Submission Successful!

In accordance with Article 6, you, as our client, are required to complete the following form. This form is an essential compliance measure to ensure adherence to the legal and regulatory obligations that govern our services. It is designed to collect specific information that helps us in conducting due diligence, mitigating risks, and maintaining the integrity of our operations in line with established norms. We kindly ask for your detailed and accurate responses to each query presented. Your cooperation is vital in helping us fulfill our commitment to regulatory compliance and overall service excellence. Please proceed to fill out the form as instructed.

Please provide a concise summary of of the legal service you are contracting from the above mentioned firm.

Please provide the contact name, address, and contact information for the individual person involved in this transaction.

Please select the option that best describes your current employment situation

Please select the option that best describes your Spouse/Partner's current employment situation

"I DECLARE THAT THE INFORMATION CONTAINED IN THIS FORM IS TRUE, COMPLETE AND PROPORTIONATE. RELIABLE AND UP-TO-DATE INFORMATION ON ALL ASPECTS ON WHICH QUESTIONS HAVE BEEN ASKED."

The applicant hereby declares that they:

Have not been involved in, convicted of, or are currently under investigation anywhere in the world for offenses related to the production, trafficking, or consumption of drugs; or any other crime associated with drugs; additionally, they have not been involved in or convicted of money laundering.

Confirm that they have performed and verified the due diligence evidence for all beneficial owners, attorneys, beneficiaries, directors, officers, and signatories of the services required by INTEGRA, and agree to provide any additional information and/or documentation requested by INTEGRA.

Solemnly declare, under penalty of perjury, that this statement has been thoroughly examined and, to the best of their knowledge and belief, is true, correct, and complete.
By submitting this statement, the applicant acknowledges their understanding of the legal implications and potential consequences of providing false or misleading information.