Know-Your-Client (KYC) Questionnaire REGENCY ASSET MANAGEMENT (CYPRUS) LIMITED
REGISTRATION
CLIENT QUESTIONNAIRE (PHYSICAL PERSON)
A. Client Information
Please fill in the fields below as appropriate.
1. Full name: ………………………………………………………………………………………………………......2. Title (Mr, Mrs, Ms): …………………
3. Nationality: …………………………………………………………………………….
4. Passport number / ID card: ………………………………………………………...
5. Place and date of birth: …………………………………………………………….
6. Country of residence: ………………………………………………………………..
7. Marital status: ………………………………………………………………………….
8. Contact Details:
Home address:
……………………………………………………………...
……………………………………………………………......
……………………………………………………………...... / Work address:
…………………………………………………………..
……………………………………………………………...
……………………………………………………………...
Postal code:
………………………………………………………….. / Postal code:
…………………………………………………………..
City and country:
………………………………………………………….. / City and country:
…………………………………………………………..
Telephone:
………………………………………………………….. / Telephone:
…………………………………………………………..
Fax:
………………………………………………………….. / Fax:
…………………………………………………………..
E-mail:
………………………………………………………….. / E-mail:
…………………………………………………………..
9. Correspondence address (if different):
………………………………………………………………………………………………………......
……………………………………………………………………………………………………………………….
B. Employment Status and Financial Position
- Employment status (tick as appropriate):
Employed
/ Self-employed
/ Student
/ Retired
/ Not working
- Nature of business:
- Total estimated annual income in EUR (tick as appropriate):
Less than 50,000
/ Between 50,000 and 100,000
/ Between 100,000 and 200,000
/ More than 200,000
- Total estimated net worth in EUR (liquid assets, investments, real property):
C. Investor Experience
- In which of the following financial instruments do you consider having sufficient knowledge and experience to conclude transactions? Specify the volume, amount, frequency and duration of transactions, as applicable:
Financial instrument / Approximate volume and amount of transactions / Frequency and duration of transactions
CFDs / ………………………………………….. / …………………………..
Equities / ………………………………………….. / …………………………..
Undertakings for Collective Investment in Transferable Securities (UCITS) / ………………………………………….. / …………………………..
Money Market Instruments / ………………………………………….. / …………………………..
Bonds / ………………………………………….. / …………………………..
Derivatives / ………………………………………….. / …………………………..
- Read the following and tick as applicable:
- Carried out transactions in significant size on the relevant market at an average of ten (10) transactions per quarter over the previous four (4) quarters.
/ No
- The size of the portfolio, including cash deposits and financial instruments exceeds EUR 500.000.
/ No
- Works or has worked in the financial sector for a period of at least one (1) year in a professional position, which requires knowledge of the transactions or services envisaged.
/ No
D. Investment Targets
- Projected time horizon (tick as appropriate):
Less than 1 year
/ 1 – 3 years
/ 3 – 5 years
/ 5 – 10 years
/ More than 10 years
- Level of investment risk acceptance (tick as appropriate: 1 indicates the lowest risk level acceptance and 5 the highest):
1
(conservative investor) / 2
/ 3
/ 4
/ 5
(aggressive investor)
- Transactions planning to perform:
Financial instrument / Approximate volume of transactions (EUR per month/year) / Frequency of transactions (number per month/year)
CFDs / …………………………………...... / …………………………
Equities / …………………………………...... / …………………………
Undertakings for Collective Investment in Transferable Securities (UCITS) / ………………………….…………………. / …………………………
Money Market Instruments / …………………….………………………. / …………………………
Bonds / ……………………………………..……… / …………………………
Derivatives / …………………………………..………… / …………………………
E. Banking (Settlement) Details
Bank name / ………………………………………………………………………………………………….Branch address / ………………………………………………………………………………………………….
City & country / ………………………………………………………………………………………………….
Swift code / ………………………………………………………………………………………………….
Account number / ………………………………………………………………………………………………….
Client name / ………………………………………………………………………………………………….
F. Other Client Documentation to be Submitted
1 / ID or Passport of the client.2 / Recent (dated within 3 months) utility bill (water or electricity or phone) of the client.
3 / Power of the Attorney for the representation of the client by Regency Asset Management (Cyprus) Limited.
4 / Agreement for providing Investment Services.
5 / Authority and Indemnity in respect of telephone and fax instructions (if not included in the agreement).
6 / ID card or Passport of authorized representative/attorney (if a 3rd person acts as representative).
7 / Power of Attorney for the representation of the client by a 3rd person (if a 3rd person acts as representative).
8 / Signature specimen of the client or the authorized representative(s).
G. Client Confirmation
To the best of my knowledge I confirm that the information contained in this Questionnaire is both accurate and complete.
……………………………………………………… / ………………………Client/Authorised Representative Signature / Date
REGISTRATION
CLIENT QUESTIONNAIRE(LEGAL PERSON)
A. Client Information
Please fill in the fields below as appropriate.
- Name: ………………………………………………………………………………………………………...
- Form of incorporation (tick as appropriate)
Public company
/ Private company
/ Other (please specify)
………………………………………………
- Nature of business (bank/credit institution, investment firm, insurance company, other):
- Registrationdetails
Registration country:
…………………………………………………. / Registration number:
……………………………………………………
Registration date:
…………………………………………………. / Name of registrar/relevant authority:
……………………………………………………
- Contact Details
Registered office address:
…………………………………………………. / Correspondence address (if different):
……………………………………………………
Contact person:
…………………………………………………. / Contact person:
………………………………………………….
Telephone:
…………………………………………………. / Telephone:
………………………………………………….
Fax:
…………………………………………………. / Fax:
………………………………………………….
E-mail:
…………………………………………………. / E-mail:
………………………………………………….
Web-site:
…………………………………………………. / Web-site:
………………………………………………….
- Company’s authorised representative
Title (Mr, Mrs, Ms):
…………………… / Name:
………………………………... / Surname:
…………………………………….
Capacity:
……………………………………………………………………
Telephone:
……………………………………………………………………
Fax:
……………………………………………………………………
Email address:
……………………………………………………………………
Full address:
……………………………………………………………………………………………………………………..
- Domicile of at least one Director
Full name:
……………………………………………………………………………………………………………………..
Telephone:
……………………………………………………………………
Email address:
……………………………………………………………………
- Beneficial owners (full name, contact details, % of ownership):
B. Financial State/Position
- Read the following and tick as applicable
- Net Annual Turnover > EUR40.000.000
/ No
- Balance Sheet Total > EUR20.000.000
/ No
- Own Funds > EUR2.000.000
/ No
C. Knowledge & Experience
- In which of the following financial instruments do you consider having sufficient knowledge and experience to conclude transactions?Specify the volume, amount, frequency and duration of transactions, as applicable
Financial instrument / Approximate volume and amount of transactions / Frequency and duration of transactions
CFDs / ………………………………………. / ……………………………..
Equities / …………………………………….… / ……………………………..
Undertakings for Collective Investment in Transferable Securities (UCITS) / …………………………………….… / ……………………………..
Money Market Instruments / …………………………………….… / ……………………………..
Bonds / …………………………………….… / ……………………………..
Derivatives / …………………………………….… / ……………………………..
- Read the following and tick as applicable
- Carried out transactions in significant size on the relevant market at an average of ten (10) transactions per quarter over the previous four (4) quarters.
/ No
- The size of the portfolio, including cash deposits and financial instruments exceeds EUR500.000.
/ No
- Works or has worked in the financial sector for a period of at least one (1) year in a professional position, which requires knowledge of the transactions or services envisaged.
/ No
D. Investment Targets
- Projected time horizon (tick as appropriate)
Less than 1 year
/ 1 – 3 years
/ 3 – 5 years
/ 5 – 10 years
/ More than 10 years
- Level of investment risk acceptance (tick as appropriate: 1 indicates the lowest risk level acceptance and 5 the highest):
1
(conservative investor) / 2 / 3 / 4 / 5
(aggressive investor)
- Investment service planning to make use of (tick as appropriate)
Portfolio Management / Brokerage
(If you have selected the brokerage service, please fill the details of the Section D4)
- Transactions planning to perform (only for brokerage services)
Financial instrument / Approximate volume of transactions (EUR per month/year) / Frequency of transactions (number per month/year)
CFDs / …………………………………... / ……………………………..
Equities / …………………………………... / ……………………………..
Undertakings for Collective Investment in Transferable Securities (UCITS) / …………………………………… / ……………………………..
Money Market Instruments / …………………………………… / ……………………………..
Bonds / …………………………………… / ……………………………..
Derivatives / …………………………………… / ……………………………..
E. Banking (settlement) Details
Bank name: ……………………………………………………………………………………………………Branch address: ………………………………………………………………………………………………
City & country: ………………………………………………………………………………………………..
Swift code: …………………………………………………………………………………………………….
Account number: ……………………………………………………………………………………………
Client name: ………………………………………………………………………………………………….
F. Other Client Documentationtobe Submitted
1. / Certificate of Incorporation.2. / Certificate of Trade Name (where the client trades by its trade name).
3. / Certificate of Registered Address.
4. / Memorandum & Articles of Association of the company.
5. / Certificate of Directors (not older than 60 days, preferably 30 days old).
6. / Certificate of Good Standing (if the company has been incorporated for more than 6 months).
7. / ID or Passport of at least one director of the company.
8. / Recent (dated within 3 months) utility bill (water or electricity or phone) of at least one director of the company.
9. / Resolution of the Board of Directors to open an account and conferring authority to those who will operate it (authorized representative).
10. / Power of the Attorney for the representation of the client by Regency Asset Management (Cyprus) Limited.
11. / Agreement for providing Investment Services.
12. / Authority and Indemnity in respect of telephone and fax instructions (if not included in the agreement).
13. / Resolution of the Board of Directors for the representation of the client by a 3rd person accompanied by a relevant Power of Attorney (if a 3rd person acts as representative).
14. / ID card or Passport of representative(s) (if a 3rd person acts as representative).
15. / Signature specimens of the director(s) or the authorized representative(s).
16. / Certificate of Shareholders (private companies only).
17. / Contact & Personal Details for the major beneficial owners and controllers of the company (private companies only).
18. / ID or Passports of all the major beneficial owners and controllers of the company (private companies only).
19. / Bank Reference/Reference from a professional (lawyer/accountant) for all the major beneficial owners should be obtained (private companies only).
G. ClientConfirmation
To the best of my knowledge I confirm that the information contained in this Questionnaire is both accurate and complete.
……………………………………………………… / ………………………Client/ Authorized Representative Signature / Date
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