FINANCIAL INSTRUMENTS


Leased sblc Instrument for Monetisation

This form should be issued with a completed Client Information Profile (CIP).

This information will remain confidential at all times.

YOUR NAME:

COMPANY NAME:

DATE:

PLEASE TELL US ABOUT THE FINANCIAL INSTRUMENT

TITLE OF INSTRUMENT:

(e.g Guarantee, Gold Bond, Pay order, etc)

CATEGORY OF INSTRUMENT:
• Demand Guarantee (i.e Bank Guarantee URDG)
• Standby Letter of Credit (SBLC)
• Bill of Exchange
• MTN or EMTN
• Bond
• Bank Pay Order
• Other
Please specify
JURISDICTION / PLACE OF ISSUE:(e.g. Country / City)

DATE OF ISSUE:

DATE OF MATURITY OR EXPIRY

JURISDICTION OR PLACE OF PRESENTATION FOR PAYMENT:
NAME OF ISSUER:

ADDRESS OR BRANCH OF ISSUE:
(Include full address or branch code)

CUSIP: (if applicable)

ISIN: (if applicable)

FACE VALUE AT ISSUE:
(please state currency)

VALUE AT MATURITY:
(if applicable)

COUPONS ATTACHED?
• YES • NO
COUPON RATE or VALUE: (%’age)

HAVE COUPONS BEEN CLAIMED or PAID?
• YES • NO
IF YES, DATE OF LAST COUPON PAYMENT:

HAVE YOU HAD THE INSTRUMENT VERIFIED AND PROFESSIONAL AUTHENTICATED?
• YES • NO
IF YES, WHAT IS THE

AUTHENTICATED CURRENT VALUE:
(B) ABOUT PROVENANCE OF THE INSTRUMENT
ARE YOU CURRENTLY IN PHYSICAL POSSESSION OF THE INSTRUMENT?
• YES • NO
If YES, how long has the instrument been in your possession?

If NO, who is in possession of the Instrument?

Where is the instrument currently held?

PLEASE STATE:
• I am the TRUE BENEFICIAL OWNER
• I am the Issuer of the Instrument
• I represent the beneficial owner under POA
• I represent the Issuer of the Instrument

HOW DID YOU RECEIVE THE INSTRUMENT?
• I purchased the Instrument
• It was issued to me by the Issuer
• I inherited the Instrument in a gift or will
• Other – please give details
PLEASE GIVE US FURTHER DETAILS

HOW YOU COME TO RECEIVE THE INSTRUMENT:

If purchased, what price did you pay?

Date of purchase:
DO YOU HAVE FULL PROVENANCE or HISTORY OF THE INSTRUMENT?
• YES • NO

In stating the above information, you declare that your
ownership (if applicable), the provenance and the authenticity of
the Instrument is legal and that the Instrument has been legally obtained.

WHAT DO YOU INTEND TO DO WITH THE INSTRUMENT?
• RAISE CREDIT AGAINST IT
Desired Credit Amount:
• SELL THE INSTRUMENT Target Sale Price:
• INVEST IT INTO AN INVESTMENT PLATFORM
Kindly advise us what you wish to do with the Instrument and why you are making this application.
• OTHER (please give details)

Please ensure that you complete the Declaration overleaf.

Signed:

Signed:

Dated:

I understand that the information provided herein and other information that may be attached to this documentation will be examined in accordance with the due diligence procedures defined under Swiss/ British Law. Please accept this form
and any attachments as authorisation for Funding Circle International / its partner firm to undertake any necessary due diligence investigations, including the search of financial, credit history or criminal databases in respect of myself, my company and any other associated parties.

In making this application and providing the information contained herein, I hereby declare that the Instrument being submitted herewith is true, legal and correct and is fully verifiable under normal protocols. I accept that FCI and its associated parties take no responsibility in the handling of false or fraudulent documents that I pass to them for verification and
authentication. In making this application, I note that I am applying for credit facilities or to sale and market the aforementioned Instrument and therefore attest the authenticity of the Instrument.

I hereby swear, under penalty of perjury, that the information provided herein and in any other attached documentation is both true and accurate and I further confirm that any funds to be engaged in this transaction contemplated are
derived from non-criminal origin; and, are good, clean and cleared. The origin of all funds are in compliance with Anti-Money Laundering Policies set forth by the Financial Action Task Force (FATF) 6/01.