Proposed Business Relationship

Independence Information Evaluation Questionnaire - Entity

Table of contents

OVERVIEW – FREQUENTLY ASKED QUESTIONS ....................................................................................1

A. ENTITY GENERAL BUSINESS INFORMATION .................................................................................3
B. ENTITY FINANCIAL, MANAGEMENT, AND OWNERSHIP INFORMATION .................................3
C. ULTIMATE PARENT COMPANY GENERAL BUSINESS INFORMATION ......................................4
D. PARENT COMPANY’S FINANCIAL, MANAGEMENT, AND OWNERSHIP INFORMATION .......4
E. CONTROLLING INDIVIDUAL(S) OWNERSHIP INFORMATION ....................................................5
FORM COMPLETION ACKNOWLEDGEMENT ...........................................................................................5

OVERVIEW – Frequently Asked Questions

Why is this information relevant, required, and necessary?
EY falls under the regulatory jurisdiction ofthe US Securities and Exchange Commission (“SEC”), IFAC, the AICPA and other
local regulatory bodies which promulgate rules and regulationsand have oversight authorityover the public accounting industry.
When EY is engaged in discussions concerning a potential business relationship, the third party is requested to provide certain
confidential business information to EY necessary to comply with the rules and regulations promulgated by our regulatorsprior to
entering into any business relationship.
EY cannot enter into a potential business relationship without all the specific information required to properly evaluate the
relationship as it relates to Independence.
All of the information requested below relating to the business, operations, personnel, financial data, and other entity data will be
held with the same degree of confidentiality1 EY uses to protect its own confidential data.

Why do you need us to release our annual revenue?

To determine the materiality of the potential relationship, EY must evaluate the dollar amount of all relationships in place with an
entity (estimated EY spend or proceeds) compared to the entity’s (or its ultimate parent company’s) annual revenue.
Why do you need us to release our shareholder/ownership details as well as any affiliations our C-Level
Executives, Directors, and/or Board Members maintain?
When EY’s relationsihp is deemed material to the third party we have to also be indpendent of the entity’s officers, directors and
substantial shareholders, or anyone in a financial reporting oversight role 2.

1
The entity or individual identified in this Questionnaire (the "Company") and EY are engaged in discussions concerning a potential business relationship (the
“Discussions”), and in connection therewith, the Company will be providing pursuant to this Questionnaire certain business information to EY that ought
reasonably to be treated as confidential (“Confidential Information”). EY shall use the same degree of care to maintain the confidentiality of the Confidential
Information that it uses to protect its own confidential information of like nature, but no less than a reasonable degree of care.
2
"Financial reporting oversight role" means a role in which a person is in a position to or does exercise influence over the contents of the financial statements or
anyone who prepares them, such as when the person is a member of the board of directors or similar management or governing body, chief executive officer,
president, chief financial officer, chief operating officer, general counsel, chief accounting officer, controller, director of internal audit, director of financial
reporting, treasurer, or any equivalent position (as defined by the SEC).
What if we have a Parent Company or anotherEntitywhich controls us (more than 50% ownership)?
If the third party we are proposing entering into a business relationship with is a subsidiary of, or controlled by another entity,then
EY also needs the requested information about the ultimate Parent Company (including annual revenue, officers, directors, and
substantial shareholder information, when applicable).
If the third party we are proposing entering into a business is not a subsidiary of, or controlled by, another entity then we require a
list of anyone who owns 50% or more of the the third party along with details about any officer, director or substantial
shareholding position they may hold with other entities (except for not for profits). This information is necessary for EY to
evaluate who the pertinent parties are to its proposed business relationship for regulatory compliance.

Will this information be used for any other purposes?

No. This information is being collected solely to comply with our internal policies, SEC,IFAC, PCAOB and other regulations. It
will not be shared with others unless EY is legally required to.

Instructions:
Complete all the applicable fields (please indicate ‘N/A’ for those that do not apply).

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 A. Entity General Business Information
Identifying information on Business Entity:
Legal Name: Enter Text
Current Alias: Enter Text
Former Alias: Enter Text
DUNS(if applicable.): Enter Text
City: Enter Text State/Provence: Enter Text Zip/postcode: Enter Text
Country: Enter Text Phone: Enter Text
Website (If available):Insert URL
SEC registrant? <<SELECT>> Listed on a Foreign (non-US) Stock Exchange? <<SELECT>>
If yes, please explain:
Is the entity a subsidiary of or otherwise controlled by another entity (do you have a Parent Company or Company with
Control)?<<SELECT>>
Instructions: If ‘Yes’,complete the sections C & D below for theUltimate ParentCompany.
If the entity is not a subsidiary of or otherwise controlled by another entity, do any individuals control 50% or more of the
entity? )?<<SELECT>>
If yes, complete section E below.
Please provide any additional comments below that you think could be relevant.
Enter Text

B. Entity Financial, Management, and Ownership Information

Entity’s estimated total annual revenue (in whole dollars, requested for independence assessment only and to be kept strictly
confidential):
Do not include the amount of this proposed business relationship.
Entity’s Estimated Annual Revenue (in whole USD): $
Comments regarding amount listed, if necessary: Enter Text
Will the total amount earned from relationships with EY exceed 7% of the entity’s annual revenue? <<SELECT>>
If yes, will the total amount earned exceed 10% of annual revenue? <<SELECT>>
If either of the above is Yes, please complete the information about the entity’s officers, directors and substantial shareholders
in the table below.

Please identify all Corporate / Executive-Level Officers and Directors and any individuals with a substantial shareholding (>10%)
in the table below:
Please list each individual’s full legal name (Last Name, First Name, and Middle Name)andtitle.
Include any other corporate/business affiliations (e.g. board memberships of other companies, positions, etc.). Include the
business name and title of applicable affiliations.
You may provide additional names (and applicable information) in a separate document.
Information for this Entity Information for Other Entity Affiliation(s)
Full Legal Name Title %Shareholding, Other Business/Entity Title/Relationship
if applicable
Last, First Middle Enter Text Enter Text Enter Text Enter Text
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle

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 C. Ultimate Parent Company General Business Information
Ultimate Parent information ofthe Business Entity:
Legal Name: Enter Text
Current Alias: Enter Text
Former Alias: Enter Text
DUNS(if applicable.): Enter Text
City: Enter Text State/Provence: Enter Text Zip/postcode: Enter Text
Country: Enter Text Phone: Enter Text
SEC registrant? <<SELECT>> Listed on a Foreign (non-US) Stock Exchange? <<SELECT>>
If yes, please explain:

D. Ultimate Parent Company’sFinancial, Management, and Ownership Information

Parent’s estimated total annual revenue (in whole dollars, requested for independence assessment only and to be kept strictly
confidential): [Note: This is needed even if you are the Prime.]
Do not include the amount of this proposed business relationship.
Parent Company’s Estimated Annual Revenue (in whole USD): $
Comments regarding amount listed, if applicable: Enter Text
Will the total amount earned from relationships with EY exceed 7% of the ultimate parent company’s annual revenue?
<<SELECT>>
If yes, will the total amount earned exceed 10% of the ultimate parent company’s annual revenue? <<SELECT>>
If either of the above is Yes, please complete the information about the ultimate parent company’s officers, directors and
substantial shareholders in the tables below.

Please identify all Corporate / Executive-Level Officers and Directors and substantial shareholders (>10%)(of the Ultimate
Parent Company)in the table below:
Please list each individual’s full legal name (Last Name, First Name, and Middle Name)andtitle.
Include any other corporate/business affiliations (e.g. board memberships of other companies, positions, etc.). Include the
business name and title of applicable affiliations.
You may provide additional names (and applicable information) in a separate document.
Information for this Entity Information for Other Entity Affiliation(s)
Full Legal Name Title %Shareholding, Other Business/Entity Title/Relationship
if applicable
Last, First Middle Enter Text Enter Text Enter Text Enter Text
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle
Last, First Middle

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 E. ControllingIndividual(s) Ownership Information
Please identify the shareholder(s) / owner(s) with >/= 50% ownership of this entity. If the individual(s) holds officer, director or
substantial shareholder(>10%) positions at other entities (other than non-profits) provide details:
Follow the same guidelines described above in the shareholder table you completed for this entity.
Ownership of this Entity Ownership of Other Entity(s)
Full Legal Name Ownership Affiliated with: Title at other entity Ownership Percent,
Percent Entity name if applicable
Last, First Middle
Last, First Middle

Form Completion Acknowledgement

Name of Business Contact Providing Information, Direct Contact Phone# for Questions, and Date of Completion:
Name: Phone#: Date:

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