Multistep form

GENERAL INFORMATION:

TRANSACTION INFORMATION

Client type?

Real Estate Agent Name

Property Description

CONTACT INFORMATION

Company name?

Phone

Trade name

Registered address

Country of Registration

Registration number

Country of Incorporation

Date of Incorporation

Name of contact person

Position

Contact email

Company Website(if available)

BOARD OF DIRECTORS:

DIRECTOR 1:

Physical person Company

Full Legal Name (as on passport) ^*

Passport Number ^*

Expiration date Passport ^*

Identification Number ^*

Tax ID Number ^*

Address ^*

Country of Residence ^*

PEP ^*

PEP Status

DIRECTOR 2:

Physical person Company

Full Legal Name (as on passport) ^*

Passport Number ^*

Expiration date Passport ^*

Identification Number ^*

Tax ID Number ^*

Address ^*

Country of Residence ^*

PEP ^*

PEP Status

DIRECTOR 3:

Physical person Company

Full Legal Name (as on passport) ^*

Passport Number ^*

Expiration date Passport ^*

Identification Number ^*

Tax ID Number ^*

Address ^*

Country of Residence ^*

PEP ^*

PEP Status

SHAREHOLDERS:

Controlling shareholder:

Physical person Company

Full Legal Name (as on passport) ^*

Passport Number ^*

Expiration date Passport ^*

Identification Number ^*

Tax ID Number ^*

Address ^*

Country of Residence ^*

PEP ^*

PEP Status

Other Shareholder:

Physical person Company

Full Legal Name (as on passport) ^*

Passport Number ^*

Expiration date Passport ^*

Identification Number ^*

Tax ID Number ^*

Address ^*

Country of Residence ^*

PEP ^*

PEP Status

Other Shareholder:

Physical person Company

Full Legal Name (as on passport) ^*

Passport Number ^*

Expiration date Passport ^*

Identification Number ^*

Tax ID Number ^*

Address ^*

Country of Residence ^*

PEP ^*

PEP Status

SOURCE OF FUNDS (“SoF”) INFORMATION

1. Description of Revenue Source

The Source of the Funds is the following:

Salary
Business
Loan
Investment
Income
Inheritance
Other revenue:

Other revenue

Please provide a detailed description of the source of the funds (e.g. if you checked the option ‘loan’ you should confirm the name of the Bank / financial institution that is extending the loan and the total amount of the same, if this is ‘salary’, the name of your employer, the nature of the company etc.):

2. The Transfer has been done from the following account:

Name of the Bank

Address of the Bank

Name account holder

Account number

Copy of recent bank or investment portfolio statement, where the funds will be transferred from (required if buyer):

3. The funds are to be used for:

4. Third Party Declaration (if applicable)

When paying by a third party (including a (your) legal entity), we must fully identify this third party. In addition, we need a statement explaining the reason why this third party is paying on your behalf. Lastly, we need underlying documents (in many cases for example a loan agreement).

The funds have been transferred on behalf of:

the undersigned
a 3rd party, namely (full name 3rd party)

SOURCE OF WEALTH (“SoW”) INFORMATION

Confirmation Sources of Wealth

SOURCE OF WEALTH (“SoW”) INFORMATION

Description of Source(s) of Wealth	Necessary Information	Please describe the requested information or refer to attachments (mandatory)
Family fortune	Specify: e.g. (former) entrepreneurial, inheritance, other resources; if possible detailed and documented description
Active entrepreneurial	Company name Short description of business activities Statutory seat Name company website (if applicable)
Former entrepreneurial	If “sold to a third party”: Name of purchaser and approximate date If other: Detailed and documented description
Business Profits	Name and address of company Nature of company Amount of annual profit Copy of latest audited financial statement
Loan	name of lender amount of loan date received
Sale of Property	Sold property address Date of Sale Total Sale amount

Please provide us copy of the relevant information and supporting documentation, which support the sources of wealth that have been mentioned by you.

The following documents have been sent to support the above:

DOCUMENTATION REQUIRED

Only files type jpeg, png, pdf, xls or xlsx. Max 1Mb per file

corporate documents required

Certificate of Incorporation (if applicable)

Articles of Incorporation

Certificate of Goodstanding (if applicable)

Share register or similar (K-1 and 1020/1160 form, list of members)

Chamber of Commerce extract or similar (e.g. certificate of incumbency)

Source of Funds Documents

Annual return (most recent)

Bank Statement of bank account where funds will be paid from (most recent)

Bank Mortgage Loan documents (if applicable)

Source of Wealth Documents

Financial Statements