Scribd Logo
Upload

Welcome to Scribd!

  • CIS Client Information Sheet

    Uploaded by

    Víctor Palacios Romero
    5K views4 pages
    Formato

    Copyright

    © © All Rights Reserved

    Available Formats

    DOC, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    Formato

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    5K views4 pages

    CIS Client Information Sheet

    Uploaded by

    Víctor Palacios Romero
    Formato

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 4

    [INSERT APPLICANT LETTERHEAD IN HEADER SPACE]

    CLIENT INFORMATION SHEET

    Directions: This document should be completed in full. If a line item does not pertain
    then insert the term: “N/A” (non-applicable).

    Corporate Information

    Full Name of Corporation:


    Date of Incorporation:
    Incorporated in (City/State/Country):
    Registration Number:
    Board of Directors (Name & Title):
    Officers (Name & Title):
    Shareholders:

    Location of Address: Registered Address (Corporation)

    Full Name of Corporation:


    Street Address:
    City:
    State:
    Country:
    Postal Code:

    Location of Address: Mailing Address (Corporation)

    Full Name of Corporation:


    Street Address:
    City:
    State:
    Country:
    Postal Code:

    Contact Information (Corporation)

    Telephone Number:
    Fax Number:
    Mobile Number:
    Email Address:

    Languages / Translator

    Languages:
    Does the Signatory speak English?:
    If No, Name of Translator:
    [INSERT APPLICANT LETTERHEAD IN HEADER SPACE]

    Tel Number:
    Email Address:

    Legal Advisor

    Full Name:
    Company:
    Address:
    City:
    State:
    Country:
    Postal Code:
    Telephone Number:
    Fax Number:
    Email Address:

    Bank Information (Corporate)

    Bank Name (where funds are currently on deposit):


    Street Address:
    City:
    State:
    Country:
    Postal Code:

    Account Name:
    Account Number:
    Sort Code ABA No.:
    SWIFT Code:
    Account Signatory (1):
    Account Signatory (2):

    Bank Officer # 1 Name:


    Bank Officer # 2 Name:
    Telephone Number:
    Fax Number:

    Client Account where Profits to be paid

    Bank Name:
    Street Address:
    City:
    State:
    Country:
    Postal Code:

    Account Name:
    [INSERT APPLICANT LETTERHEAD IN HEADER SPACE]

    Account Number:
    Sort Code ABA No.:
    SWIFT Code:

    Bank Officer Name:


    Telephone Number:
    Fax Number:

    Personal Information of the Transactional Signatory Authorized by Corporation


    (Please attach copy of the corporate resolution adopted by the Board of Directors
    appointing and authorizing said officer(s) below to represent and legally bind the
    corporation)

    First Name:
    Middle Name:
    Last Name:
    Gender:
    Date of Birth:
    Social Security Number:
    Country of Citizenship:
    Languages:

    Passport Information of Officers(s) of Corporation


    *Please attach copy of photo and signature page of passport

    Passport Number:
    Date of Issue:
    Date of Expiry:
    Issuing Authority:

    Location of Address: Home-Legal Residence (Officer of Corporation)

    Full Name of Officer:


    Street Address:
    City:
    State:
    Country:
    Postal Code:

    (You may duplicate the section above for each Director involved in transaction)

    Investment

    Funds available for this transaction:


    [INSERT APPLICANT LETTERHEAD IN HEADER SPACE]

    Type of currency:

    Origin of funds:

    Are these funds free and clear of all liens, encumbrances and third party interests:

    I, (NAME), hereby swear under penalty of perjury, that the information provided herein
    is accurate and true as of this date: ________ ___, 2010

    For and on behalf of (NAME OF COMPANY)

    Signature: __________________________________ SEAL OF COMPANY


    Name / Title:
    Company:
    Passport Number:
    Date of Issue:
    Date of Expiry:
    Country of Issuance:

    You might also like