Beneficial Ownership Declaration

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Date

{{date}}

To Whom It May Concern

This Beneficial Ownership Declaration (the 'Declaration') is made by {{company_name}} (the 'Company'), incorporated under the laws of {{country}}, with its registered office at {{registered_office_address}}.

Purpose of Declaration

This Declaration is provided in compliance with applicable anti-money laundering (AML) and counter-terrorist financing (CTF) regulations, and to confirm the ultimate beneficial owners of the Company as of the date hereof. The Company understands and acknowledges that this Declaration will be relied upon by {{requesting_entity_name}} for due diligence, compliance, and regulatory purposes.

Beneficial Owners

We hereby declare that the following individuals are the ultimate beneficial owners of {{company_name}} in accordance with [**Insert relevant national legal reference, e.g., the Companies Act 20__ / AML Act 20__ / FATF Recommendations**]. For the purpose of this Declaration, a 'beneficial owner' is an individual who ultimately owns or controls, directly or indirectly, a certain percentage (e.g., 25% or more) of the company's shares or voting rights, or who otherwise exercises ultimate effective control over the company.

**Beneficial Owner 1:**

**Full Legal Name:** {{owner_1_full_name}}

**Date of Birth:** {{owner_1_dob}}

**Nationality:** {{owner_1_nationality}}

**Residential Address:** {{owner_1_address}}

**Passport/ID Number:** {{owner_1_passport_id_number}}

**Percentage of Ownership/Control:** {{owner_1_percentage_ownership}}

**Nature of Control (e.g., direct shareholding, indirect через another entity, voting rights, significant influence):** {{owner_1_nature_of_control}}

**Beneficial Owner 2 (if applicable):**

**Full Legal Name:** {{owner_2_full_name}}

**Date of Birth:** {{owner_2_dob}}

**Nationality:** {{owner_2_nationality}}

**Residential Address:** {{owner_2_address}}

**Passport/ID Number:** {{owner_2_passport_id_number}}

**Percentage of Ownership/Control:** {{owner_2_percentage_ownership}}

**Nature of Control:** {{owner_2_nature_of_control}}

[**Add more beneficial owners as necessary, using the same format**]

Confirmation and Undertaking

We confirm that the information provided in this Declaration is true, accurate, and complete as of the date of this Declaration. We undertake to inform {{requesting_entity_name}} promptly of any changes to the beneficial ownership information provided herein.

We understand that providing false or misleading information may have legal consequences under applicable laws, including those relating to money laundering and terrorist financing.

Supporting Documentation

Copies of identification documents (e.g., passport, national ID) for each beneficial owner, and any other relevant corporate documents (e.g., share registers, corporate structure charts), are attached hereto as Appendix A.

Governing Law

This Declaration shall be governed by and construed in accordance with the laws of {{country}}.

Signature Block

Signed for and on behalf of {{company_name}}:

_____________________________

**Name:** {{authorized_signatory_name}}

**Title:** {{authorized_signatory_title}}

**Date:** {{signature_date}}