Express Gold Refining - Corporate Account Application

Corporate Account Application
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General Information

Please provide all required details to register your business with us
IncorporatedPartnershipSolo ProprietorshipNot-for-ProfitOther
*Please attach any registration document such as a Certificate of Incorporation, Master Business Licence, Partnership Agreement, etc
As per legal requirements, you must provide us with your Company Registration Document. Could you please upload these documents using this form?
Yes No*
Upload ID*

Driver's License or Passport
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Upload Company Registration Document*

Certificate of Incorporation or Master Business License
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I will ensure that the necessary documents are provided separately to fulfill the transaction process and meet all legal requirements.*
Registered Business Name*
Trade Name (If applicable)
HST Number*
Address*

Street Address

Country

CityState / Province

Postal / Zip CodeCountry
This is the primary location of the business
Yes No*
StoreMallWorkshopMelting Facility
Other:
Phone Number*
Format: (000) 000-0000.
Fax Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail*
example@example.com
By opening an account with us, you consent to us contacting you about your transaction and to provide you with company news and promotions. For more information, please see our privacy policy.
Description of the Nature of Business*
BullionGoldSilverPlatinumPalladiumMelted BarsJewelleryDiamonds and other precious stones.
Beneficial Ownership

List ALL person who own/control 25% or more of the corporation. Please use a separate sheet if necessary.
Name*

First NameLast Name
Ownership %*
Date of Birth*

MonthDayYear
Date
Phone Number*
Format: (000) 000-0000.
Home Address*
Authorized to deal?
Yes No*
Name

First NameLast Name
Ownership %
Date of Birth

MonthDayYear
Date
Phone Number
Format: (000) 000-0000.
Home Address
Authorized to deal?
Yes No
Directors

List ALL directors of the corporation. Please use a separate sheet if necessary.
Name*

First NameLast Name
Home Address*
Occupation*
Name

First NameLast Name
Home Address
Occupation
Persons Authorized to Deal for the Corporation

The following person(s) are authorized to deal (i.e. book trades, sign documents, etc) for the corporation:
Name*

First NameLast Name
Specimen Signature*
Name

First NameLast Name
Specimen Signature
Are any of the individuals listed in this application or their immediate family Politically Exposed Persons?
Yes No*
A politically Exposed Person is an individual who holds or has ever held one of the following offices or positions in or on behalf of a country: head of state or government; a member of the executive council of government or member of a legislature; a deputy minister (or equivalent); an ambassador or an ambassador's attaché or counsellor; a military general (or higher rank); a president of a state-owned company or bank; a head of a government agency; a judge, or a leader or president of a political party in a legislature. Politically Exposed Person also includes the following family members of the individual described above: mother or father, child, spouse or common-law partner, spouse's or common-law partner's mother or father and brother, sister, half-brother or half-sister (that is, any other child of the individual's mother or father).
Additional Information
Purchase of Precious MetalsSales of Precious MetalsRefining Services
Less than 20,00020,000 to 50,00050,000 to 100,000100,000 to 300,000300,000 to 750,000750,000 to 1,000,000over 1,000,000
DailyWeeklyMonthlyYearly
WireCashChequeCredit Card
Do you deal with transactions in cash over CAD 10,000.00?
Yes No*
Are you registered in FINTRAC?
Yes No*
Do you have an AML Program?
Yes No*
Additional Notes
Notice to Clients

To assist in preventing the financing of money laundering or terrorist activities, the Canadian government has passed the Proceeds of Crime (Money Laundering) and Terrorist Financing Act, which requires financial institutions, securities dealers, money service businesses and others to obtain, verify and record information that identifies persons or entities who engage in certain transactions with or through our company.

It means that for individuals, including individuals who purport to represent a corporate or not-for-profit client, Express Gold Refining Ltd. ("EGR") will verify, among other things, your name, residential or street address, date of birth and occupation. We may also ask to see a driver's license or other government-issued identifying documents from you and seek information about you from a credit-reporting agency.

For corporate or not-for-profit entities, this means that we will verify, among other things, beneficial ownership information and the purpose for which your account with us exists. EGR will also verify the identity of individuals authorized to provide instructions for the accounts of certain entities. We shall also require that certain information be kept up to date, including beneficial ownership information. We will also ask to see the constating documents for each corporate or not-for-profit entity.

By signing below, you authorize EGR to obtain personal information about you.
Signature*

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Name of Legal Representative or Owner*
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Corporate Account Application

General Information

Beneficial Ownership

Directors

Persons Authorized to Deal for the Corporation

Additional Information