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customer Statement on non Embargo situation
Please fill out this form completely. When completed, please return this form together with the additional documentation by responding to this email
or via e-mail to sales@leaseweb.com
Company Information
customer number:
company name (hereinafter: “Customer”):
street address:
postal code:
city:
country:
phone:
fax:
mobile:
chamber of:
commerce no.:
authorized representative
name:
position:
LeaseWeb Deutschland GmbH (“LeaseWeb”) requires a copy of the following documentation:
· ID of the authorized representative;
· chamber of commerce registration document.
Statement
· The Customer and its authorized representative(s) hereby declare that they are not sanctioned by the EU and or the US authorities and
the services rendered by Customer are not sanctioned by the EU and/or US authorities.
· The Customer shall immediately notify LeaseWeb in the event the Customer and/or its authorized representative(s) are sanctioned by
the EU and/or US authorities and/or in the event the services rendered by Customer are sanctioned by the EU and/or US authorities.
· LeaseWeb is entitled to terminate the Agreement and/or an Order Form by giving written notice to the Customer, without an obligation
to take into account a notice period, if the Customer and/or its authorized representative(s) are sanctioned by the EU and/or US
authorities/or in the event the services rendered by Customer are sanctioned by the EU and/or US authorities.
· LeaseWeb may, at any time, by notice in writing, require the Customer to provide statement of its Ultimate Beneficial Owners. Within
the meaning of the law, Ultimate Beneficial Owners of a legal entity are natural persons who hold or control a participation of at least
25% in the capital or at least 25% of the voting rights of a company or who undertake de jure or de facto management of the legal entity.
With this signature, I hereby confirm that I have read and confirm the information provided in this form.
Signature: ____________________________ (Signature by authorised representative)
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