Formulario de Debida Diligencia

Due Dilligence Form

Institutions
Basic Information
Company Name*
Country*
The country in which the company is incorporated is on the list of countries sanctioned by OFAC, we cannot continue with the registration process.

If you have any questions regarding this matter, please contact us at our email info@alphayield.io
Commercial Name (If applicable)
Email *
Can we use this email as primary contact?*

YesOther
Website
www.ejemplo.com
Phone Number *

Country codePhone number
Fax Number

Country codePhone number
Tax ID Number*
Business Address*

Line 1

Line 2

CityState

Postal Code
Shipping Address (if different from Billing Address)*

YesNo
Shipping Address

Line 1

Line 2

City State

Postal Code

Declarations
PEP Statement: Do you or any person who exercises control of the company carry out or has performed public, military, political or judicial functions or positions in the United States or any other country in the last 2 years? If yes, please detail country, name of position, start date and date of completion*

YesNo
Detail
Related PEP Statement: Does any relative or spouse have or have held public, military, political or judicial functions or positions in the United States or any other country in the last 2 years? If yes, please detail country, name of position, start date and date of completion*

YesNo
Detail
Who is filling the form?*

UBORepresentative LegalOther

Supporting Documentation
Company Formation Documents (Must include Proof of EIN (SS4, LTR147C, etc.) and Proof of Incorporation (Filed Articles,FL annual report, etc. )*

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Company Bank Statement (Must be from the same bank previously entered in the "Banking Information" section)*

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Legal Representative Passport 1*

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Legal Representative Proof of Address 1*

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Legal Representative Passport 2*

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Legal Representative Proof of Address 2*

Cancelof
Legal Representative Passport 3*

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Legal Representative Proof of Address 3*

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Beneficial Owner Passport 1*

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Proof of Address Beneficial Owner 1*

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Beneficial Owner Passport 2*

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Proof of Address Beneficial Owner 2*

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Beneficial Owner Passport 3*

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Proof of Address Beneficial Owner 3*

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Desginated Trader Passport*

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Designated Trader Proof of Address*

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Desginated Trader Passport #2*

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Designated Trader Proof of Address #2*

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Desginated Trader Passport #3*

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Designated Trader Proof of Address #3*

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Should be Empty:

Due Dilligence Form