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Questionnaire for Foreign Natural Persons

In the process of prevention of illicit income legalization, in accordance with law of Georgia, Insurance Company is obliged to apply respective procedure based on which it is determined whether the customer and his beneficiary is a Politically Exposed Person

Politically Exposed Person (PEP) - Person, who has been entrusted with prominent state (public) functions in a respective country or / and carries out significant public and political activities. The PEPs are as follows: the head of the state, the head of the government and members of the government, their deputies, senior official of government institution, a member of the parliament, a member of the supreme court, a member of the constitutional court, a senior military official, a member of the central (national) bank’s council, an ambassador, a senior executive of state owned corporation, important political party (union) official and member of executive body of the political party (union), other prominent politician, his / her family members as well as persons having close business relations with him / her; a person shall be considered as a politically exposed during a year following his / her resignation from the foregoing positions;

Family member – a spouse of a politically exposed person (PEP), his / her parents, siblings, children (including step – children) and their spouses;

Person having close business relationship with the politically exposed person (PEP) – a natural person who owns or / and controls a share or voting stock of that legal entity, in which a share or voting stock is owned or / and controlled by the Politically Exposed Person (PEP); also, a person having other type of close business relationship with the Politically Exposed Person (PEP).

According to the above mentioned information, please answer the following questions:

Are you, or are you affiliated with, a Politically Exposed Person?

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