Finance Client Knowledge Form

FINANCE CLIENT KNOWLEDGE FORM

Client Identification

Client Name:

Entity Type

Please indicate applicable entity type(s):
Individual   Corporation   Trust   Partnership   Other

Beneficial Ownership (for entities)

Provide details for all beneficial owners holding 25% or more of ownership or control. If none, enter "None".

Tax Residency and Reporting

List all jurisdictions where the client is a tax resident, and corresponding tax identification numbers. Provide all that apply.

Source of Funds / Wealth

Indicate the principal source(s) of funds to be used in relation to the account or transaction. Check all that apply and provide estimated amounts and explanation where requested.

Employment income   Business income   Investments / Dividends   Inheritance / Gift   Other

Investment Profile

Income   Growth   Capital preservation   Speculation

None   Limited   Moderate   Extensive

Low   Medium   High

Compliance / AML / Sanctions Screening

The Client certifies that all information provided in this form is true, complete and correct. The Client authorizes the firm and its affiliates to verify any information provided, to perform identity verification, to conduct sanctions and watch-list screening, and to obtain such reports and records as necessary to satisfy applicable anti-money laundering and regulatory obligations. The Client understands that false or misleading statements may result in account restriction, closure, and reporting to competent authorities under applicable law.

Is the Client or any beneficial owner a senior foreign political figure, head of state, government official, or closely associated person (politically exposed person)?  Yes   No

Documentation Provided

Please indicate which of the following documents are being submitted with or have been previously provided to support this profile.

Government-issued photo ID
Proof of address (utility bill, bank statement)
Ownership or incorporation documents (articles, trust deed)
Recent bank statement
Tax documentation / tax identification evidence
Other supporting documents

Declarations, Consent and Certification

By signing below, the Client certifies, represents and warrants that: (a) the information provided in this form and in any accompanying documentation is true, accurate and complete; (b) the Client will promptly notify the firm of any material changes to such information; (c) the Client consents to the collection, use and retention of personal data in accordance with the firm's privacy and compliance policies for the purposes of account opening, regulatory reporting and ongoing monitoring; and (d) the Client understands that the firm may be required to disclose information to regulators or law enforcement where required by applicable law.

The Client acknowledges that the firm may take steps as it deems appropriate to verify identity and source of funds, including obtaining third-party reports, and that account activity contrary to representations made herein may result in account restriction, closure, and/or reporting to competent authorities.

Additional Remarks

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