Residential address - грузинский адрес, где остановились Personal Identification number - номер загран паспорта Purpose of opening a bank account(s) - Receive salary, pay bills and purchases in Georgia and abroad The source of funds intended to be placed on the account - Salary Full name of the employing organization - (наименование компании-работодателя, если работаете на себя, то свое ИП) Country of the organization's main business activities - Georgia Name of the legal entity - (наименование компании-работодателя, если работаете на себя, то свое ИП) Please specify the types of transactions to be carried out on the account:

• Personal transfers of funds
• Payments to the state budget
• Debit card payments (POS terminal, Internet)
• Cash transactions (ATM withdrawal)

Please specify the types the expected counterparties - Internet stores, restaurants

Please specify the total value of your wealth (total assets) and the source of your wealth - The total value of wealth is approx.. $XXX (including free cash, stock, real estate (flat) in St.-Petersburg - Russia, car, etc.). Source of wealth: Salary, dividends