KYC
Know Your Customer Form. Pursuant to Regulation 15 of The Financial Obligations Regulation 2019 (as amended) this KYC form must be completed before our company can conduct a business transaction with a Client.
Personal Details
Mr/Ms/Mrs
*
Please Select
Mr
Ms
Mrs
Name
*
First Name
Last Name
Email
*
type in your email for a copy
Date of Birth
Month MM
*
Day DD
*
Year YYYY
*
Nationality
*
Country of Birth
*
ID Type 1 (Please provide a Copy)
*
Driver's Permit
ID Card
Passport
Other
ID Type 2 (Please provide a Copy)
*
Driver's Permit
ID Card
Passport
Other
ID 1 #
ID 2 #
Upload ID #1
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Permanent Address & Contact Information
Please indicate your residential status
*
Citizen of Trinidad and Tobago
Resident
Foreign National
Non Resident
Mobile Number
*
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Home Number
Please enter a valid phone number.
Address Line 1
*
Street
City/Town
*
Country
*
Please Indicate which document you would be providing as proof of your address
*
Utility Bill
Bank Statement
Telephone Bill
Other
Upload Copy of Utility Bill
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DEFINITIONS
PEP- A Politically Exposed Person is a person who is entrusted with important public functions in Trinidad an Tobago or a foreign country as classified below. Please indicate you PEP classification Accordingly. (1) A Head or State or Government Judicial or Military Official (2) Senior Executive of a State-Owned Corporation -Chairman, Deputy Chairman, President or Vice-President of the Board of Directors; -The Managing Director, General Manager, Comptroller, Secretary or Treasurer; -Any other person who performs for the body corporate functions similar to those normally performed by the holder of any office specified above and who is duly appointed to perform those functions; or -An Ambassador or an Ambassador's attache or Counsellor. (3) Senior Government Official A Permanent Secretary or any other person appointed as an Accounting Officer under the Exchequer and Audit Act or an individual holding the equivalent position in a foreign country. (4) Senior Politician -A person elected to office in national, local or Tobago House of Assembly elections; -A person appointed to serve as a Senator in the Parliament of Trinidad and Tobago; -A person appointed to serve on the Tobago House of Assembly under the Tobago House of Assembly Act; or -A person selected to serve as an Alderman in a Municipality or Regional Corporation under the Municipal Corporations Act. (5) Important Political Party Official The Chairman, Deputy Chairman, Secretary or Treasurer of a political party registered under the Representation of the People Act or an individual holding the equivalent position in a foreign country. (6) An immediate family member of a person referred to in paragraphs 1 - 5 such as the spouse, parent, siblings, children and children of the spouse of that person. (7) An individual publicly known or actually known to the relevant financial institution to be a close personal or professional associate of the persons referred to in paragraphs 1 - 5.
Are you a Politically Exposed Person (PEP)?
*
Yes
No
If you answered yes based on the definitions above please provide the following details below:
Country of Origin
Position Held
Length of Time in Office
Length of Time Out Of Office
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Occupation & Income
Occupation
*
If Self Employed, Please Specify
Name of Employer
If Self Employed, Please Specify
Address Of Employer
Please Indicate Your income by selecting the box below
*
Under $10,000
$10,000-$20,000
$20,000-$50,000
Over $50,000
Source of Funds (Eg. Employment)
*
Eg Job
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NATURE OF BUSINESS
Type a question
*
Sale
Rental
Lease
Property Type
*
Residential
Commercial
Land
Value of Transaction (Purchase or Rental Value)
*
Property Address Description
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DECLARATION
I hereby declare and confirm that the information provided above is true and correct and agree to promptly inform our company of any changes to the above information
Date
*
-
Day
-
Month
Year
Date
Signature of Client
*
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