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?
Second name choice
Third name choice
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.
Cancelof
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
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
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