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About Us
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KYC
Title:
Mr.
Ms.
Mrs.
Miss.
Other
First Name*:
Middle Name:
Last Name*:
Passport or Identity Card No.*:
Passport No.
Identity Card No.
Passport Expiry date*:
Country of issue*:
Phone number*:
Fax number:
Email address*:
Country of permanent residence*:
Nationality*:
Date of Birth*:
Place of Birth*:
Gender:
Male
Female
Other
Marital Status:
Single
Married
Widowed
Divorced
Taxable Residence
Are you a United States Resident for Tax purposes:
Yes
No
Are you a United States Citizen:
Yes
No
Jurisdiction(s) for Tax purposes*:
Tax Identification Number (TIN)*:
Are you Politically Exposed or associated to any Political Person:
Yes
No
If Yes, please give details::
Occupation
Employer's Name:
Employer’s Business Address:
Employer’s Phone:
Employer’s Website:
Permanent Physical Address*
Street name & number:
Flat:
Area:
Postal code:
City:
Country:
Mailing Address (if different from the Permanent Address)*
Street name & number:
Flat:
Area:
Postal code:
City:
Country:
Telephone Number*
Home:
Work:
Mobile:
Fax:
Email Address*
Personal:
Work:
Preferred Language of Communication*:
English
Arabic
French
General Terms
I hereby confirm that the information given above is true, correct and complete and you are hereby authorized to use this information for all services offered and for which I may apply from time to time and for all the services offered in the future.
Change of data
For any changes in the data given above, I have the obligation to notify the company the soonest possible and I acknowledge that the company is not liable for any wrong data, or for the non-prompt amendment of data which I have omitted or neglected to send and to inform the company.
Know Your Client documentation
Please attach to this application form, where applicable, the following documents:
Color Copy of Identity Card or Passport
Copy of a recent Utility bill (e.g. of electricity or telephone, or other document to the satisfaction of the Company evidencing the permanent residence of the Customer - maximum 6 months old).
Recent bank statement if applicable (maximum 6 months old)
*The above documents are not exhaustive and the Company may require additional documents where this shall be deemed necessary.
I hereby declare and confirm that these are true and correct and that I have not withheld any relevant or substantial information.
I confirm that I have delivered whatever is required in accordance with point 3 above and that such are original and authentic and content is true and accurate.
Client name:
Date:
Signature:
Color Copy of Identity Card or Passport:
Copy of a recent Utility bill:
Recent bank statement if applicable (maximum 6 months old):