Standard KYC Questionnaire

In keeping with International Business Standards it is important you provide the following
background information. This will ensure we have a clear understanding of the proposed
business relationship

1. Corporate Details
Full Registered Company Name

CUMMINS AUTOMOTIVE
SERVICES & PARTS LTD

28-11-2011

Incorporation Date

P.O BOX FW 397

LUSAKA

Town / City

PLOT NO. 6980, KATANGA ROAD, INDUSTRIAL AREA, LUSAKA.

Physical Address of Head Office

97689

Initial point of contact at

counterparty:

0211845818

Telephone Number

0211845818

Fax Number

0211845819

Mobile Number

965186323

E-Mail Address

sales@cummins-zambia.com

Company Registration Number

www.cummins-zambia.com ; www.thebestofzambia.com/cummins

Website

2. Third party business partner indentification details

2.1

ZAMBIA

Country of Incorporation

PLOT NO. 6980, KATANGA ROAD, INDUSTRIAL AREA, LUSAKA.

Registered Street Address

Post Code

Any trading name(s):

Documents to be provided for Company

Certificate of Incorporation or Memorandum/ Articles
of Association

2.2

Names of Directors

2.3

Corporate document evidencing the full names and

shareholding of all Ultimate Beneficial Owners

2.4

Bank Reference Letter

3. Third party business partner details

Please provide copies of the below documents. These documents should be provided in the
English Language or with an English Translation. If the company is publicly listed, state owned
or regulated please note these documents are NOT required.
Documents to be provided for individuals

Please tick

2.5

Copy of identification document (passport)

2.6

Proof of address - Utility Bill from the last 3 months

2.7

Bank Reference Letter

Please tick

Details of the proposed new third party business partner

Third party business partner Status: (Please Tick)

3.1
Public Company (If publicly quoted company, please
name Stock Exchange(s) and listing(s))

Private Company

Partnership

State or Government Entity

Individual
Please note the beneficial owner must be a public limited company, state owned, or an individual. If the majority shareholder of a company is another privately
owned company, further enquiries must take place until the ultimate beneficial owner has been identified

4. Banking

Please provide the full banking details for this third party business partner.

4.1

Principal Bankers (Name of the Bank)

FIRST ALLANCE BANK

4.2

Swift BIC

4.3

Bank Branch Address Details

4.4

Bank City & Country

4.5

Bank Account Name (Beneficary Name)

4.6

Currency of Bank Account

USDOLLAR

ZMW (KWACHA)

4.7

Bank Account Number/ IBAN number

0102205014

0000102205006

4.8

Name of Bank Account Manager & Contact Details

FALLZMLU
CAIRO ROAD BRANCH
LUSAKA, ZAMBIA
CUMMINS AUTOMOTIVE SERVICES & PARTS

Mr. Zulu

Tel. 0211220386

5. Justification for new third party business partner

Type of business partner (supplier, contractor, service
station dealer, customer etc)

Please give basic explanation of services provided by third party business partner and why
you wish to use new third party business partner.

CUMMINS DIESEL ENGINES, GENERATION SETS SALES AND SERVICE ( AFTER MARKET SUPPORT).
SUPPLIERS OF FLEET GUARD FILTERS, CUMMINS PREMIUM BLUE OIL AND GENUINE ENGINE PARTS

Justification:

Details of individual completing KYC form

Name (Print):
Signature:

Prasad Panicker

Date:

09/9/2014