KYC Form

KYC Form
A. Identity Details
1. Name of the Applicant*

First NameLast Name
2a. Gender*

MaleFemale
2b. Marital Status*

SingleMarried
2c. Date of Birth*

MonthDayYear
Date
3. Nationality*
4. Status*

Resident IndividualNon ResidentForeign National
5. Proof of Identity being Submitted*

PassportVoter IDDriving LicenseOther
6. Personal Number*
Please enter a valid phone number.
7. Business Number
Please enter a valid phone number.
8. Personal Email*
example@example.com
9. Business Email
example@example.com
B. Home and Business Address Details
1. Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
2. Proof of Address to be Provided by Applicant*

Voter Identity CardLease/Sale Agreement of ResidenceLatest Bank Account StatementLatest Telephone BillLatest Electricity BillOther
3. Business Address (If different from home address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4. Proof of Address to be Provided by Applicant

Lease/Sale Agreement of ResidenceLatest Bank Account StatementLatest Telephone BillLatest Electricity BillOther
C. Company Information
1. Proposed incorporation name? *
2. Which position will you hold within the company? *
3. What is your share percentage? (If you are not a shareholder please state 0%)*
4. Provide us with a clear understanding of the nature of business.
D. Additional Services
If you are interested in any of the services below, please select and we will provide you with a quote.

Bank Account Application and document preparationBusiness License
If you selected business license, please state the nature of business and whether it’s home based or storefront.
E. Upload a Copy of Your Passport

Please upload related photographs and documents.
File Upload*

Cancelof
F. Upload a Copy of Your Address Verification of your home address.

Please upload related photographs and documents.
Cancelof
G. Upload a Copy of Your Address Verification of your business address if different from home address.

Please upload related photographs and documents.
Cancelof
H. Upload a Copy of Your NIB Smart card.

Please upload related photographs and documents.
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I. Declaration
I hereby declare that the information provided in this form is accurate and complete. I note that MackBeth Accounting and Corporate Services may require additional information and documentation from me upon request and I agree to provide such if requested. I confirm that any information is found incorrect and/or incomplete that leads a violation of regulations may initiate legal actions, and I accept that I am the responsible party for any and all charges, penalties and violations.
Name of the Applicant*

First NameLast Name
Signature of the Applicant*

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Date Signed

MonthDayYear
Date
For Office Use Only
Documents

Originals verified and Self-Attested Document copies received
Name of the Authorized Signatory

First NameLast Name
Signature of the Authorized Signatory

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Date Signed

MonthDayYear
Date
Should be Empty:

KYC Form

A. Identity Details

B. Home and Business Address Details

C. Company Information

D. Additional Services

E. Upload a Copy of Your Passport

F. Upload a Copy of Your Address Verification of your home address.

G. Upload a Copy of Your Address Verification of your business address if different from home address.

H. Upload a Copy of Your NIB Smart card.

I. Declaration

For Office Use Only