I. GENERAL INFORMATION

Company Name

Place of incorporation

Registration number

Date of incorporation

Legal address (Street, Town, Postal Code, Country)

Principal place of business (if different from the above)

Type of business  (LTD, LLP, LLC, PLC, Sole Trader, Government, non-profit etc.)

Business sector (SIC/NACE)

Is company publicly listed on a stock exchange?

Trademark(s) (if any)

Tax residence country code

Tax Identification Number (if any)

VAT registration number (if any)

Duration of business activity (less than 1 year, less than 3years, more than 3 years etc.)

Number of employees

Telephone number

Email

Website

Business Description in details if there is no website 

II. FINANCIAL INFORMATION

Currency/ies of the account 

INCOMING PAYMENTS

Name/s of partner/s

Country/ies of partner/s

Brief description of the economic essence of planned transactions

Country/ies of servicing Bank/s

Number of incoming payments (per month)

Estimated maximum MONTHLY turnover for Incoming payments

Estimated largest Incoming payment 

Source, amount, payer, name and country of servicing Bank, and purpose of FIRST Incoming payment

‍OUTGOING PAYMENTS

Name/s of partner/s

Country/ies of partner/s

Brief description of the economic essence of planned transactions

Country/ies of servicing Bank/s

Number of outgoing payments (per month)

Estimated maximum MONTHLY turnover for Outgoing payments

Estimated largest Outgoing payment 

III. ULTIMATE BENEFICIAL OWNER/S

Name

Surname       

Date of birth

Place of birth          

Nationality  

Identification document type and No. (issue and expiration date, issuing authority, name of issuing country)     

Residential address (street, city, postal code, country)

Tax Identification Number

Are you politically exposed person (PEP) or a PEP family member, or a close associate of a PEP?

Are you a U.S. person?

Participation in the company (%)

Telephone number

Email   

IV. SHAREHOLDER/S

Name

Surname       

Date of birth

Place of birth          

Nationality  

Identification document type and No. (issue and expiration date, issuing authority, name of issuing country)     

Residential address (street, city, postal code, country)

Tax Identification Number

Are you politically exposed person (PEP) or a PEP family member, or a close associate of a PEP?

Are you a U.S. person?

Participation in the company (%)

Telephone number

Email   

V. DIRECTOR/S

Name

Surname       

Date of birth

Place of birth          

Nationality  

Identification document type and No. (issue and expiration date, issuing authority, name of issuing country)     

Residential address (street, city, postal code, country)

Tax Identification Number

Are you politically exposed person (PEP) or a PEP family member, or a close associate of a PEP?

Are you a U.S. person?

Participation in the company (%)

Telephone number

Email   

VI. ACCOUNT-USE (OR POA/GPOA HOLDER/S) AUTHORIZED PERSON/S

Name

Surname       

Date of birth

Place of birth          

Nationality  

Identification document type and No. (issue and expiration date, issuing authority, name of issuing country)     

Residential address (street, city, postal code, country)

Tax Identification Number

Are you politically exposed person (PEP) or a PEP family member, or a close associate of a PEP?

Are you a U.S. person

Participation in the company (%)

Telephone number

Email