Know Your Customer (KYC) — Powerhouse Engines (Mockup)

Legal entity information

Provide the full legal identity of the customer.

Full legal name

Company type (legal form)

Trade name (DBA)

Corporate registration number

Tax number (VAT / TIN / EIN)

Are you tax exempt?

Yes No

USA entities: please attach a valid resale certificate and W-9 with your submission.

Country of registration

Date of incorporation

Directors / management

List each member of the Board of Directors (if any), as well as the CEO, President, CFO (if any), and any individual who effectively exercises control over the customer. Attach a separate sheet if needed.

Directors and executive management

Ownership

Provide shareholders / ultimate beneficial owners. If a shareholder is itself a corporation, provide the name and ownership percentage. Total ownership must equal 100%.

Owner name / entity

Country

Ownership %

Ownership total: 0.00% (must equal 100%)

Is your company owned or controlled, directly or indirectly, by a military entity at a level of 51% or greater?

Yes No

If yes, please explain

Contact and locations

Registered address

Warehouse address

Phone number

Company website

Invoice email address

Financial & operational contacts

Provide the primary points of contact for accounting, purchasing, and shipping so we can route documents and communications correctly.

Accounts Payable (AP) contact — Name

Accounts Payable (AP) contact — Email

Accounts Receivable (AR) contact — Name

Accounts Receivable (AR) contact — Email

Purchasing contact — Name (if different from AP)

Purchasing contact — Email

Shipping / Receiving contact — Name (if applicable)

Shipping / Receiving contact — Email

Trade references

Please provide three (3) trade references. All fields are required for each reference.

Trade reference #1

Company name

Primary contact name

Phone

Length of business relationship

Trade reference #2

Company name

Primary contact name

Phone

Length of business relationship

Trade reference #3

Company name

Primary contact name

Phone

Length of business relationship

Export control and sanctions compliance

The Customer (“Legal Entity”) represents, warrants, and undertakes that:

Compliance with laws. The Legal Entity shall comply with all applicable export control and sanctions laws and regulations, including those of the United States (e.g. EAR, ITAR, OFAC), the European Union, the United Arab Emirates, the United Nations, and any other relevant jurisdiction.

Responsibility for authorizations. The Legal Entity is solely responsible for determining whether any goods, software, technology, or services are subject to export, re-export, or transfer restrictions, and for obtaining all required licenses or approvals.

Sanctions status. The Legal Entity represents and warrants that neither it nor any of its owners, affiliates, directors, officers, employees, agents, or partners is subject to, or owned or controlled by, any person or entity subject to applicable sanctions or listed on any restricted party lists maintained by the United States, European Union, United Nations, United Arab Emirates, or other relevant authorities. The Legal Entity further represents that it is not established in, operating from, or engaged in transactions involving jurisdictions subject to comprehensive or significant trade restrictions, including, without limitation, Iran, Russia, or Belarus, except as permitted under applicable laws and with all required governmental authorizations.

Prohibited jurisdictions and uses. The Legal Entity shall not export, re-export, transfer, or use any goods or services in violation of applicable embargoes or for any prohibited end-use under applicable law.

Notification. The Legal Entity agrees to promptly notify Powerhouse Engines of any change affecting its compliance with this clause.

Authority and accuracy. The Legal Entity confirms that all information provided is accurate and that it is authorized to agree to these terms.

I confirm I am duly authorized to sign on behalf of the Legal Entity, and that all information provided in this form is true, complete, and accurate.

Signature

Name

Title

Date

Signature

In production, this becomes a live signature pad. For mockup review, treat as a placeholder.

Required attachments

Please attach the following supporting documents.

1. Certificate of Incorporation (or equivalent)

2. Valid resale certificate and W-9 (USA entities only)

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