Anti-Money Laundering Certification
This section must be completed for you/beneficial investor. For this section, please see Definitions.
By submitting this form, I hereby represent and certify that I am not involved in any anti-money laundering scheme and that my investment funds have not been directly or indirectly derived from activities that may contravene U.S. or international laws, rules and regulations designed to avoid money laundering, including, without limitation, the provisions of the Bank Secrecy Act of 1970, as amended. Neither I nor any person controlling, controlled by, or under common control with me, nor any person having a beneficial interest in my investments is a country, territory, person or entity named on the U.S. Department of Treasury’s Office of Foreign Asset Control list, or is a person or entity that resides or has a place of business in a country or territory named in such lists. I agree to notify you promptly should I become aware of any changes to the information set forth in this statement. I hereby agree to hold Sandell and each of its principals, members, directors, officers, and employees harmless and to indemnify the same against any loss arising as a result of a inaccuracy in the foregoing or any other statement in this questionnaire. Users of the Sandell website may view, download and print information and materials on this Site for their own personal and internal business use provided that all hard copies contain all copyright and other applicable notices. Users may not reproduce, modify, copy, alter in any way, distribute, sell, resell, transmit, transfer, license, assign or publish any information obtained from this Site. Registered Users shall not use this Site at any time for any purpose that is unlawful or prohibited and shall comply with any applicable local, state, national or international laws or regulations when using this Site.
If I am (I) acting as trustee, agent, representative or disclosed nominee for another person or entity, or (II) an entity investing on behalf of underlying investors (including a fund-of-funds), other than a publicly traded company listed on an organized exchange (or a subsidiary or a pension fund of such a company) based in a Financial Action Task Force (FATF) Compliant Jurisdiction (the persons, entities and underlying investors referred to in (I) and (II) being referred to collectively as the (Beneficial Owners), I represent and warrant that:
- I understand and acknowledge the representations, warranties and agreements made herein are made by me (A) with respect to me, and (B) with respect to the Beneficial Owners
- I have all requisite power and authority from the Beneficial Owners to execute and perform the obligations under this Questionnaire and Registered User s Agreement
- I have adopted and implemented anti-money laundering policies, procedures and controls that comply with, and will continue to comply in all respects with, the requirements of applicable anti-money laundering laws and regulations
- I have established or have access to the identity of all Beneficial Owners, hold evidence of or have access to such identities and will make such information available to a fund upon request and have procedures in place to ensure that the Beneficial Owners are not Prohibited Investors.
We will review the information you have submitted and contact you directly with any follow-up questions we may have.
* Required fields