APPLICATION FOR ACCEPTANCE AS A CLIENT OF
LUTEA (HONG KONG) LIMITED
For the Purposes of the
Drug Trafficking (Recovery of Proceeds) Ordinance (CAP405)
Organised and Serious Crimes Ordinance (CAP455)
Completed by
(Please insert full name)
This form is designed to obtain sufficient information from you to enable us to discharge our
duties under Hong Kong Law. We will keep this information confidential unless we are
required by law or a court order to disclose it. You should be aware that we will retain copies
of all documents provided to us to establish and verify your identity and home address.
Specifically we need to satisfy ourselves that you are a person who conducts his affairs with
integrity, and that the money or assets you may ask us to deal with for you, in whatever
capacity, is not derived from criminal activity.
Failure to complete the form honestly will result in our refusal to deal further with you. In
addition, we are under a statutory duty to report to the Hong Kong Authorities anything that
leads us to suspect that you are, or have been, involved in criminal activity.
We will require from you, in addition to the completion of this form, two references from
professional people who have acted for you in your financial affairs for at least the last 5
years. In addition we shall require a copy of your passport or driving licence certified by a
lawyer or Notary Public. Depending upon the information provided, we may ask you for
further information and in particular may require you to verify the source of any monies or
assets with which we will be involved.
Once this form, the references and your identification document have been received, these
will be passed to our compliance officer for approval. Only after he has confirmed he is
satisfied will we able to act for you.
This form should be completed and returned to us in its entirety, dated and signed by you and
your signature witnessed. The name address and occupation of the witness must be written
legibly. If it is not possible to read the details of the witness it may be necessary for you to
complete the form again.
Lutea
Please provide the following information about yourself and your spouse or partner:
You
1.
Full name:
2.
Home address:
3.
How long have you lived there?
(if less than three years please
give previous address(es)):
4.
Home telephone no.:
5.
Facsimile:
6.
E-mail:
7.
Date of birth:
8.
Place of birth:
9.
Marital status:
10. Profession / Employment:
11. Passport no.:
12. Issuing authority:
13. Driving licence
14. Issuing authority:
15. Details of children:
Name(s) Date(s)
and place(s) of birth:
16. Office telephone number
17. Office facsimile:
18. Office e-mail:
Your partner
We are required to obtain professional references. Attached are drafts of the sort of references we require. Please
provide the following details of your referees and ask them to provide us directly with the references we require. If
you prefer, we can write to them direct.
REFERENCES:
1.
2.
3.
a)
Name and address of solicitor/lawyer:
b)
Telephone number:
c)
Facsimile:
d)
E-mail:
a)
Name and address of accountant:
b)
Telephone number:
c)
Facsimile:
d)
E-mail:
a)
Name and address of banker:
b)
Telephone number:
c)
Facsimile
d)
E-mail:
TYPE OF STRUCTURE
What type of structure do you want established / assets do you intend to introduce?
(eg company to receive royalty payments, trading company, trust, trust & company, nominee
account, stocks, shares, cash, etc.)
Source of your personal wealth (please provide full details):
Source of your funds
Source of the funds for this particular proposed structure
REQUEST FOR SERVICES
I confirm that I wish you to establish administer and provide all usual services to the Structure
set out under the heading Type of Structure above.
DECLARATION
1.
I propose to introduce cash and assets to you in the manner described above.
2.
I declare and warrant
2.1
The information I have provided in the attached schedules is true and correct
2.2
that the money and other assets hereby introduced are owned by me and not on
behalf of any person.
2.3
that I am not insolvent and have never been declared bankrupt
2.4
that the money and other assets forming part of the assets of the Settlement do not
emanate from any activity which is illegal or unlawful in their country of origin.
2.5
that there are no pending or threatened claims against me or relating to the assets
hereby introduced and that I am not aware of any ground or basis upon which any
such claims could be made and that I am not under any investigation or involved in
any legal or administrative proceedings.
2.6
that the information given herein is true and accurate and authorise you to obtain
references from the above-named as appropriate.
2.7
that I will provide you with all and any information which you may require concerning
the Trust and its affairs immediately upon request.
2.8
that I will use my best endeavours to ensure that (so far as I am lawfully able to do so)
the Structure and its affairs are conducted in a proper and lawful manner and in
compliance with all applicable laws and regulations.
2.9
that I will not alienate, assign, sell, pledge or otherwise dispose of any of my interest
in the Structure without previous notice to you in that regard.
2.10
that the introduction of the money and other assets is not calculated to carry out any
illegal or immoral purpose.
2.11
I confirm that if you are required by any government authority to determine the source
of funds, I will provide you with any necessary information and explanations to
establish that the source of funds is from a lawful activity.
2.12
that I understand that you are relying on the terms and conditions set out or referred
to in this Application Form in entering into your relationship with me
Signed
___________________________________
Witnessed by
(Name)
(Address)
(Occupation)
Date
______________________
From Referee (to be typed on the referee’s own paper)
Lutea (Hong Kong) Limited
Suite 1309
Asia Standard Tower
59-65 Queens Road Central
Hong Kong
Dear Sirs
I confirm I have known / acted for [insert client name] for [insert number of years to exceed 5]
years.
I have acted for him in his financial affairs.
I believe him to be a man of honesty and integrity in his financial dealings and am not aware
that he has ever committed any criminal act or acted in contravention of the money laundering
regulations of any jurisdiction.
I know of no professional or other reason why you should not accept him as a client.
His residential address is: [insert residential address]
or if a bank:
We confirm [insert name] has been a customer of ours since [insert date when relationship
started]
His residential address is: [insert residential address]
Attached is a sample of his signature (attach copy signature)
The account has been operated satisfactorily
Yours faithfully