Legal KYC Form

Legal KYC Form

This Legal KYC Form is made as of Date: between Client Name: with Registered Address: (Client) and Service Provider Name: with Registered Address: (Provider).

RECITALS

WHEREAS, the Provider requires certain identity, ownership, financial and compliance information from the Client to comply with applicable anti-money laundering, counter-terrorist financing, sanctions and related legal obligations;

WHEREAS, the Client agrees to provide complete and accurate information and supporting documentation to enable the Provider to perform client due diligence and ongoing monitoring;

WHEREAS, the parties intend that the information provided in this form will be relied upon by the Provider to determine compliance with applicable laws, regulations and internal policies;

NOW THEREFORE, in consideration of the mutual covenants set forth below, the parties agree as follows.

1. IDENTIFICATION

Individual    Corporation    Partnership    Trust    Other:

2. OWNERSHIP AND CONTROL

Provide the full legal names, dates of birth, nationality, residential addresses and percentage ownership of all natural persons who directly or indirectly own or control 10% or more of the Client, as well as any natural persons who exercise ultimate effective control. If none, state 'None'.

3. SOURCE OF FUNDS

Describe the anticipated nature and expected volumes of transactions, and the principal sources of funds or wealth to be used in relation to the Provider's services.

Employment income    Investments    Inheritance    Business revenue    Other:

4. AML / PEP / SANCTIONS

The Client must disclose whether the Client, any beneficial owner or any controlling person is a Politically Exposed Person (PEP), subject to sanctions, or has adverse media that may reasonably affect the Provider's risk assessment.

Politically Exposed Person (PEP)    If yes, explain:

Subject to sanctions or sanctions screening hit    If yes, explain:

Adverse media or reputational risk identified    If yes, explain:

5. IDENTIFICATION DOCUMENTS

Provide copies of official identification and corporate documents where applicable. At minimum, provide one government-issued photo ID for individuals and registration documents for entities.

Document Type: Passport    National ID    Driver's License    Registration Document

6. DATA PROTECTION AND CONSENT

The Client acknowledges that the Provider will collect, store and process personal and corporate data provided in this form for the purposes of compliance, risk assessment and the provision of services. The Client consents to such processing and to the disclosure of such information to competent authorities and third parties where required by law or necessary for compliance.

The Client hereby consents to the processing and disclosure of the information provided in this form for the purposes described above.

7. CERTIFICATIONS AND REPRESENTATIONS

The Client certifies and represents to the Provider, with respect to the information supplied in this form and any attachments, as follows:

All information and documentation provided are true, complete and correct to the best of the Client's knowledge and belief.

The person(s) signing this form have the authority to provide this information and to bind the Client.

The Client will notify the Provider promptly of any material changes to the information provided and will supply updates and additional documentation upon request.

8. USE OF INFORMATION AND CONFIDENTIALITY

Information supplied under this form will be treated as confidential and used solely for the purposes described in this form, subject to disclosures required by law, regulation, or competent authorities. The Provider shall implement commercially reasonable safeguards to protect personal data received from the Client.

9. GOVERNING LAW

This form and any dispute arising out of or in connection with this form shall be governed by the laws of:

10. ENTIRE AGREEMENT

This Legal KYC Form, together with any attachments and documents provided, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior statements, proposals and understandings, whether written or oral, relating to such subject matter.

11. SEVERABILITY

If any provision of this form is determined to be invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions shall not be affected or impaired.

12. NOTICES

All notices, requests, consents and other communications required or permitted under this form shall be in writing and delivered to the addresses set forth below or to such other address as either party may designate in writing.

13. AMENDMENTS; WAIVER; COUNTERPARTS

No amendment to this form will be effective unless in writing and signed by duly authorized representatives of both parties. Failure to enforce any provision shall not operate as a waiver of that provision. This form may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

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