KNOW YOUR CUSTOMER (KYC) FORM

KNOW YOUR CUSTOMER (KYC) FORM
1 Full Name of the Customer*
2 Legal Status*

IndividualCompanyPartnershipOther
3 Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4 Business/Trading Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
5 ID No./CR No./Registration No.
6 Purpose and Nature of Transaction to be undertaken
7 In the case of Individual
(i) Nationality
(ii) Occupation or Profession
(iii) Name of Establishment or Employer
(iv) Location of activity
(v) Is the Individual a Politically Exposed Person (PEP)?

YesNo
8 In case of Others?
(i) City & Country of Incorporation
9 Date of Birth / Incorporation

MonthDayYear
Date
10 What is the principal business/activity of the Customer?
KNOW YOUR CUSTOMER (KYC) FORM
11 Is the Customer acting on behalf of another person? If yes,

YesNo
(i) Name of Beneficial Owner
(ii) ID No./CR No./Registration No.
(iii) Domicile Country
(iv)If Beneficial Owner is an Individual, then
a) Nationality
b) Is the Individual a Politically Exposed Person (PEP)?

YesNo
12 Regulatory Status

Independent RegulatorNon-Independent RegulatorUnregulated
13 Name of Regulator (if any)
14 Name of Stock Exchange (if listed)
15 If a Holding company. name of any other subsidiaries/branches/associated companies
16 If not, Group Company (if any)
17 If business activities are conducted in more than one country, please indicate the names of all countries
18 Bank Details
19 Contact Details of Customer
(i) Contact Person
(ii) Tel & Fax
(iii) Email/Website
(iv) Contact details of Compliance Officer (if any)
KNOW YOUR CUSTOMER (KYC) FORM
20 Copies* of Customer Identification Documents

Please submit the documents and tick (X) against the documents attached
(i) Individual:

ID Card/Passport/Driving License (DL)Proof of Domicile Country**
(ii) Company:

Company Registration (CR)List & Passport copies of Authorised SignatoriesList of Major ShareholdersList & Proof of Domicile Country** of Directors
Major Shareholders: Shareholders who, directly or indirectly, ouns or controls more than5% of the shares or voting rights
(iii) Partnership:

Certificate of RegistrationPartnership DeedList & Passport copies of Authorised SignatoriesList & Proof of Domicile Country** of Partners
(iv) Trust:

Certificate of Registration Trust DeedList & Passport copies of Settlor.Trustees.ProtectorList & Passport copies of Authorised SignatoriesList of Major Beneficiaries
Major Beneficiaries:-Beneficiary who is to receive at least 25% of the funds of the Trust
(v) Any other Legal Persons:

Registration DocumentList & Passport copies of Authorised SignatoriesList of the Individuals/Entities who ultimately owns, or exercises effective control over such person
Declaration

I/We hereby confirm that the above information provided to you is true and correct to the best of our knowledge. I/We acknowledge that if the information provided is found to be false or misleading, then the business relationship may be annulled anytime at your discretion. I/We hereby agree to provide any additional information/documentation that may be required.
Date*

MonthDayYear
Date
Signature of Authorised Signatory*

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*Certified copies of documents clearly signed. stamped. and dated by any of the following: (1) A representative of an embassy. consulate. or high commission of the country: or (2) A lawyer or attorney: or (3) A notary public or commissioner of oaths: or (4) A chartered or certified accountant.

The date of signatory should not be older than 3 months. Copies of certified copies are not acceptable.

** 'Any document to show the residential address like a utility bill. tenancy agreement.
Please Print and Stamp

Incase of company

KNOW YOUR CUSTOMER (KYC) FORM

7 In the case of Individual

8 In case of Others?

KNOW YOUR CUSTOMER (KYC) FORM

(iv)If Beneficial Owner is an Individual, then

19 Contact Details of Customer

KNOW YOUR CUSTOMER (KYC) FORM

20 Copies* of Customer Identification Documents

Declaration

Please Print and Stamp