Source of wealth declara on - 2023

This document is to be lled by Ul mate bene cial owners (for corporate applica ons) and by Individuals (for
personal applica ons) reques ng a payment bank account to be issued at Codego.

The source of wealth declara on describes the way/s in which you acquired your nancial wealth. Codego, as
a licensed nancial ins tu on, is obliged to collect this informa on.

All the elds are to be fully completed. Please input N/A if it’s not applicable to you.

An applica on form is not considered complete unless the relevant informa on is fully completed as per
these guidelines.

Please complete as follows:

1. Self-declara on
Self declara on
I,

having an occupa on/profession/job tle as:

declare that I have legi mately acquired my source of wealth through:

Salary/Self employment

If ‘Salary/Self employment’ is chosen, kindly provide your employment contract or payslips or self-employment invoices/agreements

Assets/Investing/Trading/Dividends

If ‘Assets/Inves ng/Trading/Dividends’ is chosen, kindly provide the relevant proof detailing this wealth such as nancial statements, contract of
sale/s, investment statements, and/or any other relevant documenta on suppor ng the described wealth

Other (please provide more details)

If ‘Other’ is chosen, kindly provide suppor ng documenta on to jus fy the described wealth

Date: Signature:

Please sign electronically. If this is not possible, kindly print this form, sign it, and scan it.

1
This document is strictly con den al, neither to be shared in public nor outside your organiza on
Codego | Via Monte Napoleone 8 | 20100, Milan | Italy | banking@codegotech.com
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