Know Your Customer (KYC) & Customer Due Diligence (CDD) QuestionnaireThis form is designed to support Know Your Customer (KYC), due diligence, compliance, risk assessment, and the safe and effective management of maritime operations in accordance with applicable national and international regulations, industry best practices. 1. Client Information Please provide the legal, registration, and contact information of the applicant, including the authorized representative. Ensure all information is accurate and consistent with your official corporate records, as it will be used for identity verification, KYC, and regulatory due diligence. Legal Company NameTrading NameYear of Incorporation / Establishment- Select -20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950Before 1950Country of Incorporation- Select -PanamaBelizeBahamasMarshall IslandsLiberiaUnited StatesUnited KingdomGreeceSingaporeOtherRegistration NumberTax Identification Number (TIN)Registered AddressWebsiteMain Company EmailMain TelephoneAuthorized RepresentativePosition / TitleAuthorized Representative emailAuthorized Representative phone 2. Entity Classification Please select the legal structure, principal business activity, and service category that best describe the applicant. This information enables us to determine the applicable due diligence requirements and regulatory obligations. Main Service- Select -Ship OwnerShip OperatorShip ManagerTechnical ManagerCommercial ManagerCrew ManagerChartererShip BrokerCargo OwnerTrading CompanyShipping AgencyPort AgentFreight ForwarderShipyardMarine Service ProviderMarine Equipment SupplierLSA Service ProviderFFE Service ProviderRadio Service ProviderRadio TechnicianUTM Service ProviderNavigation Equipment Service ProviderMarine Electronics Service ProviderMarine Engine Service ProviderElectrical Service ProviderHydraulic Service ProviderCalibration Service ProviderNDT Service ProviderThickness Measurement CompanySurvey CompanyClassification SocietyFlag AdministrationBunker SupplierP&I ClubInsurance CompanyFinancial InstitutionOtherType of entity- Select -CorporationLimited Liability Company (LLC)Limited Company (Ltd.)Public Limited Company (PLC)PartnershipLimited PartnershipSole ProprietorshipGovernment EntityState-Owned EnterpriseNon-Profit OrganizationFoundationTrustJoint VentureBranch OfficeRepresentative OfficeAssociationCooperativeOtherBusiness Description 3. Ownership & Management Please provide information about the individuals who own, control, or manage the applicant. This information is required to identify the Ultimate Beneficial Owners (UBOs), directors, and persons exercising significant control, in accordance with applicable KYC, AML/CFT, and international regulatory requirements. 3.1 Ultimate Beneficial Owners (UBOs) Please provide the details of every individual who directly or indirectly owns or controls 25% or more of the entity, or otherwise exercises effective control over its management or ownership. Click "Add Beneficial Owner" to include additional individuals. Repeater Container Full Name Nationality- Select -PanamaBelizeBahamasUnited StatesUnited KingdomGreeceSingaporeOther Passport / National ID Ownership (%) 3.2 Directors & Senior Management Please provide the details of all directors, senior officers, or individuals responsible for the management of the applicant. Click "Add Director" to include additional individuals. Repeater Container Full Name Nationality- Select -PanamaBelizeBahamasUnited StatesUnited KingdomGreeceSingaporeOther Passport / National ID Position Ownership Structure 4. Compliance Screening Please answer the following compliance questions accurately. This information is required for Know Your Customer (KYC), AML/CFT, sanctions screening, and regulatory due diligence. If you answer "Yes" to any question, please provide details in the explanation field below. 4.1 Is any director, officer, shareholder, UBO, immediate family member, or close associate a Politically Exposed Person (PEP)? Yes No4.2 Is the company, any related party, director, shareholder, or UBO currently subject to sanctions, embargoes, or restrictive measures? Yes No4.3 Has the company, any related party, director, shareholder, or UBO ever been investigated, convicted, blacklisted, or involved in sanctions violations, corruption, money laundering, terrorism financing, fraud, or other financial crimes? Yes No4.4 Does the company conduct business with or operate in countries subject to sanctions, embargoes, or enhanced due diligence requirements? Yes No4.5 If you answered "Yes" to any of the above questions, please provide complete details, including dates, jurisdictions, authorities involved, and the current status of the matter. 5. Supporting Documents Please upload clear and valid copies of the required supporting documents. These documents will be used to verify the legal existence of the entity, confirm ownership and identity, and comply with KYC, AML/CFT, sanctions screening, and due diligence requirements. Accepted format: PDF only • Maximum file size: 5 MB per document. All documents will be treated as strictly confidential and processed in accordance with applicable data protection laws. 5.1 Company ProfileChoose File 5.2 Certificate of IncorporationChoose File 5.3 Company Registry / Good StandingChoose File 5.4 Passport / ID of Beneficial OwnersChoose File Additional Information 6. Declaration & Consent Please carefully review the declaration below before submitting this form. By submitting this KYC, you confirm that you are authorized to act on behalf of the applicant and that all information and supporting documents provided are true, complete, and accurate. You also consent to the processing of this information for KYC, Customer Due Diligence (CDD), AML/CFT, sanctions screening, risk assessment, and other legitimate compliance and business purposes. Authorized Representative Full NamePosition / Title Final Review & Submission Before submitting this form, please ensure that all information provided is complete, accurate, and supported by the required documentation. Once submitted, your application will be reviewed by the Kallberg Group Compliance Department as part of our Know Your Customer (KYC) and Customer Due Diligence (CDD) procedures. After successful submission, you will receive a confirmation email containing your KYC reference number for future correspondence. Submit