KNOW YOUR CUSTOMER (KYC) FORM

KNOW YOUR CUSTOMER (KYC) FORM
This Know Your Customer (KYC) form collects essential personal data from our customers to comply with legal and regulatory obligations, such as Anti-Money Laundering (AML) and tax transparency requirements (e.g., CRS, FATCA). Your information helps us prevent illicit financial activities and manage risk, ensuring a secure and compliant environment. All data is processed in accordance with North Carolina Identity Theft Protection General Statutes § 75-60 to § 75-67 and North Carolina Consumer Protection Laws § 75-1.1
CUSTOMER DATA
Legal Name / Full Name
Customer Type (Individual / Corporation)
Tax ID / EIN / SSN / Cédula
Country / City
Address
Primary Phone
Format: (000) 000-0000.
Corporate Email
example@example.com
DBA / TRADE NAME
Website
Business Activity (NAICS CODE)
Authorized Representative
Representative ID Document

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Shareholders / Partners with more than 25% ownerships:

Compliance & AML
Are you or your company currently subject to any sanctions, investigations, or regulatory enforcement actions? (Y/N)
Do you confirm that all funds, transactions, and business activities are conducted in compliance with applicable Anti-Money Laundering (AML) laws and regulations? (Y/N)
Can you certify that neither you nor your beneficial owners are listed on any international sanctions or watch lists (OFAC, UN, EU, etc.)? (Y/N)
Is the customer a Politically Exposed Peron(PEP)? (Y/N)
Does your organization agree to cooperate with ongoing compliance reviews and provide supporting documentation, beneficial ownership information, or regulatory disclosures upon reasonable request? (Y/N)
Declaration and Certification:
I hereby certify that all information provided in this form is true, accurate, complete, and provided in good faith to the best of my knowledge. I understand that any false, misleading, or incomplete information may result in the rejection of this application, termination of business relations, or further compliance review.
I further confirm that the organization complies with all applicable laws and regulations related to anti-money laundering (AML), tax transparency, anti-corruption, and regulatory compliance requirements.
Date:

MonthDayYear
Date
Customer Signature:
Should be Empty:

Financial Details