CURRENCY TRANSACTION
Know Your Client (KYC)
Date: ______
“Note: Information must be typed – hand written KYC document will NOT be accepted”
PERSONAL INFORMATION – ensure the ID used has NOT expired
Full Name:
Current Home Address:
Primary Phone Number:
Fax Number:
Personal email Address:
Passport Number- Country :
ORDriver License Number:
Date of Issue :
Expiration Date:
Who Referred you:
SS, SIN or other Number:
Country Issued By:
Date of Birth:
Place of Birth:
BUSINESS INFORMATION If Client (if using a registered Business)
Company Name:
Company Address:
Registration Number:
Registered Office Address:
Employer Identification Number (EIN):
Company Telephone Number:
Company Fax Number:
Company Email Address:
Company Website Address:
BANKING INFORMATION – all fields are mandatory and must be filled in
Account Name:
Name of Bank:U.S. banking info goes here
Bank Address:Credit Unions can be used
Bank Account Number:
SWIFT Code:
ABA Routing Number:
IBAN Number:
Transit & Bank Institution Numbers:
Bank Officer Name and Title:
Bank Officer Phone Number:
Bank Fax Number:
Bank Officer Email Address:
Banks Special Wiring Instructions:
BANKING INFORMATION for second bank– all fields are mandatory and must be filled in
Account Name:(You can put “Leave in Hong Kong”) if you need
Name of Bank:time to set up financial structures)
Bank Address:
Bank Account Number:
SWIFT Code:
ABA Routing Number:
IBAN Number:
Transit & Bank Institution Numbers:
Bank Officer Name and Title:
Bank Officer Phone Number:
Bank Fax Number:
Bank Officer Email Address:
Banks Special Wiring Instructions:
Personal Documentation Required
1.Notarized KYC).
2.NotarizedPhoto ID(passport or driver license)–must be color copy. If not available than 2 notarized government issued documentswith photo.
ADDITIONAL documentation for company
1.Notarized KYC withnotarized color photo ID for any and all directors/shareholders with 5% or greater ownership.
2.Article of Incorporation.
3.Certificate of Incorporation.
4.Certificate of Good Standing. From the Secretary of State of Company registration
5.Board Resolution.
By signing above, I hereby authorize an updated investigation into my background and records, to comply with Customer Identification Program (CIP), Anti-Money Laundering (AML), Know Your Customer (KYC) and other regulations. I understand that I will not be allowed to participate in this exchange transaction program should I refuse an updated investigation, or if the results of that investigation indicate that I do not meet suitable standards, as determined in the sole discretion of the Transaction Principals. I release all persons and entities involved in the background investigation, from any and all liability in relation to the information obtained and action taken. If denied participation, I understand and agree that my sole remedy is the return of product.
I hereby swear under penalty of perjury, that the information provided herein is accurate and true.
Client Signature: ______
Date: ______, 2015
This 3 page Client Information Sheet (KYC) document was signed before me on this day ______of ______, 2015.Notary Signature: ______
Notary Printed Name: ______
Notary expiration date: ______
Notary Seal
CURRENCY TRANSACTION - KYC – revised August 22, 2015 Page 1of 3
Client Initials ______