BASIC CUSTOMER INFORMATION
LEGAL PERSON
LEGAL PERSON OR NATURAL PERSON
POLITICALLY AND/OR PUBLICLY EXPOSED PERSON (Mark an X where appropriate) It is the public servant who, in the positions he holds, has the following responsibilities: the general direction, the formulation of institutional policies and the adoption of plans, programs and projects, the management direct property, money or securities of the state (External Circular No. 100-000020 of July 2, 2026)
NATIONAL OR FOREIGN PUBLIC SERVANT Is any person who holds a legislative, administrative or judicial office in a State, its political subdivisions or local authorities, or a foreign jurisdiction, regardless of whether the individual has been appointed or elected, ( Law 1778 Congress of Colombia, 2016, p.02.)
RELATIONSHIP WITH STATE OR PUBLIC ENTITIES
If yes, please explain.
RELATED THIRD PARTIES
FINAL BENEFICIARY, PARTNERS OR SHAREHOLDERS INFORMATION
If the partner or shareholder is a legal entity, please attach a letter listing the final beneficiaries.Beneficial Owner: Natural person who ultimately own or control and/or the natural person on whose behalf a transaction is made. If the space provided is not enough, attach the shareholding composition of the company signed by the legal representative and/or statutory auditor
Type of Document
NIT
Pasaporte
ID de otro país
RUC
VAT /TAX ID
ID NUMBER
Full Name
Equity interest %
Type of Document
NIT
Pasaporte
ID de otro país
RUC
VAT /TAX ID
ID NUMBER
Full Name
Equity interest %
Type of Document
NIT
Pasaporte
ID de otro país
RUC
VAT /TAX ID
ID NUMBER
Full Name
Equity interest %
Type of Document
NIT
Pasaporte
ID de otro país
RUC
VAT /TAX ID
ID NUMBER
Full Name
Equity interest %
FINANCIAL INFORMATION OF THE COMPANY
(as of December 31 of the two most recent accounting periods. Integers only, no decimals)
Cash
Accounts Receivable
Other current Assets
Total Current Assets
Fixed Assets
Other Assets No current
Total No Current Assets
Total Assets
Notes and loan payable
Account payable
Other Liabilities
Total Liabilities
Total Equity
Total Net Sales (year)
Total expense (year)
Total cost (year)
Cash
Accounts Receivable
Other current Assets
Total Current Assets
Fixed Assets
Other Assets No current
Total No Current Assets
Total Assets
Notes and loan payable
Account payable
Other Liabilities
Total Liabilities
Total Equity
Total Net Sales (year)
Total expense (year)
Total cost (year)
DESCRIPTION OF THE ECONOMIC ACTIVITY (*)
INFORMATION ABOUT VIRTUAL ASSETS
(Virtual Asset: is the digital representation of value that can be traded or digitally transferred and can be used for payments or investments). External Circular No. 100-000020 of July 2, 2026.
BUSINESS REFERENCES
Name or Company Name
Contact
Phone
Name or Company Name
Contact
Phone
Name or Company Name
Contact
Phone
INFORMATION OF WHO MAKES THE PAYMENTS
Position
Name
Phone
City
E-mail
Cargo Pagos 2
Nombre Pagos 2
Teléfono Pagos 2
Ciudad Pagos 2
Email Pagos 2
Cargo Pagos 3
Nombre Pagos 3
Teléfono Pagos 3
Ciudad Pagos 3
Email Pagos 3
PERSONAL INFORMATION
The undersigned and main executives of this entity declare that the data and information provided in this document, and its updates, correspond to the truth. We authorize NOMBRE_ENTIDAD (hereinafter THE COMPANY) to use, store, classify, guard, delete, transmit and in general process the data contained in this document, for lawful purposes described in the corporate purpose of THE COMPANY, including for statistical purposes and commercial information. THE COMPANY is expressly authorized to report or inform any entity that lawfully manages a database, the management, compliance, non-compliance and extinction of commercial obligations under our responsibility. By signing this document, I authorize NOMBRE_ENTIDAD to collect, store, use and process my personal data as provided in the constitution, Law 1581 of 2012 and the company's personal data protection policy, during the commercial relationship and after its termination, in order to carry out promotional, advertising, marketing, sales, customer service, collection management, collection, fiscal and statistical activities, as well as any other activity related to the sale of products. I declare that I know the data protection policy of NOMBRE_ENTIDAD and the procedure to exercise my rights as the owner of the data. The information obtained for the Processing of my personal data has been provided voluntarily and is true.
This authorization includes, in addition to requesting information about our commercial history, corroborating a history of public conduct and which includes verifying disciplinary, names and identification documents in the databases managed by the administrative and judicial authorities of national, departmental, municipal and /or any other source that the company considers important to consult.
We consider nothing said herein harmful to our fundamental interests, nor in violation of our rights to privacy, honor, family peace, good name and other constitutional rights.
CODE OF CONDUCT
NOMBRE_ENTIDAD operates in accordance with its Code of Conduct, which is published on page NOMBRE_ENTIDAD
NOMBRE_ENTIDAD requires its clients, who are essential for its development, to adopt the same conduct regarding issues such as human rights, health and safety at work, environmental protection and the fight against corruption.
COMPLIANCE AGREEMENT WITH THE TRANSPARENCY AND BUSINESS ETHICS PROGRAM
On behalf of the legal entity I represent, or as an individual service provider, I declare my commitment to adopting the necessary measures to prevent conduct related to corruption and bribery, including the following:
No bribes, nor any other type of improper incentive or arrangement involving public officials, clients, suppliers, or any other counterparty, shall be offered, given, or promised. This prohibition includes "facilitation payments"—that is, illicit and/or covert payments intended to secure or expedite an administrative procedure, even if the objective is legitimate.
Under no circumstances should gifts, hospitality, or invitations be offered that influence—or give the impression of influencing—business decisions. Gifts, hospitality, and invitations must not exceed what is customary in normal business relationships. Any form of gift, hospitality, and/or invitation that could damage the reputation of NOMBRE_ENTIDAD must be avoided. It formally commits to issuing instructions to all its employees and third parties involved in the performance of this contract, as well as to any other representatives, requiring them to comply at all times with the laws of the Republic of Colombia—particularly those governing the performance of this contract—and shall impose upon them the obligations described above. The company commits to complying with applicable regulations regarding Money Laundering, Terrorist Financing, the Financing of the Proliferation of Weapons of Mass Destruction, Local Corruption, and Transnational Bribery (LA/FT/FP and C/ST), as well as the policies and procedures established by NOMBRE_ENTIDAD within its LA/FT/FP and C/ST Risk Management and Self-Control System. The company shall refrain from using payments, remuneration, commissions, or other benefits for intermediaries or third parties as a mechanism to make hidden or indirect payments, bribes, or gratuities to domestic or foreign public officials. The company shall promptly notify NOMBRE_ENTIDAD of any situation that may constitute a breach of this commitment or a risk related to ML/TF/PF and C/ST, and shall cooperate with any applicable due diligence and verification processes. NOMBRE_ENTIDAD may evaluate the continuation, suspension, or termination of the business relationship—in accordance with applicable law, contractual terms, and its compliance policies—upon the identification of situations representing an unacceptable risk of ML/TF/PF and/or C/ST, false or inconsistent information, or a failure to meet the commitments established herein. If the Company, its legal representatives, or its ultimate beneficial owners were to be convicted as a result of a criminal or administrative investigation related to illicit activities associated with money laundering, the financing of terrorism, the financing of the proliferation of weapons of mass destruction, corruption, and transnational bribery, or were to be included in international lists binding upon Colombia pursuant to international law (United Nations—UN lists) or on the OFAC list.
DECLARATION OF CONFLICT OF INTEREST At NOMBRE_ENTIDAD, we promote transparency and integrity in all our business relationships. Therefore, we require our counterparties to proactively disclose any situation that could represent a conflict of interest and potentially affect the transparency of our business dealings.
We appreciate your cooperation in answering the following questions:
DECLARATION OF SOURCE OF FUNDS (*)
The resources I manage and my own resources come from the following sources:
I declare that these resources do not come from any illegal activity of those contemplated in the Colombian Penal Code or in any norm that modifies or adds it.
I will not allow third parties to make deposits in my name, with funds from illegal activities contemplated in the Colombian Penal Code or in any norm that modifies or adds it, nor will I carry out transactions destined to such activities or in favor of people related to them.
The information provided here corresponds to reality and I authorize its verification before any public or private person without any limitation, from now on and while any relationship with NOMBRE_ENTIDAD subsists. or with whom you represent your rights. I undertake to promptly report any relevant changes regarding the source of funds, economic activity, ownership or control structure, ultimate beneficial owners, banking information, jurisdictions of operation, or any other circumstance that could alter the company's risk profile.
I authorize NOMBRE_ENTIDAD. to cancel the contract and/or commercial relationship that he maintains with me and/or the company that I represent in the event of verifying any infringement of the legal norms tending to control money laundering in accordance with current Colombian legislation and I exempt NOMBRE_ENTIDAD. of all responsibility that derives from erroneous, false or inaccurate information that has been provided in this document, or from the violation thereof.
I promise to submit to the conditions of sale established by NOMBRE_ENTIDAD and I authorize the entity NOMBRE_ENTIDAD or whoever represents its rights or holds the capacity of creditor in the future to report, process, request and disclose to the information center TransUnion and/or Datacrédito, which manages the banking association and financial entities of Colombia, or any other entity that manages or administers a database for the same purposes, all the information regarding my commercial behavior. The foregoing implies that the compliance or breach of my obligations will be reflected in the aforementioned database, where all the data referring to my current and past behavior towards the financial sector and in general, regarding the breach of my obligations.
DOCUMENTATION