Customer KYC Questionnaire

CUSTOMER KYC QUESTIONNAIRE AND AGREEMENT

Customer Name:   Company Name:

Effective Date: / /

WHEREAS

WHEREAS, Company Name: is engaged in providing customer due diligence, compliance screening, and business services; and

WHEREAS, Customer Name: seeks to establish a relationship and provide information necessary for identity verification, anti-money laundering screening, and regulatory compliance; and

WHEREAS, the parties desire to set forth the KYC information to be collected, the obligations of the parties with respect to confidentiality and accuracy of information, and the terms governing the use of such information.

KYC QUESTIONNAIRE

Individual    Corporation    Partnership    Trust    Other:

Day:   Month:   Year:

BENEFICIAL OWNERS

SOURCE OF FUNDS AND ACTIVITY

Savings   Salary   Investment Proceeds   Inheritance   Business Revenue   Loan   Other:

DOCUMENTS PROVIDED

Passport   National ID   Certificate of Incorporation   Proof of Address   Articles of Association   Other:

SCOPE OF WORK

PAYMENT TERMS

TERM AND TERMINATION

Term Start Date:

Term End Date:

CONFIDENTIALITY

Each party shall keep confidential all non-public information obtained from the other party in connection with this Questionnaire and Agreement. Confidential information shall not be disclosed except (i) as required by law or regulation, (ii) to employees, agents or professional advisers who have a need to know and who are bound by confidentiality obligations, or (iii) with the prior written consent of the disclosing party. The receiving party shall use at least the same degree of care in protecting confidential information as it uses to protect its own confidential information, but in no event less than reasonable care.

GOVERNING LAW

This Questionnaire and Agreement shall be governed by and construed in accordance with the laws of the jurisdiction specified below. Any dispute arising out of or in connection with this document shall be subject to the exclusive jurisdiction of the courts of that jurisdiction.

ENTIRE AGREEMENT

This Questionnaire and Agreement, together with any schedules or attachments expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations, understandings and agreements, whether written or oral. No amendment or modification shall be effective unless in writing and signed by authorized representatives of both parties.

DECLARATION AND CONSENT

The undersigned certifies that all information provided in this Questionnaire is true, accurate and complete to the best of their knowledge. The undersigned authorizes Company to perform identity verification, background, credit and anti-money laundering screening, and to retain copies of identification documents for compliance purposes. The undersigned will promptly notify Company of any material changes to the information provided.

I certify the information provided is accurate and I consent to the checks described above.

ACKNOWLEDGEMENTS

The Customer acknowledges that provision of false or misleading information may result in termination of any engagement, reporting to regulatory authorities, and refusal to provide services. The Company reserves the right to request additional documentation and to withhold services pending satisfactory completion of due diligence.

Sign Now