PCMLTFA Compliance

Enhanced Due Diligence Form (EDD)

Individual Client Verification • Bullion Mart Limited

Unit: #105, 1060 Sheppard Ave W

Location: Toronto, ON, M3J 0G7

Date:

General Information

Full Legal Name *

Date of Birth (YYYY-MM-DD) *

Nationality *

Is there any Name mismatch in your provided Government Issued ID & other documents? *

Yes No

Purpose of Transaction *

Investment Re-sale Trading Others

Sources of Income & Wealth

Please specify your sources of funds (Further supporting documentation may be requested by compliance).

Salary / Employment Income Business / Self-Employment Profit Real Estate Sale Proceeds Investment / Retirement Funds Inheritance or Gift Loan / Credit Facility Others

Name of Employer / Business

Years in Employment / Business *

Estimated Value of Business (CAD $) *

Beneficial Owners Information

Are you the beneficial owner for the intended transactions? *

Yes No

Politically Exposed Persons (PEP) / Head of International Organization (HIO)

Are you a Politically Exposed Person (PEP) or Head of International Organization (HIO) or a family member or close associate of such a person at present or within the last 5 years? *

Yes No

Acknowledgement & Legal Authorization

The information provided in this form is true, accurate and complete to the best of my knowledge. I understand that this information is being collected in accordance with the Proceeds of Crime (Money Laundering) and Terrorist Financing Act (PCMLTFA) and regulations enforced by FINTRAC (Financial Transactions and Reports Analysis Centre of Canada). I agree to provide additional information or documentation if requested to verify the sources of funds, beneficial ownership (if applicable), or any aspect of this transaction. I am aware that false or misleading information may lead to refusal of service or termination of the business relationship.

Applicant Signature

Full Legal Name *

Date

Digital Signature (Draw below) *

Draw using mouse, touchpad, or finger on mobile touchscreens.

Data encrypted & compliant with Canadian FINTRAC standards.

Enhanced Due Diligence (EDD) Form

Enhanced Due Diligence Form (EDD)

General Information

Sources of Income & Wealth

Beneficial Owners Information

Politically Exposed Persons (PEP) / Head of International Organization (HIO)

PEP / HIO Position Information

Acknowledgement & Legal Authorization

Applicant Signature

Notification