Westwinds Source of Funds Statement

At Westwinds, we have a regulatory requirement to verify the source of money/assets introduced at any stage throughout the whole life of a relationship.

Please provide details of the activity that has generated the funds that are referenced within this form (e.g. your occupation, business activities, investment transactions or an alternative source).

We may need to request documentary evidence to support/verify the information provided in relation to the source of funds. If this is the case you will be informed accordingly.

Amount Currency

Amount

Remitting Bank Name

Account Name of the Bank Account

Date of Expected Transaction (if unknown please provide details below)

Date

Details

Source of Funds Origins (Please select all that apply)

Please describe the origin of the funds

Please be as descriptive as possible. Short answers such as 'Salary' or 'Proceeds of Sale' will not be accepted.

List jurisdiction(s) from which these funds originate (Please select all that apply)

I confirm that the information contained in this form represents the true source of funds

Signature

Full Name

First NameMiddle NameLast Name

Role / Position

Please state details of your role / position if you are completing this form on behalf of a client

Please verify that you are human

Source of Funds Declaration