Please note: This form is served across a protected 256 bit SSL (Secure Socket Layer) connection that uses a SHA256 Certificate. It is the industry standard protection.
If you are the Representative of {nameinHeb}{nameEng}, please click the Next button below to complete your portion of the form.
*Please note. If at any time you need to stop and you want to save your progress, you will need to scroll down to the bottom and press the "Save" button. By doing so you will be provided a link (or an email with the link) to continue the form at a later time.
Address of main residence:
A Politically Exposed Person (PEP) is:
Source Bank account details
IBAN of my Israeli bank acccount
Foreign bank account details
*Please approximate amounts in $USD
If purchasing a home, please check all that are applicable
Certification:
I, {nameEng}{nameinHeb}, certify that (1) I have examined the information on this form and that (2) to the best of my knowledge, all of the information provided in this form and other attached forms is true, accurate and complete. I agree to notify Clearshift Israel Ltd promptly of any change in the information that I have provided. I am aware that providing false information, including failure to provide updates of a reportable information item, to prevent the filing of a report, or in order to cause an incorrect report filing pursuant to Section 7 of the Israel Prohibition on Money Laundering Law, constitutes a criminal offense.
To be signed electronically after form is approved.
3: Declaration:I, {nameEng}{nameinHeb}, certify that I am the beneficial owner of all the account(s) to which this form relates. Under penalties of the law, I declare that: (i) I have examined the information on this form; (ii) that, to the best of my knowledge, all of the information provided in this form is true, accurate and complete; (iii) that I am NOT a tax resident of any country other than the countries disclosed above. The account will not be used to avoid any Israeli or foreign reporting or tax obligations that may apply to me pursuant domestic and international laws. In any event of a change in the information provided in this form, I undertake to submit a new form within 30 days.
To be signed electronically when the form is accepted.
I, {nameEng}{nameinHeb}, hereby legally obligate myself to inform the regulated financial services provider, in writing and at the earliest possible opportunity, regarding any change in the information provided above; I am aware that providing false information, including failure to provide updates of a reportable information item, to prevent the filing of a report, or in order to cause an incorrect report filing pursuant to Section 7 of the Israel Prohibition on Money Laundering Law, constitutes a criminal offense.
To be signed electronically after the application is completed.
**A Beneficiary is a person who, on his/her behalf of or for his/her benefit, property is being held or transacted in or who has the ability to direct a transaction in such property, whether directly or indirectly.
Authorization from the ultimate customer:
I, {nameEng}{nameinHeb}, authorize the representative listed directly above to open up an account in my name and in trust for my benefit with Clearshift (Israel) Ltd and to exercise authority and perform any act on my behalf in connection with my Clearshift account, including transfers to his/her own account. All orders and transactions will be governed by the Clearshift Account Terms and Conditions, a copy of which was made available to me and to the representative.
To be signed electronically once the form is accepted.
You have reached the end of your section. Please enter the email address of your representative above and click submit. The form will be forwarded to your representative for completion. Please contact your representative after submitting the form to confirm that he receives an email with the link. Please contact us if you need any assistance in this regard.
Sincerely.
The Clearshift Team
Name: {nameinHeb}{nameEng}
Gender: {gender144UC}
Teudat Zehut/Passport #: {teudatZehut}{passportUC}{passportCountryUC}
Date of Birth: {dateOfBirthUC}
Country of Birth:{CountryOfBirthUC}
I have had a relationship with the ultimate customer since: * insert year.
I, {nameinHebRep}{nameEngRep}, certify that (1) I have examined the information on this form and that (2) to the best of my knowledge, all of the information provided in this form and other attached forms is true, accurate and complete. I agree to notify Clearshift Israel Ltd promptly of any change in the information that I have provided. I am aware that providing false information, including failure to provide updates of a reportable information item, to prevent the filing of a report, or in order to cause an incorrect report filing pursuant to Section 7 of the Israel Prohibition on Money Laundering Law, constitutes a criminal offense.
To be signed electronically after the application is finalized.
Ulitmate Customer:
{nameinHeb}{nameEng}
Teudat Zehut #:
{teudatZehutUC}
Passport # and Country:
{passportUC} {passportCountryUC}
Date of Birth:
{dateOfBirthUC}
I, {nameinHebRep}{nameEngRep}, hereby legally obligate myself to inform the regulated financial services provider, in writing and at the earliest possible opportunity, regarding any change in the information provided above; I am aware that providing false information, including failure to provide updates of a reportable information item, to prevent the filing of a report, or in order to cause an incorrect report filing pursuant to Section 7 of the Israel Prohibition on Money Laundering Law, constitutes a criminal offense.
To be signed electronically after completion of the form