other (please specify in detail)	
	For example: positive	
21. Market experience
	* 

For example: 2 years	
22. Official site	*	
	For example: site.com	

Sources of funds origin and (or) other propertyof sole trader	
23. The sources of origin of the funds and (or) other property are	*
- Income from ongoing activities

- Income from additional activities
_____________________________________________________ 
(Please specify)
- other_______________________________________________ 
_____________________________________________________

(Please specify)
	
	Select an option.
If the sources of origin of funds are revenues from the implementation of additional activities, indicate its views and provide details.	
Beneficiaries
(Persons who are not participating in the operation, but for the benefit of which the client operates, including on the basis of the agency contract, agency contract, commission and trust management in conducting banking operations and other transactions)	
24. Beneficiaries
A person does not work for surety agreements, commissions, asset management, agency agreements or other civil contracts in favor of third parties, all transactions, payments are made to their own benefit and at its own expense
In the presence of the beneficiary - natural person - to fill in additional information number 2;
if the beneficiary is a legal entity - to fill in additional information number 1	*
Right
(All transactions, payments are made to their own benefit and at its own expense)

Not right
(There are beneficiaries)	
25. For information about serving the credit institution and bank account number	*

For example: OJSC "Sberbank of Russia", 40702810502548321458	
Information about the use of payment systems and transactions with electronic money	
26. Specify the name of the payment systems, which are used (use) 
(Insert the correct option or enter your own)	*
1. Yandex
2.WebMoney
3.OOO NSCA «RIB» (Robokassa)
4.OOO RNKO "Rapid"
5. Other: _______________________________________________________________
(Insert name)
For example, Yandex. Money	
For Client Representative
(Fill in if there is,
in the absence of a representative indicate the word No)	
27. Details of the document confirming the existence of the client's representative office (name, date of issue, expiry date;)	Name	Date of issue	Validity	number of the document confirming the authority of representative of the client	
	*

For example: Power of Attorney	*

For example: 08/15/2015	*

For example: before 01.08.2018	* 

For example: 5468 646424	
For client:
Accuracy and completeness of these details confirm.
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	

*
 __________________________________                           ___________________      _______________
Name of sole trader /representative of sole trader                    Signature                          Date of completion

Stamp
    For the employee responsible RNKO:

* The information stated by the client, tested and verified

*

		

	Name of the Responsible Officer RNKO
		(Signature)		(Date of completion)	

_____________________________________________________________________________________ The fields marked * are obligatory for filling

In accordance with the legislation of the Russian Federation, identity documents are:

1. For citizens of Russian Federation:
Passport of a citizen of the Russian Federation;
passport of a citizen of the Russian Federation, diplomatic passport, service passport, identity document of a citizen of the Russian Federation outside the Russian Federation;
a birth certificate of a citizen of the Russian Federation (for Russian citizens under the age of 14 years);
temporary identity card of a citizen of the Russian Federation, which is issued prior to the issuance of the passport of the Russian Federation;
2. for foreign nationals:
passport of a foreign citizen;
3. for stateless persons:
document issued by a foreign state and recognized in accordance with the international treaty of the Russian Federation as a document certifying the identity of the person without citizenship;
a residence permit;
a document certifying the identity of the person without a valid identity document for the period consideration of the application for recognition of a citizen of the Russian Federation or for admission to the citizenship of the Russian Federation;
refugee certificate, certificate of examination of an application for refugee status on the territory of the Russian Federation;
4. Other documents, recognized identity documents of a citizen of the Russian Federation in accordance with Russian law and the documents certifying the identity of the foreign citizen and stateless persons in accordance with Russian and international treaty law.

Documentation proving the financial position:

Section 1 (for sole trader with the period of activity from 3 months and more):
1.	a copy of the annual financial statements (balance sheet, statement of financial performance) and / or;
2.	a copy of the annual (or quarterly) tax return with the tax authority of their adoption (with or without the mark - but with a copy of: the receipt of sending a registered letter with a list of attachments - if the mailing was by mail or by sending a copy of the confirmation on paper, if shipping was in electronic form and / or;
3.	a copy of the audit report on the annual report for last year, which confirms the reliability of the financial (accounting) statements and compliance of accounting procedures with the legislation of the Russian Federation and / or;
4.	the certificate of execution of duties by the taxpayer to pay taxes, fees, penalties, fines, issued by the tax authority, and /or;
5.	information about the absence of proceedings by the insolvency (bankruptcy), which entered into force court decisions on the recognition of his insolvent (bankrupt), of the liquidation procedures as of the date of submission of documents to the RNKO, about the absence of arrears to the budget and / or;
6.	information about the absence of evidence of non-fulfillment of its financial obligations due to lack of funds in bank accounts;
7.	information of the official site about your rating (website address), placed in a network "Internet" on the sites of the international rating agencies ( "Standard & Poor's", "Fitch-Ratings", "Moody's Investors Service") and the national rating agencies, if any.
8.	other accounting and (or) financial records, which allows to make a conclusion on the financial situation

IMPORTANT: For individuals, the period of activity is less than 3 months from the date of their registration at the time of treatment, as supporting documents must be submitted:

Section 2 (sole trader for the period of activity within 3 months):

1.	a copy of the monthly financial statements: balance sheet, profit and loss statement (Form №1 and № 3) and / or;
2.	reference with data about the turnover of funds on clients' accounts from other credit institutions serving the Client and / or;
3.	information: the absence of the Client in respect of insolvency proceedings (bankruptcy); the decision of the judicial authorities for recognition of his insolvent (bankrupt); for liquidation procedures as of the date of submission of documents to the lending institution; the lack of evidence of non-fulfillment by the Client of its financial obligations due to lack of funds in bank accounts; about the absence of arrears to the budget;
4.	other accounting and (or) financial records, which allows to make a conclusion on the financial situation.

The client, not at the date of treatment in the RNKO, a complete set of the required information specified in section number 1, must provide the information specified in the NKOs as they arrive / formation. According to the requirements of the Federal Law №115 «On the legalization (laundering) of proceeds from crime and terrorist financing", RNKO have the right to refuse to execute client orders to commit transactions, except for transactions on transfer of funds, as well as to terminate the contract of bank account (denying service) to persons, in particular, not to provide the requested information provided by the present Federal Law.

Documentation of goodwill: as proof of goodwill can be given: the reviews in any form on the assessment of your business reputation provided by other credit institutions in which you served before; site address with information about your business reputation and other information disclosing goodwill.

Additional information № 1
ADDITIONAL INFORMATION ABOUT THE LEGAL ENTITY FOR THE CLIENT PROFILE FOR WALLET ONE

*  By Client’s Wallet one profile ______________________________________________________________
* Be sure to select an option:
□ 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	

Addition information №2
ADDITION INFORMATION ABOUT THE NATURAL PERSON FOR THE MAIN CLIENT PROFILE FOR WALLET ONE

* By Client’s Wallet one profile ______________________________________________________________
* Be sure to select an option:
□ Shareholder
□ Founder
(participant)	□ Member
of the Board_________________ 
(specify position)	□ The sole executive body / head of the organization	□ A person who has power of attorney is authorized to act on behalf of the organization, client - physical persons and legal entities	□ other:
______________ 
(indicate)	

General information	
1. Full name	*	
	
Например: Иванов Иван Сергеевич	
2. Citizenship	*	
	
Например: РФ	
3. Date and place of birth	*	
	В соответствии с паспортным данными
Например: 24.02.1987, Кировская обл., г.Киров	
4. Details of the document proving the identity 

* Further request our expert, you must submit the original (ly) or copy (s) of the document (s) certifying (them) the person (s)	Name		*	
		For example: passport	
	Series, number	*	
		For example: 5468 646424	
	Date of issue	*	
		For example: 24 September 1986	
	Name of the authority issuing the document	*	
		For example: 76 police department	
	Unit code (if any)	*	
		
For example: 782-276	
5. Address	Place of residence (registration)	*	
		For example: 107123, Moscow, st. Kedrov, 10, of. 64	
	The actual place of residence	*	
		For example: 122123, Moscow, st. Vavilov, 8, of. 13	
6. Individual Taxpayer Identification Number		
	If any	
7. SNILS (Insurance Number of Individual Ledger)	*	
	Be sure to specify, for example: 120-198-064-23
If you have not received SNILS select NO	
8. Other an additional document (eg policy number)		
9. Contact phone number	*	
	For example: +7 (916) 324-23-34; +7 (495) 545-51-10	
10. E-mail		
11. For citizens - non-residents of the Russian Federation	Information about the migration card
(Card number, date of commencement of the period of stay and expiration date of your stay)		
	Data on the document confirming the right of a foreign citizen or stateless person to stay (reside) in the Russian Federation
(Series (if available), and number of the document, the date of commencement of the residence rights (residence), date of expiry of the right of residence (stay))	

	
12. Attitude to "public officials" category 
(Persons -ispolnyayuschie important state functions, or are (were not more than 1 year ago) persons in positions of public trust назад) лицами, облеченными общественным доверием
	*
 It is not TDL
 TDL    	
	In the case related to the category of TDL (RPDL, MPDL, FPO) must specify the job title, the name and address of the employer.
 In the case of kinship with PEPs must specify the degree of relationship or the status of your (spouse) in relation to PEPs, full name and position of TDL.	
Origin of funds and (or) other property	
13. Origin of funds and (or) other property is
(Underline the correct version)

Field is required only for the categories: Insurance Beneficiary, beneficial owner, representative of the individual. In other cases, filling NOT REQUIRED	*
- income from state benefits
- income from personal earnings
_____________________________________________________ 
_____________________________________________________ 
(Specify what)
- other_______________________________________________ 
_____________________________________________________
(provide details)
		
	For example, revenues from personal income, income from government benefits, etc.	
14. Size of the obtained income 
Field is required only for the categories: Insurance Beneficiary, beneficial owner, representative of the individual. In other cases, filling NOT REQUIRED	*
- Up to 50 000 rubles;
- from 50 000 rubles to 100 000 rubles;
- More than 100 000 rubles.
	
For Representative of the Client	
15. Details the document confirming the authority of the client's representative (name, date of issue, expiration date) 
Field is required only for the category: A representative a natural person. In other cases, filling NOT REQUIRED	Name	Date of issue	Validity	Number of the document confirming the authority of the client's representative	
	*

For example: Power of Attorney	*

For example: 08/15/2015	*

For example: 08/15/2018	* 

For example: 5468 646424	

For customer RNKO:
Accuracy and completeness of these details confirm.
About changes in the information about an individual, I undertake to notify the Wallet one by means of the direction of the information letter or the questionnaire as amended.

*		
*
		
*
	
	Customer data (full name)
		(Signature)		(Date of completion)	
     Stamp (in the presence of)

For the employee responsible RNKO:
* The information stated by the client, tested and verified
	
*		

	
	Name of the Responsible Officer RNKO
		(Signature)		(Date of completion)	
_____________________________________________________________________________________ The fields marked * are obligatory for filling

In accordance with the legislation of the Russian Federation, identity documents are:

1. For citizens of Russian Federation:
Passport of a citizen of the Russian Federation;
passport of a citizen of the Russian Federation, diplomatic passport, service passport, identity document of a citizen of the Russian Federation outside the Russian Federation;
a birth certificate of a citizen of the Russian Federation (for Russian citizens under the age of 14 years);
temporary identity card of a citizen of the Russian Federation, which is issued prior to the issuance of the passport of the Russian Federation;
2. for foreign nationals:
passport of a foreign citizen;
3. for stateless persons:
document issued by a foreign state and recognized in accordance with the international treaty of the Russian Federation as a document certifying the identity of the person without citizenship;
a residence permit;
a document certifying the identity of the person without a valid identity document for the period consideration of the application for recognition of a citizen of the Russian Federation or for admission to the citizenship of the Russian Federation;
refugee certificate, certificate of examination of an application for refugee status on the territory of the Russian Federation;
4. other documents, recognized identity documents of a citizen of the Russian Federation in accordance with Russian law and the documents certifying the identity of the foreign citizen and stateless persons in accordance with Russian and international treaty law.