Counter Party Registration Form

OZ Seventy Five Holdings (M) Berhad - KYC Documentation

1. COMPANY PARTICULARS

Company Name *

Overseas Office Details

Date of Incorporation *

Place of Incorporation *

Company Registration Number *

GST Number VAT Number TIN Number

Registered Address *

Correspondence Address

Telephone Number *

Fax Number

Paid-up Capital *

Email Address *

Listed Company Status

Holding and Subsidiary Companies

2. SHAREHOLDER(S) INFORMATION

Name *

Date of Birth *

Nationality *

% of Share Holding *

Source of Funds *

3. DIRECTORS & MANAGEMENT INFORMATION

Name *

Nationality *

Position *

Year(s) in Oil & Gas

Politically Exposed Person (PEP)?

4. NAME OF TRADERS

Name

Commodities

Contact Number

Email Address

5. BANKING INFORMATION

Bank Name *

Bank Address *

Bank Account Number *

Currency Code *

SWIFT Code *

IBAN Number

Correspondent Bank

Correspondent Bank SWIFT Code

Trade Facilities Provided?

6. COMPLIANCE & SANCTIONS

Is your company, shareholders or directors currently under any investigation, sanctions or blacklists?

CONFIRMATION: Our company complies with local & international AML/CFT regulations, including BNM, AMLA 2001 and FATF *

7. BUSINESS ACTIVITIES

OIL & GAS BUSINESS

Crude Oil - Manufacturer

Crude Oil - Trader

Fuel Oil - Manufacturer

Fuel Oil - Trader

Gasoil - Manufacturer

Gasoil - Trader

Gasoline - Manufacturer

Gasoline - Trader

JetA1 - Manufacturer

JetA1 - Trader

Naphtha - Manufacturer

Naphtha - Trader

LPG/LNG - Manufacturer

LPG/LNG - Trader

Bitumen - Manufacturer

Bitumen - Trader

Petrochemical - Manufacturer

Petrochemical - Trader

MINING BUSINESS

Sand Mining - Manufacturer

Sand Mining - Trader

Other Mining - Manufacturer

Other Mining - Trader

DECLARATION

Authorized Signatory Name *

Designation/Position *

Date *

We hereby declare the above information is true and complete. We authorize OZ Seventy Five Holdings (M) Berhad to conduct verification, sanctions & PEP screening, and keep this data for ongoing compliance monitoring.

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