Full Name | |
Residential Address
| |
Telephone Home | |
Telephone Work | |
Telephone Mobile | |
Date of Birth | |
Place of Birth | |
Passport Number | |
Nationality | |
Principal Occupation | |
Tax residency, jurisdiction | |
Tax identification number | |
Source of Wealth Please describe your sources of wealth eg: inherited wealth – explain approx. amounts and from whom, earned income – explain salary from role and give employer and period, proceeds of sale of business – explain which business, when and approx. amounts etc.) | |
Note that the verification requirements listed below are the minimum initial due diligence requirements. We will carry out independent checks and enquiries on the individuals and reserve the right to request further information or verification documentation at any stage in the process.
I confirm that I have completed the above form and the information is accurate
_________________________ __________________________
SIGNED DATE
Verification of Identity
Acceptable documents:
- Passport
- Driving Licence (photocard type only)
Please provide a certified and clearly legible copy of the photo page at the back of passport or other document, ensuring that all parts of the page are visible in the copy and that the photo can be seen clearly. The certifier should meet the individual at the time the documents are certified and so state in the certification.
The wording for the certification of the passport should be as follows:
“I certify that this is a true copy of the original, and that the photograph is a true likeness of [ Name ], who presented the original document to me at [ place ] on the [ ] day of [ ] 202x”
The certifier should then sign and date the copy document (printing their name in capitals underneath) and indicate their occupation and /or professional qualification and provide their contact details.
Verification of Current Residential Address
Acceptable documents:
- Utility Bill
- Bank Statement
The document to prove address must be dated within three months
The original document can be provided or a certified true copy with the certification worded as follows:
“I certify that this is a true copy of the original taken on the [ ] day of [ ] 202x.”
The certifier should then sign the certification and print their name and occupation and/or professional qualification and contact details. The certification should then be dated.
In the event that the document is not in the English Language we will need to translate it/ arrange to have it translated
Suitable Persons to Certify documents
Acceptable persons to certify evidence of identity (suitable certifiers) include:
- a lawyer, an accountant or notary public
- an officer of an embassy, consulate or high commission of the country of issue of documentary evidence of identity;
- a director, officer, or manager of a regulated financial services business which is operating in a well-regulated jurisdiction