FINTRAC- MANDATORY Ascertaining Identification of Each Client as required by the Proceeds of Crime

(Money Laundering) and Terrorist Financing Act

* Please complete this form with information from a source of current identification.

CENTURY 21 In Town Realty 421 Pacific Street, Vancouver, BC V6Z 2P5

Date:   

Realtor’s Name: Mike Stewart

Client’s Name:  Joe Smith

Is this your LISTING:  Yes    No

Is this your SALE:  Yes    No

Subject Property Address:   

INDIVIDUAL

ID Type:                     _________BC Drivers License____________

 (eg.: BC Driver’s License, BC ID, Canadian Passport)

ID Number:                ____________123456___________________________

Name:                         _______Joe Smith______________________________

Address:                     ________666-123 Anystreet, Vancouver, BC________

                       
Date of Birth:             ____________January 1, 1980____________________

Occupation:                _______________Labourer______________________

CORPORATION (if applicable)

Corporation Name: N/A

Address:                     N/A

Copy of Official Corporate Records:  Certificate of Corporation Registration Number, List of Directors,
Verification of Authority to sign on behalf of Corporation
(Included:  Yes or No (circle)

THIRD PARTY
Written agreement in place that the individual of company is being identified (including a relative) and that
the agent has seen the identification.