Know your customer questionnaire

Customer information 1
KINDLY ATTACH THE FOLLOWING SUPPLEMENTARY ATTACHMENTS PROVIDED?
DOCUMENTS

Remarks
Yes No

Customer Name

Customer age

Customer nationality

National address

Do you have a residence in one of the countries that require you to pay tax
outside the Kingdom of Saudi Arabia ?

Are you a PEP?

Are you related to a PEP?

 Declaration 2
I/We declare that the above mentioned information and statements are true and correct to the best of knowledge of the
undersigned and it has been made in good faith. I further declare and accept that Al-Etihad insurance Company. Will depend
on this information in order for them to fulfil as well their regulatory
.obligations

Name Signature and Stamp Date

_______________________________ _____________________________ _______________________