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KYC REGISTRATION

Section 1

* indicates a required field

Language
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Vivo Energy Country / Company *
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Which Vivo Energy country are you registering to do business with?
Type of Entity *
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Type of Counterparty *
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Entity Name *

Retail Site Name

Physical Address *

Country *
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Company Registration Number *

Regulated Industry Details

Trustee(s) *
Entity Type
First Name(s)
Last Name/Reg. Number
Nationality / Country of Incorpo.
Date of Birth
 
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Beneficiary(ies) *
Entity Type
First Name(s)
Last Name/Reg. Number
Nationality / Country of Incorpo.
Date of Birth
 
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Ultimate Beneficial Owners *

An Ultimate Beneficial Owner is a natural person or persons who ultimately owns
or controls an interest in a legal entity or arrangement, such as a company, a
trust, a foundation, or a vessel.

Are there any other UBO’s for this entity that were not already listed above?

No
Politically Exposed People *

A Politically Exposed Person (PEP) is an individual that holds a prominent
public position or function. Due to their role, they may be more susceptible to
bribery or corruption.

Are there any PEP's linked to the counterparty that may assert illegal or undue
influence on behalf of Vivo Energy or its companies?

No
Sanctioned Entities *

A Politically Exposed Person (PEP) is an individual that holds a prominent
public position or function. Due to their role, they may be more susceptible to
bribery or corruption.

Are there any PEP's linked to the counterparty that may assert illegal or undue
influence on behalf of Vivo Energy or its companies?

No

I confirm that explicit consent have been obtained from all individuals
mentioned in this checklist authorising me to disclose their personal details to
Vivo Energy for the purpose of conducting KYC checks in line with the Vivo
Energy Know Your Counterparty Policy.

Vivo Energy (VE, “we”, “us”, or “our”, if not explicitly referring to the
company) seeks to be clear and transparent in the work that we do and in our
business dealings; as a company that transacts business internationally, we may
share your personal information within VE and other members of its Group. Our
use and holding of personal data is governed by the VE Privacy Policy, which is
publicly available through our external company website: www.vivoenergy.com.

By submitting this form you, on behalf of yourself and others whose names appear
on it, acknowledge that it will be used by us for the purpose of running checks
to verify compliance with the VE General Business Principles and the Vivo Energy
Third-Party Code of Conduct which can be located on the external company website
(www.vivoenergy.com) and to perform the necessary administration to fulfil
contractual obligations.

Section 2 – Vivo Energy Compliance Statement
Your Details
Full Name *

Position *

Email *

Signatory Details

Will someone other than you be the signatory representing this counterparty?

No

I, , acting on behalf of the Counterparty () confirm that in doing business with
members of the Vivo Energy group of companies (the Vivo Energy Group), we, the
Counterparty, acknowledge and, where applicable, will adhere to, the following:

 1. The Vivo Energy Group insists on honesty, integrity and fairness in all
    aspects of its business and expects the same in its relationships with all
    those with whom it does business.
 2. We will abide by the principles contained in the Vivo Energy General
    Business Principles and Vivo Energy Third-Party Code of Conduct as published
    on the Vivo Energy Group’s website (www.vivoenergy.com) in all of our
    dealings with, for or on behalf of members of the Vivo Energy Group.

With regard to Anti-Bribery and Corruption:

 1. The direct or indirect offer, payment, soliciting or acceptance of bribes in
    any form is illegal and unacceptable. Facilitation payments are also bribes
    and must not be made.
 2. We have effective policies and procedures in place to proactively prevent
    and detect any form of bribery and corruption. This includes policies and
    procedures that prevent actual or perceived conflict of interest between
    personal and business interest including using Vivo Energy’s information and
    resources for improper gain as well as money laundering or the act of hiding
    illegal funds especially in relation to those with possible links to
    criminal or terrorist activity.

With regard to modern slavery and human trafficking:

 1. The trafficking and exploitation of workers is prohibited by law and
    unacceptable to the Vivo Energy Group.
 2. We confirm that we have complied with all applicable laws, statutes and
    regulations related to modern slavery.
 3. We will take reasonable steps to ensure that this prohibition is
    communicated to our management team and to all relevant staff within our
    organisation as well as to our subcontractors rendering services on behalf
    of Vivo Energy and its companies.

If you witness or become aware of any violation of the Vivo Energy General
Business Principles, Vivo Energy Counterpart Code of Conduct as published on the
Vivo Energy Group’s website (www.vivoenergy.com) or any other unethical or
illegal/criminal act, you must promptly report the matter to our whistleblowing
helpline. The helpline can also be found on our website at
www.vivoenergy.com/About/Our-Principles-Policies.

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