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Client/ contractor
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representative
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Beneficiary
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, , / GIVES the FOLLOWING PERSONAL detals FOR the CONCLUSION And CONTRACT EXECUTION ON WHICH is the Client OR Beneficiary, OR THEIR REPRESENTATIVE
| / surname
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| /name
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| ( )/ patronymic (IF ANY)
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| /date of birth
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| /place of birth
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| ( )/taxpayer identification number of individual (IF ANY)
| |
| / rf resident
| /rf non-resident
| ( )/ citizenshipif differs from the rf citizenship
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| ,
/id document
| /document name
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| /series
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| /number
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| /issued
| / issued by
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| / issued date*
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| ( )/ THE SUBDIVISION CODE (IF ANY)
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/THE ADDRESS
REGISTRATION IN THE RESIDENCE
| /postal CODE
| | , , , / republic,kray,oblast,REGION,DISTRICT
| |
| /COUNTRY
| | / city/toun/village
| |
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/street
| | /
house
| | ./ building
| | ./
sq
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( ) / THE ADDRESS OF THE ACTUAL RESIDENCE (THE STAY PLACE (AT DIFFERENCE FROM THE REGISTRATION ADDRESS) differs from the registered address)
| /postal CODE
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| , , , / republic,kray,oblast,REGION,DISTRICT
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|
| /COUNTRY
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| / city/toun/village
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/street
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house
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| ./ building
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sq
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| () ( /)/telePHONE (+COUNTRY and city codes)
| | ( / )/fax(+ COUNTRY and city codes)
| | E-mail
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| ( ) / I am a foreign public officer or a relative of a foreign public officer
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| /statutory registration detals
| - / REGISTRATION id in the country of REGISTRATION
| | /REGISTRATION DATE
| | | |
| , /series and number of document of statutory registration
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/address of registration agency
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() / IT IS FILLED WITH THE NON-RESIDENT AND (OR) AT DIFFERENCE FROM CITIZENSHIP OF THE RF
| ( )/migration card detals (for foreign nationals and non-citizens
| /series
| | /number
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| /residence period beginning date
| | / residence period expiry date
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| , () /detals of documentto confirm right of foreign nationals and non-citizens to reside/stay in rf
| / document type
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| / /beginning date of the efective period of the right to stay/reside
| | / /expiry date of the efective period of the right to stay/reside
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| ( )/ series(if any)
| | / number
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/TO BE FILLED UP IN THE PRESENCE OF SPECIFIED BELOW tipe & conditions of business
| / tipe & conditions of business
| / Activity directed on gambling arranging
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| , , , , , , /Sales-oriented affairs, including commission sales of objects of fine art, antiques, furniture, extremely luxury articles and other high costed superior goods
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| , , - , , , , / Activity directed on buying up, purchase and sale of precious metals, jewels and other pieces of jewelry and scrap of them as well
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| , / / Real estate-oriented affairs and/or rendering intermediary services in the course of activity type
|
| , ( )/ Tour operator activities and travel agency activities, as long as other kinds of recreational activity (travel industry)
|
| , / Activity directed on intensive cash turnover
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| - / Fulfilment of any business operation by implementation of internet technologies & other systems of remote access
|
| , () () () ( )/ Performance of activity within any country or in the area of concessional tax treatment and (or) demanding no information disclosure during financial operation (off-shore area)
|
| / / I AM/ THE BENEFICIARY IS THE PARTICIPANT OF FEDERAL TARGET PROGRAMS OR NATIONAL PROJECTS
|
| / / I AM/ THE BENEFICIARY IS THE RESIDENT OF THE SPECIAL ECONOMIC ZONE
|
| ( ) / I OPERATE IN INTERESTS (TO BENEFIT) THE FOREIGN PUBLIC OFFICIAL
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| (), , / I AM THE HEAD OR THE FOUNDER OF THE PUBLIC OR RELIGIOUS ORGANIZATION (ASSOCIATION), WELFARE FUND, THE FOREIGN NONCOMMERCIAL NON-GOVERNMENTAL ORGANIZATION
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| (), , / ACTIVITY OF THE PUBLIC AND RELIGIOUS ORGANIZATIONS (ASSOCIATIONS), WELFARE FUNDS, THE FOREIGN NONCOMMERCIAL NON-GOVERNMENTAL ORGANIZATIONS
|
| , / Activity carried out by me does not correspond to tipe & conditions listed above
|
| ?
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, , / , , : / DATA ON THE BASES, TESTIFYING THAT THE CLIENT/COUNTERPART OPERATES TO BENEFIT OF THE THIRD PARTY, OR IS ITS REPRESENTATIVE, ARE SPECIFIED IN:
| / a contract
| / power of attorney
| /application
| / Other document
|
|
| (, )/ DOCUMENT REQUISITES (Number, DATE)
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|
| | | | | | |
, , , . . I CONFIRM THAT THE INFORMATION RESULTED IN THE PRESENT QUESTIONNAIRE, IS FULL AND AUTHENTIC. I UNDERTAKE TO INFORM IMMEDIATELY THE SOCIETY ON ALL CHANGES OF THE GIVEN INFORMATION.
| /SIGNATURE
| , / initials and surname
| / DATE OF FILLING OF THE QUESTIONNAIRE
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