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Customer Information Sheet
Dear Sir,In accordance with Articles two (2) through five (5) of the Due Diligence Convention and the Federal Banking Commission Circular of December 1998, concerning the prevention of money laundering, and Article 305 of the Swiss Criminal Code, the following information may be supplied to banks and/or other financial institutions for the purpose of verification of identity and activities of the investing Member, and the nature and origin of the funds that are to be utilized. All parties have an obligation to respect professional secrecy and to take all appropriate precautions to protect the confidentiality of the information each holds in respect of the others’ activities. This legal obligation shall remain in full force and effect at all times.
Client Information
Client/Signatory Name:
*
Nationality:
*
Passport Number:
*
Date of Issue:
*
Expiration Date:
*
Issued by:
Date of Birth:
*
Place of Birth:
*
Email
*
Home Information
Street address:
*
City
*
State
*
Zipcode
*
Telephone:
*
Skype:
Business Information (if company)
Business Name:
Street address:
Registered Office:
Registered Number:
Telephone:
Legal Advisor Name:
Legal Advisor address:
Mailing Address Information
Street address:
*
City
*
State
*
Zipcode
*
E-Mail Address:
*
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