C-Gold Technologies LLC

Institutional Customer Onboarding & AML/KYC Questionnaire

Confidential — for institutional and corporate customers, partners, distributors and financial institutions. Completion does not guarantee approval; C-Gold may request additional information or enhanced due diligence before establishing or continuing a relationship.

1.Institution / Company Details

Legal name*

DBA / trade name(s)

Entity type

Country of incorporation / formation*

Date of incorporation / formation

Registration / company number

Tax identification / registration number

Registered address

Principal business address

Website(s)

Telephone

General institutional email*

Primary C-Gold relationship contact / title*

External financial auditor

Number of employees

Number of subsidiaries / affiliates

Corporate / group organizational chart

Describe subsidiaries, affiliates and parent entities. Documents may be requested separately.

If publicly listed: exchange(s), ticker(s), listing jurisdiction(s)

C-Gold Technologies LLC — Confidential Institutional Onboarding & AML/KYC Questionnaire