Qualified Verifier Compliance Check Report Template

Entered into force on February 21, 2026.

On-chain voting result: association.dao.eth/transaction-hash

This Compliance Check Report (hereinafter the "Report") constitutes a legal attestation by the Qualified Verifier (hereinafter the "Verifier") of fulfillment of fiduciary due diligence obligations in accordance with the Governance Resolution and the Anti-Money Laundering, Counter-Terrorism Financing, and International Sanctions Policy.

1. Transaction Identification

Report ID: [Internal ID, e.g., COMP-RPT-2025-001]

Review Date: [DD.MM.YYYY]

Verifier Name/ID: [Name/Address of Verifier conducting the review]

Proposal/Transaction ID: [On-chain proposal hash or ID for voting]

Transaction Purpose: [e.g., "Executive Act: Appointment of DPO", "Grant: Final Tranche, Project 1"]

Amount (USD equivalent): [$XX,XXX.XX]

2. Counterparty Identification

Counterparty Name: [Legal name or full name]

Receiving On-Chain Address: [0x...]

Counterparty Jurisdiction: [Country of residence/registration]

3. KYC/KYB Verification

Is KYC/KYB required?

[ ] YES (Authorized Representative OR Grant > 10k USD) [ ] NO

Status (if "YES"): [ ] Completed [ ] Error [ ] Not Applicable

Verified Documents (if "YES"): [e.g., "Passport (ID: XXXXX)", "Registry Extract (No. YYYYY)", "UBO Documents"]

4. Mandatory Sanctions Screening

OFAC (USA): [ ] No Matches Found [ ] Match Found

EU (European Union): [ ] No Matches Found [ ] Match Found

UN (United Nations): [ ] No Matches Found [ ] Match Found

SECO (Switzerland): [ ] No Matches Found [ ] Match Found

Screening Tools: [e.g., Chainalysis, ComplyAdvantage, World-Check]

Screening Date and Time: [DD.MM.YYYY, HH:MM (UTC)]

Comments: [e.g., "Checked name 'Ivanov Ivan Ivanovich' and address 0x... No matches found."]

5. On-Chain Analysis

Direct Link to Mixers: [ ] YES [ ] NO

Direct Link to Darknet Markets: [ ] YES [ ] NO

Direct Link to Extortion/Phishing: [ ] YES [ ] NO

Other Risks (e.g., Sanctioned Address): [ ] YES [ ] NO

Analysis Tools: [e.g., TRM Labs, Elliptic, Etherscan]

Enhanced Due Diligence (EDD) conducted? (Mandatory if any "YES" above): [ ] YES [ ] NO [ ] Not Applicable

EDD Conclusions (if applicable): [e.g., "Counterparty provided satisfactory explanation of funds’ source..."]

6. Final Decision and Attestation

6.1. Verifier’s Decision

[ ] APPROVE

— Basis: All checks completed; no risks found or risks acceptably mitigated.

[ ] REJECT

— Basis: [Specify reason, e.g., "Match found in OFAC sanctions list" or "Unresolved 'Red Flag' (Mixer)"]
— Actions Taken: [ ] Notified other Verifiers. [ ] Prepared Suspicious Activity Report (SAR) for DPO.

6.2. Verifier’s Attestation

"I, the undersigned Verifier, hereby confirm that I have personally and diligently conducted a review of the results of all due diligence procedures described in this Report, fully in compliance with the Anti-Money Laundering, Counter-Terrorism Financing, and International Sanctions Policy and the Governance Resolution of New Epoch Association.

To the best of my knowledge, the information presented in this Report is accurate and complete as of the review date. I understand this attestation constitutes a legal certification upon which the Association’s legal protection and my personal right to indemnity depend."

Verifier ID (Signature): [Verifier’s wallet public key]

Date: [DD.MM.YYYY]

Storage Section (for Data Processor):

Storage Status: [ ] Encrypted and Stored

Storage Location: [Secure Data Processor Storage ID]

Archive Date: [DD.MM.YYYY]