Ref # : 1,615, Date : 17 Oct 2017 (Please also fill FATCA Compliance Form and Risk Profiling Form for account opening) Holder of any Government office, (MNA/MPA/Local bodies) Yes No Unique Identification Number. : AUTHORIZED SIGNATORY coverage (i) Has any Financial Institution ever refused to open your account? No Yes ____________________________________________________________________ (ii) Are you acting on behalf of any other person? No Yes ____________________________________________________________________ (iii) Are you holding a senior position in any public office? No Yes ____________________________________________________________________ (iv) Are you holding a senior position in any political party? No Yes ____________________________________________________________________ (v) Do you deal in high value items such as Gold, Silver, Diamond etc.? No Yes ____________________________________________________________________ (vi) Do you have any links to offshore tax heaven countries? No Yes ____________________________________________________________________ 13. ADDITIONAL QUESTIONNAIRE (Please describe if YES is selected) NBP FUNDS Managing Your Savings NBP FUND MANAGEMENT LIMITED NBP Funds NBP Funds Account Number www.nbpfunds.com NBP Funds NBP Funds.