Client Intake

Client Profile

Compliance Due Diligence Convention
In accordance with Articles 2 through 5 of the Due Diligence Convention and the Federal Banking Commission Circular of December 1998, and under the United States Patriot Act of 2002, as amended in February 2003 concerning the prevention of Money Laundering and 305 of the Swiss Criminal Code, the following information may be supplied to banks and / or other Financial Institutions for purposes of verification of identity and activities of the Client described below, and the nature and origin of the assets or funds that are to be utilized. The foregoing is subject to agreement by all parties to whom this information is provided that they are obligated to respect the privacy rights of the Client and all Individuals described herein, as well as the generally accepted professional standards relating to the maintenance of confidential information, and to take all appropriate precautions to protect the confidentiality of the information contained herein, this legal obligation shall remain in full force indefinitely without restriction.
Business Information
Business Name
Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business EIN/DOMICILE
Telephone
Facsimile
Email Address

Save and Continue Later

Save and Continue Later

Auditor Information
Auditor
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone
Fax

Save and Continue Later

Legal Representation
Legal Counsel
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone
Facsimile
Email Address

Save and Continue Later

Bank Representation
Name of Bank
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Name
Account No.
S.W.I.F.T Code
IBAN / Routing No.

Save and Continue Later

Save and Continue Later

Save and Continue Later

Save and Continue Later

Declaration
I hereby swear under penalty of perjury, that the information provided is both true and accurate. I am the signatory on the aforementioned bank account. All monies engaged in this transaction are derived from non-criminal origin; and, are good, clean and cleared. The origin of funds is in compliance with Anti-Money-Laundering Policies as set forth by the Financial Action task Force (FATF) 6/01.

Notice
I hereby swear under penalty of perjury, that the information provided is both true and accurate. I am the signatory on the aforementioned bank account. All monies engaged in this transaction are derived from non-criminal origin; and, are good, clean and cleared. The origin of funds is in compliance with Anti-Money-Laundering Policies as set forth by the Financial Action task Force (FATF) 6/01.
For and on behalf of:
Name
Title
Passport Identity Number
Country of Origin
Country

Save and Continue Later

Client Profile