Annex 2

LEGAL ENTITY QUESTIONNAIRE

LEGAL ENTITY IDENTIFICATION DETAILS

Company name Sparkline Marketing
Entity type (private company, LLP etc.) Single member llc
Company number 922803752
Date of incorporation/establishment 03/9/2023
Registered office address (country, city, 24464 Park Granada, Calabasas, CA, 91302, USA
building No., room No.)
Business address (country, city, building No., same
room No.)
Phone number +19365367606
E-mail [email protected]
Website Click or tap here to enter text.

TAX INFORMATION (specify the countries where you pay taxes and codes)
Country Tax Identification Number VAT code (if you pay VAT)
USA 922803752 Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.

Signature ______________________________
LEGAL REPRESENTATIVE 1 DETAILS
Name, surname Steve Hannah
Personal code Click or tap here to enter text.
Date of birth 15/06/1990
Citizenship usa
PERSONAL IDENTITY DOCUMENT
Country of issue usa
Type (passport, person identity card, temporary or passport
permanent residence permit)
Document No. A35268797
Date of issue 09/02/2024
Date of expiry 08/02/2034
CONTACT DETAILS
Phone number +19365367606
E-mail [email protected]
Correspondence address (country, town, 24464 Park Granada, Calabasas, CA, 91302, USA
building No., room No.)
BASIS OF APPOINTMENT
The representative is acting on the Appointment (specify role): Single member, controller, ubo
basis of PRoxy
Power of Attorney, date of issue: 01/03/2024

Other (specify): Click or tap here to enter text.

Please explain the purpose of the Account (please provide a detailed answer – legal entities registered outside the
Republic of Lithuania should ensure that they include any details that explain why it is necessary for them to open an
account with a Payment Service Provider outside their home country):
We provide consultancy and advisory on business and management worldwide . We need a day to day operational account,
where we can accept customers payments for our services, mainly c2b, worldwide, and payout affiliates, contractors,
expenses b2b b2c . We chose Lithuania , based or referral from others, considering the developed banking industry, wide
range of services , and flexibility, which matches our needs as we transact Worldwide .

1
A Legal Representative is a private individual duly authorised to provide instructions to Contomobile on behalf of a Legal entity. Legal entities must
identify at least one Legal Representative. The Legal Representative identified in this Annex shall be the primary Legal Representative of Legal entity.
The primary Legal Representative may authorise the appointment or removal of other Legal Representatives duly appointed by the Legal entity by
submitting the Legal Representative Nomination/Termination Forms.
The Legal Representative identified above confirms that he/she is duly authorised to provide instructions to Contomobile on behalf of the Legal entity, to
enter into Payment Transactions on its behalf, to operate the Account and has the legal authority to bind the Legal entity. The Legal entity
acknowledges that Contomobile shall be entitled to accept, rely upon and act in accordance with any instruction which may from time to time be, or
purport to be, given by any private individual who has been identified to us as a Legal Representative. We may, at any time, require submitting such
documents or information as we, in our sole discretion, consider necessary to evidence the Legal Representative’s authority.

Signature______________________________
INFORMATION ON THE LEGAL ENTITY BUSINESS ACTIVITIES
Main business activities of the Legal entity Consultancy and advisory on business and management worldwide
Does the business require a regulatory licence to No Yes
operate?
If Yes, please provide details of all licences / Licence issuing country: Click or tap here to enter text.
registrations Licence issue date: Click or tap here to enter text.
Licence expiry date: Click or tap here to enter text.
Licence number: Click or tap here to enter text.
FATCA GIIN (if applicable): Click or tap here to enter text.
Do you conduct any of the following activities (please check all that apply):
☐ Trade in arms and ammunition
☐ Trade in virtual currencies/activities related to virtual currencies
☐ Organising of gambling and lotteries
☐ File sharing service
☐ Adult entertainment, pornography, dating/escort services
☐ Trust services
☐ Donations, charity
☐ Multi-level marketing, financial pyramid schemes, investment programmes with high rewards
☐ Ferrous, non-ferrous and precious metals, precious stones, jewellery, works of art
☐ Organising and conducting of auctions
☐ Trade in petroleum products
☐ Financial services and currency exchange/financial intermediation
☐ Provision of legal services, practice of law, notarial activities
☐ Auditors, auditing of financial statements
☐ Bailiffs, bailiffs’ representatives
☐ Pharmaceutical activities
☐ Trade in vehicles
☐ Real estate trade
☐ Personal health care
☐ Tourism or tour operator activities
☐ Wholesale trade services of alcoholic beverages and alcoholic products, tobacco products
☐ Company establishing and administration services
Please identify the countries where you do / Australia, Canada, USA, Italy, UK, UAE
plan to do business
Please identify the total number of employees 2

Is the business part of a group of companies? No Yes

If yes, how many companies are in the group? Click or tap here to enter text.

Please identify the name of the ultimate parent Click or tap here to enter text.
company and the country of incorporation of
the ultimate parent company
Please identify the nature of the industry of the Click or tap here to enter text.
ultimate parent company

Signature______________________________
INFORMATION ON MAIN BUSINESS PARTNERS
Please identify the main customers/ business partners that you will receive income / payments from:
Partner 1:
Partner’s name Individuals sending us payments for our services worldwide
Partner’s code Click or tap here to enter text.
Nature of relationship Click or tap here to enter text.
Purpose of payment Click or tap here to enter text.
Partner’s country of incorporation Click or tap here to enter text.
Partner’s country of operation Click or tap here to enter text.
Partner 2:
Partner’s name Contractors and affiliates are the outgoing payments for b2b b2c worldwide
Partner’s code Click or tap here to enter text.
Nature of relationship Click or tap here to enter text.
Purpose of payment Click or tap here to enter text.
Partner’s country of incorporation Click or tap here to enter text.
Partner’s country of operation Click or tap here to enter text.
Partner 3:
Partner’s name Click or tap here to enter text.
Partner’s code Click or tap here to enter text.
Nature of relationship Click or tap here to enter text.
Purpose of payment Click or tap here to enter text.
Partner’s country of incorporation Click or tap here to enter text.
Partner’s country of operation Click or tap here to enter text.
Please identify the main vendors / business partners that you will make payments to:
Partner 1:
Partner’s name Click or tap here to enter text.
Partner’s code Click or tap here to enter text.
Nature of relationship Click or tap here to enter text.
Purpose of payment Click or tap here to enter text.
Partner’s country of incorporation Click or tap here to enter text.
Partner’s country of operation Click or tap here to enter text.
Partner 2:
Partner’s name Click or tap here to enter text.
Partner’s code Click or tap here to enter text.
Nature of relationship Click or tap here to enter text.
Purpose of payment Click or tap here to enter text.
Partner’s country of incorporation Click or tap here to enter text.
Partner’s country of operation Click or tap here to enter text.
Partner 3:
Partner’s name Click or tap here to enter text.
Partner’s code Click or tap here to enter text.
Nature of relationship Click or tap here to enter text.
Purpose of payment Click or tap here to enter text.
Partner’s country of incorporation Click or tap here to enter text.
Partner’s country of operation Click or tap here to enter text.

Signature______________________________
INFORMATION ON ANTICIPATED ACCOUNT VOLUMES
Anticipated monthly account turnover ☐ up to EUR 15000
☐ EUR 15000 – EUR 50000
☒ EUR 50000 – EUR 100000
☐ over EUR 100000
PLANNING TO USE THE SERVICES
☒ SEPA payments ☒ International payments ☒ International payments ☐ Conto Quickpay 2 via PIS
(outgoing) (incoming)
☐ Conto Quickpay via ☐ Other (specify)
Payment Cards 3

OWNERSHIP INFORMATION
Shareholders: Single member llc has no shareholder/director/ubo as only one person can be in it whom
obviously the one covering all, it is basically being self employed with limited liabilty
Shareholder 1
Name, surname/Company name Click or tap here to enter text.
Total shares (number and %) Click or tap here to enter text.
Personal code or Date of Click or tap here to enter text.
birth/Company code
Residence address Click or tap here to enter text.
Shareholder 2
Name, surname/Company name Click or tap here to enter text.
Total shares (number and %) Click or tap here to enter text.
Personal code or Date of Click or tap here to enter text.
birth/Company code
Residence address Click or tap here to enter text.

Shareholder 3
Name, surname/Company name Click or tap here to enter text.
Total shares (number and %) Click or tap here to enter text.
Personal code or Date of Click or tap here to enter text.
birth/Company code
Residence address Click or tap here to enter text.

Shareholder 4
Name, surname/Company name Click or tap here to enter text.
Total shares (number and %) Click or tap here to enter text.
Personal code or Date of Click or tap here to enter text.
birth/Company code
Residence address Click or tap here to enter text.

2
Conto QuickPay is a e-payment collection service enabling e-shops to receive e-payments online and allowing customers having an account with a
bank or other financial institution to pay for goods or services via payment initiation service (PIS) or payment card.
3
E-payments settled by payment cards can be collected only to an account within Contomobile. Marking up for this service, the Online merchant
questionnaire form must be filled out.

Signature______________________________
Beneficial owners 4:
Beneficial owner 1
Name, surname Click or tap here to enter text.
Type of control direct via proxy
Date of birth/Personal code Click or tap here to enter text.
Citizenship Click or tap here to enter text.
Residence address Click or tap here to enter text.

Beneficial owner 2
Name, surname Click or tap here to enter text.
Type of control direct via proxy
Date of birth/Personal code Click or tap here to enter text.
Citizenship Click or tap here to enter text.
Residence address Click or tap here to enter text.

Beneficial owner 3
Name, surname Click or tap here to enter text.
Type of control direct via proxy
Date of birth/Personal code Click or tap here to enter text.
Citizenship Click or tap here to enter text.
Residence address Click or tap here to enter text.

Beneficial owner 4
Name, surname Click or tap here to enter text.

Type of control direct via proxy

Date of birth/Personal code Click or tap here to enter text.
Citizenship Click or tap here to enter text.
Residence address Click or tap here to enter text.

4
Beneficial owner refers to the natural person(s) who ultimately own or control a Legal entity and/or the natural person on whose behalf a transaction
is being conducted. It includes those persons who exercise ultimate effective control over a legal person or arrangement .

Signature______________________________
By submitting this questionnaire, the Legal Representative confirms that:

▪ All information provided in this questionnaire is complete and correct.

▪ All private individuals identified as Legal Representatives have been duly authorised to provide instructions, enter
into Payment Transactions and operate the Account on behalf of the Legal entity.

▪ All Personal Data included in this questionnaire has been lawfully obtained and is lawfully supplied; and all required
notices have been provided to Data Subjects and consents have been obtained (or another lawful legal ground for
processing Personal Data exists) to allow processing of Personal Data in accordance with the Contomobile Terms –
which may include conducting searches against the names of the individuals identified in this questionnaire.

▪ All Data Subjects identified in this questionnaire have been notified that their Personal Data has been submitted to
us, and they have been provided with a copy of our Privacy Policy (available from
https://www.contomobile.com/privacy/).

Completed by:

Name, surname, signature: Click or tap here to enter text.

Position: Click or tap here to enter text.
Completion date: Click or tap here to enter date.