Entity Name:[Insert name of the DIFC registered entity]

License Number [insert license number]

Register of Ultimate Beneficial Owners

Full name of UBO that is a natural person

Residential Address*

Postal Address (if different to Residential Address)

Passport number

Nationality

Date of birth

Place of birth

Passport country

of issue

Passport issuance

date

Passport

expiry date

Date of commencement

as a UBO

Date of cessation

as a UBO

[insert details]

[insert details]

[insert details]

[insert details]

[insert details]

*Address Definition: This should include at minimum country, city, postal code or PO BOX, street no, building name, etc.

Full name of the Exempt Entity

Type of exempt entity

Name of:

Recognised Stock Exchange / Financial Services Regulator / Government / Law

Jurisdiction*

Registered Address**

Postal Address (if different to Residential Address)

[insert details]

[insert details]

[insert details]

[insert details]

Definition of Beneficial Owner that is an Exempt Entity under Regulation 2.2 of the Ultimate Beneficial Ownership Regulations:

A beneficial owner that:

• has its securities listed or traded on a recognised stock exchange;

• is regulated by a recognised financial services regulator;