COMPLETE NAME

ADDRESS, EMAIL ADDRESS, CELLPHONE NUMBER

CLIENT INFORMATION SHEET

March 15, 2020

In accordance with Articles 2 and 5 of the due diligence and federal banking commission circular of
December 1999, concerning the prevention of money laundering, and Article 305 of the Swiss
Criminal Code, the following information may be supplied to banks and to financial institutions for
purposes of verification of identity and activities of the investing member, and the nature and
origin of the funds which are to be utilized.

Client Full Name

Client Address
Client Cell Phone No.
Client Personal Email Address
Nationality Filipino
Passport / ID Number
Issued By
Issue Date
Expiration Date
Social Security/Medicare No.
Drivers License No.
Date of Birth
Place of Birth
Company Name N/A
Registered Office Address N/A
Registered Number
Business Telephone
Mailing Address ( if different to registered office
address)
Email Address
Attorney TBA
Address TBA
Telephone TBA
Fax TBA
Mobile TBA
Email Address TBA
 COMPLETE NAME
ADDRESS, EMAIL ADDRESS, CELLPHONE NUMBER
Origin Of Funds Real Property Transaction
Are Funds Free and Clear Yes
Brief Corporate Activity N/A

Facilitator and/or Intermediary for transactions

between groups and/or Buyers and Sellers of:

Commodities/Banking
Instruments/Bonds/Currency Exchange

I hereby swear under penalty of perjury that the information given above is accurate and true.

Any information, work or service conducted hereunder is that of a private transaction that is
exempt from the Securities Act and not intended for the general public but for Private Use Only as
Beneficiary to the Settlement/Closing of the private transaction.

SIGNATURE AND SEAL

Signatory:
Passport:
Country: PHILIPPINES

Date:
 COMPLETE NAME
ADDRESS, EMAIL ADDRESS, CELLPHONE NUMBER

BANKING COORDINATES FOR BENEFICIARY:

BANK NAME:
BANK ADDRESS:

SWIFT CODE:
BANK OFFICER:
BANK PHONE No:
BANK FAX No:
A/C NUMBER:
IBAN A/C NO:
BANK ACCOUNT NAME:
EMAIL:
SIGNATURE

Personal Identification Documentation

COPY OF BENEFICIARY
DRIVERS LICENCE if applicable

COPY OF BENEFICIARY
PASSPORT.

COPY OF BENEFICIARY
HEALTH BENEFITS CARDA or TIN CARD
 COMPLETE NAME
ADDRESS, EMAIL ADDRESS, CELLPHONE NUMBER
PROOF OF RESIDENTIAL
ADDRESS (Note that P.O.BOX is not
acceptable)
To validate the home addresses of all
parties, please provide at least
ONECOPY of the following:
(a)    Original and recent bank
statement from a recognized
bank
(b)   Original and recent
credit card statement
(c)    Letter from your
employer (on headed paper)
confirming your permanent
address
(d)   Utility bill

Company Identification Documentation (if registering under company name)

COMPANY OR BUSINESS
INCORPORATION CERTIFICATE

PROOF OF COMPANYOR BUSINESS

ADDRESS (Note that P.O.BOX is not
acceptable)
To validate the home addresses of all
parties, please provide at least
ONECOPY of the following:
(a)    Original and recent bank
statement from a recognized bank
(b) Original and recent company credit
card statement
(c ) Copy Utility Bill
BUSINESS
Please provide description of your
activity.

For US Citizens and Companies Only

W-9 Form
Please provide your completed W-9
Form if you are a US Citizen or
company.