RIGLTD CIS

Client Information Summary - CIS

Kindly provide the following information for initial review
Applicant*

Individual= Complete Section ACorporation = Complete Section B
Complete either A or B - then C & D & E & F

if the Prospective Applicant is neither an Individual nor a Corporation - but some other entity - please seek advice
A - Individual Applicant
Name*
Nationality*
Passport Number*
Country of Issue*
Date of Expiration*
Is copy of Passport Attached*

YesNo
Date of Birth*
Place of Birth*
Identity Number/Social Security Number*
Residential Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Telephone Number*
Mobile Telephone Number*
Email*
example@example.com
Business Activity
Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Business Registration Number
Phone Number

Area Code Phone Number
Email
example@example.com
B - Corporate Applicant
Corporation Name
Business Activity
Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Corporation Business Registration Number
Country of Incorporation
Registered Office Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Corporate Phone Number

Area Code Phone Number
Corporate Email
example@example.com
Corporation Representative Name
Position
Nationality
Passport Number
Country of Issue
Date of Expiration
Is Copy of Passport Attached?

YesNo2
Date of Birth
Place of Birth
Identity Number/Social Security Number
Residential Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Mobile Phone Number

Area Code Phone Number
Email
example@example.com
C - Banking Information
Name of Bank*
Bank Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Account Name*
Account Number*
ABA Number*
SWIFT*
Account Signatory/ies
If more than One Signatory - set out details of signing powers registered with Bank on the Account
Bank Officer Name
Bank Officer Phone Number

Area Code Phone Number
Bank Officer Email
example@example.com
D - Funds
Currency/Amount of Funds Available
Is Current Proof of Funds Available?

YesNo
Is CURRENT Proof of Funds Attached?

YesNo
Are Funds free and clear of any liens or encumbrances

YesNo
Including Third Party Interests?

YesNo
Are Funds freely transferrable?

Yes 1No2
Prospective Applicant's Initial Information Summary
E - Origin of Funds
Source of Funds?
Please set out briefly and clearly the source and origin of the funds
Languages(s)
What Language(s) do you speak?
DECLARATION
I hereby under penalty of perjury that the information is both true and accurate.

I, the person issuing thjis Client Information Summary, am the Signatory on the above referenced Bank Account and confirm that all funds are good, clean, and cleared funds of non-criminal origin, and the origin of funds is in compliance with the Anti-Money Laundering Policies as set out by the appropriate authorities.

Signed:
This Date*

MonthDay Year
Date
Signature - For an Individual*
Name*

First Name Last Name
Passport Number*
Issuing Country*
OR
For and on Behalf of : Full Name of Corporation
Signature - For a Corporation or Entity
Name

First Name Last Name
Position
Passport Number
Issuing Country
Please attach your Passport picture and credentials, and the front and back of your Driver's license - BELOW IN FILE UPLOAD
FILE UPLOAD - SEARCH FILES AND ATTACH HERE*

Browse Files

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Please verify that you are human*
Should be Empty:

Client Information Summary - CIS

Complete either A or B - then C & D & E & F

A - Individual Applicant

B - Corporate Applicant

C - Banking Information

D - Funds

Prospective Applicant's Initial Information Summary

E - Origin of Funds

DECLARATION