Due-Diligence Onboarding Natural Person

POLITICALLY EXPOSED PERSON (PEP)

PEP is a Political Exposed Person who is, or has had at any time, in the past 5 years, a prominent public function, or who has been elected or appointed to such a function, its direct family members and close associates of the persons who are or have been charged with the listed prominent political functions as PEPs.

You are or have been a Politically Exposed Person (PEP)?:

SOURCE OF FUNDS (“SoF”) INFORMATION

1. Description of Revenue Source

The Source of the Funds is the following:

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:

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

Description of Source(s) of Wealth

Necessary Information

Please describe the requested information or refer to attachments (mandatory)

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

Name and address of company
Nature of company
Amount of annual profit
Copy of latest audited financial statement

Please specify:

name of lender
amount of loan
date received

Please specify:

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.

Color copy of valid passport of Client

Color copy of valid second identification document of Client, either driver's license or ID

Proof of permanent residence document - e.g. utility bill or government issued document - for local Aruban resident Censo Papel 5 florin (not older then 3 months)

Color copy of valid passport, driver's license or identity card of spouse

Source of Funds supporting documents

Source of Wealth supporting documents

Property documents (Kadastraal uittreksel, deed of purchase (provided by current owner), etc.) .If applicable..

STATEMENT

"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 declares that:

Has not been involved in, has not been convicted of or is under investigation anywhere in the world for offences related to the production, trafficking, consumption of drugs or any other offence associated with drugs; or money laundering.
I (we) confirm that I (we) have and verify the due diligence evidence of all beneficial owners, attorneys, beneficiaries, directors, officers and signatories of the services necessary for Integra and agree to provide such information and/or documentation requested by Integra.
I declare under penalty of perjury that this statement has been examined by me and is true, correct and complete to the best of my knowledge and belief.

Please complete the form and print and send signed to the e-mail [email protected]