Puma Energy

Corporate Details

Business name *:

Process start date *:

Name of the PUMA Energy business representative who established the contact *:

Fiscal Address *:

Street address *:

State *:

Town / City *:

Country Of Registration *:

Postal Code:

Company registration number:

Country *:

Registration Date (MM/YYYY):

Contact Number:

Contact address:

Mobile Number:

Contact person :

Company rol:

Fax number:

Web Site:

Email *:

Re-enter e-mail address *:

Company Name (Other Language):

Counterparty Status:

Other:

¿Listed on the stock market?:

Stock Exchange:

Counterparty Type:

Physical Trader

Service Provider

Ship Owner

Shipping Agent

Ship Broker

Oil Broker

Swap Broker

Futures Broker

Inspector

Customer type:

* Select client type

¿Do you think your transactions with our company exceed U$S 100.000?:

Referred by:

Bank information

Principal Bankers(Bank Name) *:

Swift *:

Bank Branch Address Details:

Bank Country *:

Bank account name *:

Bank account currency *:

Bank account *:

Name of Bank Account Manager & Contact Details:

Intermediary/Correspondent Bank Name:

Intermediary/Correspondent Bank Swift:

Additional Information

Additional Comment, if any:

Statute copy: * If it does not contain details about current shareholder/partner percentage or if you do not have such information on another document, then you must choose one of the following options:

Independently emitted document

Notary document

Shareholder names document

External auditor signed document

Customs administration copy:

Declaration of Conformity:

Summary of Current Changes Act copy:

Bank reference letter:

Energy Secretariat Inscription letter:

AFIP inscription receipt:

Gross income tax inscription receipt:

CMS05:

Proof of valid exemptions or exclusions:

Withholding agent:

Last audited financial statements with a closing date less than six months:

DNI copy:

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Corporate Details

Bank information

Additional Information

Necessary documentation