QUESTIONNAIRE

• Source of funds?

Personal savings ____ Life insurance ____ Plan Loan ____

Pension plan ____ Inheritance ____ Home Mortgage ____

Investment ____ Business ____ Sales _____

Other: (Specify)
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• Business activity
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• What is the country origin of money

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• Purpose for the investment account?

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• Is the company going to receive or transfer funds?

Always _____ Sometimes ______ Occasionally _______
Name of the bank / company / person:
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• Way for receiving or transferring funds:
Checks ___ International wire transfers _____ Local wire transfers _____
Money orders ____ Certificates ____
Other: (specify)_____________________________________________________________

• Average of income and number of transactions expected:

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• Average of withdraw and number of transactions expected:
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