Non-Personal Customer Data Sheet

FOR OFFICIAL USE ONLY
SBS Account # / DEPEND Account #

SECTION A – To be completed by all Applicants

(I) Company Information

Registered Business Name
Business Address
Business type /  Sole Trader /  Partnership /  Charity
 Limited Liability /  Non-Profit Organization /  Club
 Association /  Trust

The above addressmust be supported by one of the following original documents: (please indicate which is presented)

WASA bill T&TEC bill TSTT (landline) bill Cable bill Other(the utility will need to be installed at the customer’s home address)

Note: The document submitted must be dated within the past six (6) months to the registered address for the company

Company Contact Information:
Telephone / E-mail address/ website
Country of Incorporation/Registration / Registration date

(II) Understanding the relationship

(i) Purpose for opening account
(E.g. sales, donations, membership dues etc.)
(ii) Nature of business/
Type of business activity
(iii) Source of Funding / (E.g. area of expertise)
(iv) Principal Products
(v) Primary Suppliers
(vi) Risk Profile:
Low
Moderate Speculative
High Risk / (vii) Investment Objectives:
Income
Long Term
Short Term /
(viii) Estimated level of / $ / $
activity annually / Purchase of Shares / Sale of Shares

(III) Company Documentation

Please provide the followingoriginal company documentation based on the business/organization type:

(Kindly tick the appropriate box if document is being provided)

(A) Company / Registered Business / (B) Partnership / To be provided by Organizations A-D
 Articles of Incorporation/ Certificate /  Certificate of Partnership /  Audited Financials / Management
of Continuance / Partnership Agreement / Accounts (for the last three (3)
 Certificate of Incorporation / Customer Profile forms for each / years)
 Notice of Directors / Partner /  BIR Tax Registration document
 Notice of Secretary / (C) Registered Soler Trader / Start- up entity- an opening Balance
 Notice of Address/ Notice of /  Certificate of Registration / Sheet & Cash Flow projections
Change of registered office /  Customer Profile form /  Banker’s Reference (applicable if no
 Company By Laws / Partner / Management Accounts held)
 Annual Return (last filed) / Non-Proft Organization/Trust/ /  Certificate of Registration of
 Company Stamp / Non-Governmental Organization / Business Name
 Minute / Board Resolution to open /  Articles / Charter of Incorporation /  Business website address (proof of
Account /  Annual return (last filed) / validation of address; if applicable)
Signed statement by Director /  Minute / Trustee / Board Resolution / Power of Attorney (if applicable)
outlining the nature of the Business / to open account / Evidence of submitted Foreign
 Copy of most recent AGM minutes / Investment Act information from
 List of Members / the Minister of Finance (applicable
for foreign investors only)

SECTION B – External Companies & Third Party Signatories (Power of Attorney)

(a) Will there be a Power of Attorney on this account?Yes  No 

If yes, (i) Name of Power of Attorney: ______

(ii) Please provide the Power of Attorney Deedor a notarized letter signed by Directors granting third party access

SECTION C – Listed Businesses & Non-Regulated Financial Institutions

Note:(i) Non-Regulated Financial Institutions include:Credit Unions, Building Societites, Postal Services and Cash Remitters

(ii) Listed Businesses include: Real Estate Agents, Motor Vehicle Agents, GamingHouses,Pool Betting, National Lotteries On-Line Betting Games, Jewellery Business, Private Member’s Clubs, Accountants, Attorneys-at-Law/other Independent Legal Professionals, Art Dealers, Trust and Company Service Providers

Is the company a Listed Business or Non-Regulated Financial Insititution?Yes  No 

If yes, the following documentation is required: (please indicate which are provided)

 / Proof of Registration as a Listed Business/Non-Regulated Financial Institution with the Financial Intelligence Unit of Trinidad and Tobago
 / Please complete the following checklist, confirming whether a Compliance Program exists and is in line with the Proceeds of Crime Act.
No. / COMPLIANNCE PROGRAMME QUESTIONNAIRE / YES / NO
1 / Does your institution have a written policy designed to prevent money laundering, which is in keeping with the AML criteria? If yes, kindly enclose a copy of the policy document with this form. /  / 
2 / Has a Compliance Officer been appointed responsible for the anti-money laundering (AML) program? /  / 
3 / Is there an annual staff AML training programme in place? /  / 
4 / Are your AML procedures documented, ensuring compliance with AML regulations? If yes, kindly enclose a copy of the AML procedures document with this form. /  / 
5 / Does the institution conduct an annual internal audit that includes a review of the Compliance Programme and AML policies and procedures? /  / 
6 / Do you record customer information and retain all records for a period of 5 years or more? /  / 
7 / Do you verify the identity of the customer's and retain documentary evidence of same? /  / 
8 / Do you have a “Know Your Customer” programme that is in keeping with the AML criteria? /  / 
9 / Do you report suspicious transactions? /  / 
10 / Do you log and file records of AML issues raised? /  / 

SECTION D – To be completed by Company/Registered Business (Limited Liability)

(I) Verification of Shareholders holding over 10% of total shares

Name of Shareholder/ Nominee Shareholder / % Shareholding held / National ID/DP/PP#/ Registration # / ADDRESS: (please provide documentary evidence)

Please provide the following documents for all Shareholders and /or Nominee Shareholders named above.

  1. Two forms of National Identification (National ID Card, Passport, Driver’s Permit)

  1. Utility Bill (WASA Bill, T&TEC Bill, TSTT Landline, Cable Bill)
Note: The document submitted must be dated within the past six (6) months and addressed to the sharholder. If the Utility bill is not in shareholder’s name, please attach an authorization letter signed by the Utility owner along with a copy of their identification.

SECTION F – To be completed for all Applicants

(I)Verification of Directors/Signatories/Sole Traders/Partners/Power of Attorneys/Key Functionaries/ Members of the Governing Body or Board of Trustees

Name of Individual / Postion / Signatory
Yes  No 
Yes  No 
Yes  No 
Yes  No 
Yes  No 
Yes  No 
Yes  No 
Yes  No 
Yes  No 
Yes  No 

Please provide the following documents for the individuals listed above;

  1. Two forms of National Identification (National ID Card, Passport, Driver’s Permit)

  1. Utility Bill (WASA Bill, T&TEC Bill, TSTT Landline, Cable Bill)
Note: The document submitted must be dated within the past six (6) months and addressed to the sharholder. If the Utility bill is not in shareholder’s name, please attach an authorization letter signed by the Utility owner along with a copy of their identification.

SECTION G - Other

(a) Has any person listed in Section Fabove been entrusted with a local/foreign public functionYes  No 

within the past five (5) years?

(Examples of Public Functions include: Head of State/Government, Senior Government Official[1], Senior Politician[2],Senior Executive of State-owned corporations[3], Military Official, Judicial Official, Important Political Party Officials[4], Senior Official of an International Organization)

(b) If yes, please indicate the public function(s) and term(s) of service______

______

______

SECTION H - Rule/ Policy Attachments

Did you receive a copy of the following policies?

Confilct of Interest Rule / Yes No
Fairness in Allocation Policy / Yes No

I/ We confirm that the information provided on this form is true and correct.

Customer Signature / Date (dd/mm/yyyy) / Customer Signature / Date (dd/mm/yyyy)
Customer Signature / Date (dd/mm/yyyy) / Customer Signature / Date (dd/mm/yyyy)
Customer Signature / Date (dd/mm/yyyy) / Customer Signature Date (dd/mm/yyyy)
Organizational Stamp
FOR RSL USE ONLY
Additional Comments:
Investment Advisor / Date (dd/mm/yyyy) / Manager / Date /mm/yyyy)

Rev (01/18) Page 1 of 3

[1] Senior Government Official – Permanent Secretary or an individual holding equivalent positions in a foreign country

[2] Senior Politician – Senators, Ministers of Parliament, Mayors

[3] Senior Executive of State-owned corporations – Chairman, Deputy Chairman, President or Vice President of the Board of Directors, Managing Director, General Manager, Comptroller, Secretary, Treasurer

[4]Important Political Party Official – Chairman, Deputy Chairman, Secretary, Treasurer