Required for every legal-entity borrower under FinCEN Customer Due Diligence and the Corporate Transparency Act. List every individual who owns ≥ 25% or exercises substantial control.
01Reporting Legal Entity
02Beneficial Owners — Ownership ProngEach individual who owns ≥ 25% of the entity, directly or indirectly.
#
Full legal name
Date of birth
Residential address
SSN / ITIN
ID type
ID no. & jurisdiction
Citizenship
Own %
03Control Persons — Substantial-Control ProngSenior officer or any individual with substantial control over the entity (CEO, CFO, GP, managing member, etc).
#
Full legal name
Title / role
Date of birth
Residential address
ID type & no.
Citizenship
04OFAC & Source-of-Funds Disclosure
Is any beneficial owner or control person a politically exposed person (PEP), or an immediate family member or close associate of a PEP?
Is any beneficial owner or control person currently the subject of any U.S. or foreign sanctions program (OFAC SDN, EU, UK)?
Will any portion of the loan proceeds, equity contribution, or debt service originate outside the United States?
05Certification
The undersigned, an authorized representative of the legal entity identified above, certifies that the information set forth in this Beneficial Ownership Certification is true, accurate, and complete as of the date signed, and is provided in compliance with the federal Customer Due Diligence Rule (31 C.F.R. § 1010.230) and the Corporate Transparency Act (31 U.S.C. § 5336). The undersigned agrees to notify 818 Capital Partners in writing within 30 days of any change in beneficial ownership or substantial control. The undersigned acknowledges that 818 is relying on this certification in extending credit and that material misrepresentation may constitute a federal offense punishable under 31 U.S.C. § 5336(h).
Authorized signatory
Date
Printed name & title
Entity
818 Capital Partners · 110 Wall Street, New York, NY 10005One page · Form 818-BOI