COPORATE CIS
CLIENT INFORMATION SHEET (CIS)
GOLD FIELDS AG
CLIENT INFORMATION SUMMARY
In accordance with Articles 2 (two) through to 5 (five) of the Due Diligence Convention and the
Federal Banking Commission Circular of December 1998, concerning the prevention of money
laundering, and Article 305 Of the Swiss Criminal Code, the following information may be supplied
to banks and/or Other financial institutions for the purpose Of verification Of identity and activities
of the Principal, and the nature and origin of the funds that are to be utilized. All parties have an
obligation for professional discretion and to take all appropriate precautions to protect the
confidentiality Of the information each holds in respect Of the others' activities. This legal obligation
shall remain in full force and effect at all times.
COMPANY DETAILS
COMPANY NAME: GOLD FIELDS AG
COMPANY UK ADDRESS: RUE ST. PIERRE 18, FRIBOURG, 1700 SWITZERLAND
REGISTRATION NUMBER: CHE-894.094.099
REPRESENTED BY: MR. GILBERT RUSSELL
PASSPORT NO.: 12CH16001
ISSUED PLACE: FRANCE
DATE ISSUE: 18.02.2023
DATE EXPIRE: 17.02.2033
Company Officer for Transactions Nicolas Mapleton
BANK NAME: UBS AG ZURICH
GOLD FIELDS AG
REPRESENTED BY: GILBERT RUSSEL
BANK DETAILS
COMPNAY NAME GOLD FIELDS AG
COMPNAY ADDRESS RUE ST. PIERRE 18, FRIBOURG, 1700 SWITZERLAND
BANK NAME: UBS AG ZURICH
BANK ADDRESS: BAHNHOFPLATZ 1, 6060 SARNEN, SWITZERLAND
ACCOUNT NAME: GOLD FIELDS AG
ACCOUNT ADDRESS RUE ST. PIERRE 18, FRIBOURG, 1700 SWITZERLAND
BANK SENDER IBAN: CH12 0020 620623753301 Z
ACCOUNT NUMBER: EUR: 903.0390.4321
BIC / SWIFT CODE: UBSWCHZH80A
BANK OFFICER: ALEX SMICHT
BANK IMAD UBS .58AG88343543674
IDENTITY CODE: 84KBUKBGB22XXX
GLOBAL SERVER ID: K8HGTXN0OEMD6G
SENDER GLOBAL IP: 193.5.111.18
WTS SERVER AS8883
TRANSFER CODE: UBS-000923499329439
CLEARING HOUSE CODE UBS-OST838432848929
REPRESENTED BY MR. GILBERT RUSSELL, FRANCE
SIGNATORY: MR. GILBERT RUSSELL
PASSPORT NUMBER: 12CH16001
PASSPORT ISSUE DATE: 18.02.2023
PASSPORT EXPIRE DATE: 17.02.2033
Affirmation:
I, GILBERT RUSSELL hereby swear under the full penalty of perjury, that the information provided
herein is both true and accurate. I am in control of the assets stated above, and have signatory
authority on the aforementioned bank account and have full authority to execute all contracts and
agreements relating to pleading the assets for a loan. The funds are in full compliance with the anti-
money laundering policies set forth by the Financial Action Task Force (FATF) 6/01.
GOLD FIELDS AG
REPRESENTED BY : GILBERT RUSSELL
TITLE : REPRESENTED
PASSPORT No. : 12CH16001
PLACE OF ISSUE : FRANCE
DATE OF ISSUE : 18.02.2023
DATE OF EXPIRE : 17.02.2033
PASSPORT COPY
GOLD FIELDS AG
REPRESENTED BY: GILBERT RUSSELL
COMPANY CERTIFICATE
GOLD FIELDS AG
REPRESENTED BY: GILBERT RUSSELL
Certification:
I hereby swear under the full penalty of perjury, that the information provided herein
is both true and accurate. I am in control of the accounts as stated above, and have
signatory authority on the aforementioned bank account and have full authority to
execute all contracts and agreements relating to pleading the funds for Investment &
Asset Management, the investment-grade bond. All assets/funds engaged in this
transaction were obtained with funds derived from non-criminal origin and are good
cleared funds. The origin of funds/assets are in full compliance with the anti-money
laundering policies set forth by the Financial Action Task Force (FATF) 6/01.
I, GILBERT RUSSELL hereby swear under penalty of perjury, that the information
provided herein is accurate and true as of this date.
For and on behalf of:
GOLD FIELDS AG
REPRESENTED BY : GILBERT RUSSELL
TITLE : REPRESENTED
PASSPORT No. : 12CH16001
PLACE OF ISSUE : FRANCE
DATE OF ISSUE : 18.02.2023
DATE OF EXPIRE : 17.02.2033
END OF THE CIS DOCUMENT
