CLIENT INFORMATION SHEET
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In accordance with Articles two (2) through five (5) of the Due Diligence Convention and the Federal Marketing Commission
Circular of December 1998, concerning the prevention of money laundering, the following information may be supplied to banks
and/or other Federal Institutions for purposes of verification.
Date:
Monday, 24 April 2023
Client Name
Citizenship
Passport Number
Passport Issue Country / Expiration Date
Federal ID Number
Date of Birth
Email Address
Address / Telephone
ADDRESS, CITY , COUNTRY ZIP T:(--) XXXXXXXX
Business Name
Business Address
Registered Office
Registration Number
Business Fax Number
Business Phone Number
Email Address
BANK NAME
Branch and Branch Address
Bank Officer’s Name
Telephone Number(s)
Fax Number
Bank Officer Email
Account Name
Account Signatory Name
Account Number
CASH ACCOUNT:
TRADE EXPORT ACCOUNT: if applicable
TRADE IMPORT ACCOUNT: if applicable
SWIFT CODE
Earnings Fund from
Are funds free and clear?
Lawyer Details
Accountants Details
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Declaration:
I hereby swear under penalty of perjury, that I AM AND CERTAIN BOARD MEMBERS ARE THE
SIGNATORIES of the account and that the funds/asset for Bank Guarantee. The information
provided herein is accurate and true. All monies engaged in this transaction are derived from noncriminal origin; and, are good, clean and cleared. The origins of funds are in compliance with AntiMoney-Laundering Policies as set forth by the Financial Action task Force (FATF) 6/01.
____________________
Authorized Signature
DATE: Monday, 24 April 2023
Name: MR
Title:
Passport Number:
Country of Issue:
Issue Date:
Expiry Date:
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APPENDIX 1: DIRECTOR/SIGNATORY PASSPORT
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APPENDIX 2: COMPANY REGISTRATION CERTIFICATE
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APPENDIX 3: COMPANY INCORPORATION CERTIFICATE
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