CLIENT’S LETTERHEAD, WITH FULL CONTACT DETAILS
(Address, Phone, Fax and E-mail Address)
SPECIAL HIGH-YIELD GLOBAL R/20 TRADING INITIATIVE
Number 3.0, Second Quarter, 2012
PLEASE ANSWER QUESTIONS FULLY AND ACCURATELY
IF INFORMATION IS DIFFERENT THAN AS SET FORTH BELOW, CORRECT AS REQUIRED
(Please delete this box in the final document)
Date:
To: The Coordinator
Global R/20 Trading Initiative
Re: Application (Gold Bullion)
I, _____________, an individual (or Title, on behalf of name of Company, where applicable), and the account signatory, wish to participate in your structured private financial opportunity, subject to acceptance of contract.
I hereby submit the following information for your consideration. I understand that this information will be relied upon, unconditionally, as statements by me of material fact.
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1) Please describe, in detail, your primary business activity?
ANSWER:
2) What is the nature and current valuation of the bullion metal available for placement in the Program?
ANSWER:
3) Please provide the full name and location of the bank or outside bank-controlled security facility where the bullion is held. Note: The bullion metal must be held in secure safekeeping, with full bank responsibility, in a bank vault or outside warehouse storage facility under the care, custody and control of a major, bank.
ANSWER:
4) Are you the sole account signatory on the bullion account? Where a multiple-signature account, please list the names and titles of ALL account signatories, and the dates each was placed on the account.
5) Are you willing to permit the trading platform to confirm and validate the availability of your bullion metal (and the “good-standing” status of your account) on a bank-to-bank basis? .
ANSWER:
6) How long has the bullion metal been on deposit in the bank or warehouse facility?
ANSWER:
7) Are there any fees or charges due and payable for storage or for any other reason? If so, please explain in detail:
ANSWER:
8) Are you the sole legal and beneficial owner/title holder of the bullion metal - i.e. the genuine and true owner of the bullion metal who has ACQUIRED the bullion metal himself through his own legitimate business activities or INHERITED the bullion metal as legal beneficiary? If not, please explain in detail:
ANSWER:
9) Please describe, IN DETAIL, the business activity by which the bullion metal was acquired by you. Alternatively, if the bullion product represents inherited assets, please so state:
ANSWER:
10) Is the bullion metal under your complete control, free of any restrictions, third-party interests or encumbrances, free of any independent third-party management and immediately available and FREELY TRANSFERABLE upon your sole instructions? Note: Our procedures do not require you to transfer the bullion metal.
ANSWER:
11) Did you acquire the bullion metal yourself by putting up your own cash funds? If otherwise, please describe.
ANSWER:
12) Is the bullion metal leased or borrowed, or has the bullion metal been assigned or pledged to you by a third-party for collateral, credit enhancement or investment purposes? If “yes”, please describe fully.
ANSWER:
13) Is the bullion metal “PRE-BLOCKED” by the bank or security facility, or is your ability to use the precious metal for investment purposes restricted in any way?
ANSWER:
14) Does the bullion metal represent pooled, aggregated, syndicated or invested assets belonging, in whole or in part, to other third-party owners? If “yes”, please describe fully.
ANSWER:
15) Are there any other persons/entities that have an ownership or financial interest in the bullion? If “yes”, please describe fully.
ANSWER:
16) Have you entered into a joint venture, project funding agreement, partnership, profit-sharing scheme, asset management agreement or other contractual arrangement with any third party – or anyone claiming to represent our organization - regarding your participation in the Program? If “yes”, please describe fully.
ANSWER:
17) Are you willing to instruct your bank to block/reserve your gold bullion for the period of the trading operation and to confirm the same, “bank-to-bank”, to the platform bank – and is your bank willing to cooperate fully in this undertaking? No SWIFT’s
ANSWER:
18) Do you speak and read English? If not, what language(s) do you speak and read?
ANSWER:
19) Are you personally available - by telephone, e-mail, or sit-down meeting, if necessary - to assist the transaction?
ANSWER:
20) Have you received a copy of the Global R/20 Trading Initiative Information Package for your review and consideration?
ANSWER:
21) Are you aware that commissions - equivalent to four percent (4%) of the client’s earnings – are expressly reserved to Consultants, to be shared amongst all Consultants, and that you are NOT required or expected to pay any other fees, commissions or Program earnings to Consultants?
ANSWER:
22) Are you aware that profit-sharing/fee arrangements of any description - such as partnership or joint ventures, asset management schemes, project funding agreements and the like - between clients and Consultants are NOT permitted under the Program and that you are not required or expected to share (or split) your Program earnings with any other third parties?
ANSWER:
I hereby swear, with full legal responsibility, that the information provided herein has been prepared and executed by me and is true, accurate and complete. I understand that any omissions or false or misleading statements – or the submission of false or fraudulent documents - may subject me to the full weight of sanctions under the law.
MUST BE SIGNED IN BLUE INK ONLY
SIGNATURE MUST BE NOTARIZED BY NOTARY PUBLIC OR WITNESSED BY LAW FIRM
Signed:
_________________________________ ____________________
Name of Client/Account Signatory Date
Title (where applicable)
Passport Number
Country of Issue
Date of Expiration
Client’s “Working” Contact Details:
Telephone Number: +
“After Hours” Telephone Number: +
E-Mail Address:
Skype Username:
NOTARY PUBLIC / LAW FIRM (ATTESTATION)
I hereby attest that I am witness to the signature of ______________ made this ____th day of _______ , 2012 who personally appeared before me this date, and whose identity was proved to me, on the basis of satisfactory evidence, to be the person whose name is subscribed to this document.
Signed:
_________________________________ ____________________
Name Date
Company
Professional Qualifications
Address
Telephone Number
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