P-K-01-R02

CLIENT DATA UPDATE FORMAT V:1

In effect since: 2021/08/14

CLIENT OR COMPANY DATA

Name or Business Name:

NIT: Main address: Ciudad: Telefono:

Source of capital: Audience: Private: Mixed: CIIU Code:

Description of
social object:
PERSONAL DATA OF NATURAL PERSON AND/OR LEGAL REPRESENTATIVE DATA
Document of
Names and Surnames:
identidad:
City: Telephone: Cell phone:
Email Address
Occupation / Trade / of Contact:
Company Where I Work:
Profession:
FINANCIAL INFORMATION
INCOME EXPENSES OBLIGATIONS BALANCE SHEET
Gross Income: Loans/Mortgages/Rentals: Financial Entities: Assets
$ $ $ $
Other Income: Other Expenses: Financial Entities: Liabilities
$ $ $ $
Description of other products: Other Expenses: Financial Entities: Heritage
$ $ $
Total Ingresos Total Egresos Total Obligations Utilities/Net Income
$ $ $ $
BANK REFERENCES

Entity 1 Office Account number Type

Address City Telephone Date of

opening

Entity 2 Office Account number Type

Date of
Address City Phone
opening
Commercial References

Entity 1 Contact Telephone

Address City Cell phone

Entity 2 Contacto Telephone

Address City Cell phone

IMPLEMENTED MANAGEMENT SYSTEMS

Do you have a certificate of Does it have ISO certification?

SI___ NO___ EN PROCESO___ SI___ NO___ EN PROCESO___ Do you have an ISO 45001:2018 certificate? SI___ NO___ EN PROCESO___
ISO 9001:2015 quality? 14000: 2015?

Do you have a certificate? Otros: SI___ NO___ EN PROCESO___

Does it have a certificate?
SI___ NO___ EN PROCESO___(OEA) Economic Operator SI___ NO___ EN PROCESO___
BASC?
Authorized? Which one?
VOLUNTARY DECLARATION OF SOURCE OF FUNDS AND OTHER DECLARATIONS

A. Acting in my own name, voluntarily, I declare under the penalty of perjury that the resources come from the following sources (details of occupation, trade, profession, business, etc.)
do not come from illicit activities, nor linked to the cultivation, production, or trafficking of narcotics, nor activities
contemplated in the Colombian Penal Code or in any norm that modifies or adds to it, in compliance with the provisions of Circular 304 - 000001 of February 2014 issued by the Superintendency of Companies, the Anti-Corruption Statute.
(Law 190 of 1995) and other concordant legal norms. The company does not allow third parties to make deposits on its behalf with funds from illegal activities or in favor of persons related to them. I authorize to settle
deposits I maintain in this institution, in the case of violation of any of the clauses contained in this document exempting the entity from all liability arising from erroneous, false or inaccurate information that I may have provided.
provided in this document, or in the violation of it. I authorize AGOFER S.A.S to consult and report to the company I represent or acting on my own behalf, to credit bureaus. As a sign of acceptance, I sign in the indicated place in this
formulario.

AUTHORIZATION FOR THE PROCESSING OF PERSONAL DATA

As the data holder and under the parameters of Law 1581 of 2012 and the rules that amend and/or modify it, I authorize AGOFER S.A.S. to collect, store, process, and dispose of the personal data requested here in accordance with its
Política de Tratamiento de Datos, la cual he consultado en la pagina web [Link] a sign of acceptance, I sign in the designated place on this form.
MANIFESTO OF COMPLIANCE WITH MINIMUM SECURITY REQUIREMENTS
We affirm that the organization complies with good security practices throughout the supply chain in accordance with our identified risks, as well as with secure procedures that protect us from illicit activities.
traceable to our suppliers, customers, and other business associates.
SIGNATURE OF LEGAL REPRESENTATIVE

With this signature, I declare that everything stated in this form is true.

__________________________________________________________________________________________
_________________________________
________________________
SIGNATURE AND ID DATE
DOCUMENTS TO ATTACH
NATURAL PERSON LEGAL ENTITY
Updated RUT of the current year Updated RUT and Shareholding Composition
Chamber of Commerce (no more than 30 days) Chamber of Commerce (not more than 30 days)
Citizenship Card (expanded to 150%) Citizen ID of Legal Representative (expanded to 150%)
NOTE 1. The
Commercial References (not older than 30 days) Commercial References (not older than 30 days) documents
Bank Reference (not older than 30 days) Bank Reference (no older than 30 days) attached must be
completely readable
Financial Statements (last 3 years or current year cut) Financial Statements (last year or current year cut-off)
Notes to the Financial Statements (last 3 years or current year cut-off) Notes to the Financial Statements (last year or current year cut-off)
Income Tax Declaration (last 2 years) Tax Declaration (last year)
Certificates related to supply chain security (ISO 28000, BASC, AEO) If you have