Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.LayoutFore Name (s) *DateNationalityTown/CityMobileSurname *National ID/Passport No:Physical AddressTelephoneEmail *DirectorsDirectors NameIs the director also a shareholder Yes/NoYesNoNationality (ies) Politically exposed personYesNoShareholdersShareholder’s Name Ownership % Nationality (ies)Politically Exposed PersonYesNoDoes your company have written know your customer proceduresYesNoDoes your company have written anti-money laundering (AML) proceduresYesNoSupporting Documentation – Please attached all specified documents Certificate of incorporation List/Register of Directors and shareholders Copy of passport of the authorized person to act on behalf of the company Resolution specifying the person authorized to act on behalf of the company I declare irrevocably and unconditionally that the information provided in this information request form (KYC) is to my best of my knowledge true, accurate and complete. In case any of the above information is found to be false or untrue or misleading or misrepresenting. Am aware I may be reliable for itSignature of Authorization person LayoutFull NameTitle/DesignationDate SignatureClear SignatureSubmit
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