• Westwinds Offshore Services

    Personal Questionnaire and Declaration

    Please complete all sections in full. We have the utmost respect for the confidentiality of our clients, but we have an overriding statutory duty towards the prevention of terrorist financing and money laundering which means we are committed to identifying our clients and undertaking thorough client due diligence.

  • Identity Details

  • Have you previously gone by another name or frequently use another name?*
  • Are you a dual national?*
  • Date of Birth*
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  • Addresses

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    Current Residential Address
  • Is this address the same as your correspondence address?*

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    Previous Residential Address

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    Correspondence Address

  • Contact Details

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  • Additional Contact 1
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  • Additional Contact 2
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  • Additional Contact 3
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  • Additional Contact 4
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  • Employment and Experience

  • Type a question*
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  • Source of Wealth and Source of Funds

    Please provide as much detail as possible and provide documentation to support. Further Documentation may be requested if required
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  • Declarations

    Please answer the following questions
  • Has a court or other authority ever disqualified you from acting as a director of a company, or from acting in the management or conduct of affairs of any company, partnership or association or has a court ever removed you as a trustee?*
  • Is there any outstanding civil litigation against you or any company of which you are an officer?*
  • Have you, in any capacity, ever been censured, disciplined or publicly criticized by a Court of Law or by any officially appointed enquiry or by any professional or regulatory body or trade association which you have belonged, or been the subject of a regulatory order or direction?*
  • Have you ever been declared or has a court ever adjudged you bankrupt or have any money judgements been made against you, which have not been satisfied in full?*

  • Politically Exposed Persons (PEPs)

  • Are you a Politically Exposed Person?*

  • A Politically Exposed Person includes:

    • A head of state, head of government, minister, deputy minister, or assistant manager
    • A senior government or local government official
    • A member of a national legislature
    • A senior politician
    • An important political party official
    • A senior judicial official
    • A member of a court of auditors or the board of a central bank
    • An ambassador, chargé d'affaires, or other high-ranking officer in a diplomatic service
    • A high ranking officer in the armed forces
    • A senior member of an administrative, management, or supervisory body of a State Owned Enterprise (SOE)
    • A senior official in a international entity or organisation
  • Is an immediate family member a Politically Exposed Person?*

  • Immediate family members include:

    • a spouse
    • a grandparent
    • a grandchild
    • a partner considered by national law as equivalent to a spouse
    • a child or the spouse or partner of a child
    • a brother or sister (including a half-brother or half-sister)
    • a spouse or partner of a brother or sister (including a half-brother or half-sister)
    • a parent
    • a parent-in-law
  • Is a close associate a Politically Exposed Person?*

  • Close associate includes any natural person who:

    • is known to have joint beneficial ownership of a legal entity or legal arrangement, or any other close business relations, with such a persona grandparent
    • has sole beneficial ownership of a legal entity or legal arrangement which is known to have been set up for the benefit of such a person
    • who is known to be a beneficiary of a legal arrangement of which such a person is a beneficial owner or beneficiary
    • who is known to be in a position to conduct substantial financial transactions on behalf of such a person
  • Please select all of the applicable categories and provide details - For a relative or close associate, select the categories that apply to the family member or associate*

  • Declaration of Tax Residence

  • We are obliged under the Isle of Man Income Tax Act 1970, Regulations, Guidance Notes made pursuant to that Law and Treaties and Intergovernmental Agreements entered into by the Isle of Man in relation to the automatic exchange of information for tax matters (collectively ’AEOI‘), to collect certain information about each account holder’s tax status. Please note that we may be obliged to share this information with relevant tax authorities. Terms referenced in this form shall have the same meaning as applicable under the relevant Isle of Man Regulations, Guidance Notes or Agreements. If any of the information below regarding your tax residence or AEOI classification changes in the future, please ensure you advise us of these changes promptly. For further guidance, we advise you to refer to the OECDs CRS Commentaries, the OECD AEOI Portal, the Isle of Man’s FATCA and/or CRS guidance or contact your tax advisor.

    • Jurisdiction 1 
    • Jurisdiction 2 
    • Jurisdiction 3 
    • Jurisdiction 4 
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    • Declaration of US Citizenship or Residence for Tax Purposes

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    • Declaration and Undertakings

    • By submitting this form, I declare that the information provided in this form is, to the best of my knowledge and belief, accurate and complete. I undertake to advise the recipient promptly within 30 days where any change in circumstances occurs which causes any of the information contained in this form to be inaccurate or incomplete. I confirm that I have read and agree to the Westwinds Privacy Policy which can be found on our website and that a copy of this form can be sent to me by email. I understand that the recipient may be obliged to share this information with the relevant tax information authorities.

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