GIG Wealth Questionnaire for Natural Persons

Questionnaire for Natural Persons
Personal Information
Full Name*

PrefixFirst NameMiddle NameLast NameSuffix
Identity or Passport Number*
Citizenship or Permanent Residence*
Copy of ID or Passport*

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Do we have permission to externally verify your identity?*

YesNo
Physical Address (Main Residence)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Proof of Residence (If you don’t have proof of your residential address in your name, please request a separate form for you to fill in).*

Proof of residence document (within last 3 months)
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Email address*
example@example.com
Mobile Phone Number*
South African Income Tax Number*
Please attach a confirmation of Bank Account from your bank*

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Current employment status*

Salaried employeeSelf-employedRetiredStudentUnemployedMinor
Employers Name (if appliocable)
Occupation (if appliocable)
Employement Industry (if applicable)

Activities of religious, political and extraterritorial organisations/bodies:All security, safety and defense activities (private or government):All trade (wholesale, retail etc.) in gold, metals, diamonds, pearls and other precious/semi-precious stones:Cryptocurrency:Extraction of crude petroleum, natural gas:Foreign affairs and representatives of foreign countries:Gambling and betting activities:Growing, manufacture, wholesale or retail sale of tobacco and tobacco products:Manufacture of basic chemicals, fertilisers, nitrogen compounds pesticides explosives and pyrotechnic products:Manufacture of refined petroleum products:Manufacture of weapons, ammunition and military fighting vehicles:Manufacture, trade in or articles of fur/leather:Mining:Other:Public administration at national, provincial or local government level:Refining of precious metals, e.g. gold, silver and platinum:
Source of Income*

Income from employmentMaturing investments/encashments claimPensionInheritanceDirector/Owner of BusinessLoanAsset sale/Company sale/Sale of an interest in a CompanyDivorce settlementCourt orderGift/DonationDirector/Member of Company/CCLotteryGambling/Lottery winningsOwn Company profitsMaintenanceLoanDividend from InvestmentsAllowanceBursaryOther
Is the transaction linked to a proposed forex transaction?*

YesNo
If yes - Type of forex transaction

Forex – Single Discretionary AllowanceForex – Foreign Investment AllowanceForex – Inward FundsForex – RepatriationLitigationUnit trustSharesDerivativesFinancial PlanningRisk ProductsEntityEstate LateEndowmentTax Free InvestmentRetirement AnnuityLiving AnnuityPreservation FundOffshore InvestmentMedical AidEmployment BenefitsLife InsuranceUmbrella Retirement FundBusiness InsuranceShort Term Investment PlanningReview of Investment PortfoliosProperty TransactionBond RegistrationVehicle PurchaseCredit AgreementStaff Screening – Compliance/Legal (that can alter policies)Staff Screening – Managers Responsible for Onboarding of ClientsStaff Screening – Managing Director/CFO/CEOStaff Screening – Manager/Financial Manager/Senior AccountantStaff Screening – Financial Officer/Junior Accountant/AssistantStaff Screening – ITC ExecutiveStaff Screening – Clerical Staff/Data Capture/Admin StaffStaff Screening – Information Officer/Data StewardHigh Value GoodsTax ReturnReal Estate RentalNotarial ServicesCommercial MatterStaff Screening Managers responsible for onboarding of clientsStaff Screening Compliance/Legal (that can alter policies)Intermediary Financial ServicesFinanceLOANLendingRepayment AgreementDebtors FinanceProject Loan
Transaction Frequency*

Single TransactionMultiple Transactions
Source of Funding/Wealth*

AllowanceBeneficiary of TrustBondBudgetBursaryCompany ProfitsCompany Sale or Sale of Interest in CompanyCourt OrderCryptocurrencyDealer in High Value GoodsDeceased EstateDirector/Member of Company/CCDirector/Owner of own BusinessDividendsDivorce SettlementEncasement ClaimGift/DonationIncome from EmploymentIncome from Previous EmploymentInheritanceLeviesLoanLottery or Gambling WinningsMaintenanceMaintenance FundMaturing InvestmentsNew InvestmentsPensionPrivate Capital RaisePublic Capital RaiseRental IncomeReserve FundSale of Asset/PropertySale of AssetsSale of SharesSavingsStaff ScreeningSurplus Levy
Principals Information

(If you are contracting with GIG Wealth on behalf of another person (i.e. a principal), please complete the section below.
If you are contracting with GIG Wealth in your personal capacity then please ignore this Principals Information section.)
Principals Full Name

First NameMiddle NameLast Name
Principals Identity or Passport Number
Principals Citizenship or Permanent Residence
Copy of Principals ID or Passport

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Principals Physical Address (Main Residence)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Principals Proof of Residence

Utility bill (within last 3 months)
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Principals Email address
example@example.com
Principals Mobile Phone Number
Principals South African Income Tax Number
Authorisation documents to act on behalf of Principal

Power of Attorney or similar
Cancelof
Services Required

from GIG Wealth
Please select one or more of the following-*

Life coverShort term coverWill and TestamentCash ManagementPortfolio ManagementInvestmentOther
How will any payments to GIG Wealth or other parties be financed?*
e.g. bank transfer, cash, etc.
Will any of the payments be a cash payment of R 50 000.00 or more?*

NoYes
Governance Questions
Do you occupy, or have you occupied (in the last 12 months), in a country other than South Africa, any of the following positions?*

Head of StateMember of Royal FamilyCabinet MemberSenior member of a political partySenior Judicial OfficerSenior Executive of a state-owned entityHigh rank in the militaryNone of the above
Do you occupy, or have you occupied (in the last 12 months), in South Africa, any of the following positions?*

President or Deputy PresidentCabinet minister or deputy ministerPremier of a provinceMEC of a provinceMayor of a municipalityLeader of a political partyMember of a royal familySenior traditional leaderHead, accounting officer or CFO of a national or provincial departmentManager or CFO of a municipalityChairperson, CEO, accounting authority, CFO or chief investment officer of a public entityJudgeAmbassador, high commissioner or other senior representative of a foreign country based in South AfricaChairperson of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the governmentNone of the above
Do you, a family member or a close associate have a relationship with any of the people in the last two questions?*

YesNo
Please name the person with whom there is a relationship (above).
What position does this person occupy?
If you answer Yes to any of the above Governance questions, please indicate your source of wealth.
Signature*

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