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Name of company or fund *

ASSETS AND PARTICIPATIONS

Do you participate in any of these activities or own assets?

Bienes

Holding, explain the type of participation
Other companies (provide names and location)
Real Estate (provide location of property and estimated value)
Bonds, stocks or other securities
Society dedicated to commerce, electronic commerce and/or industry (explain the activity please)
Other activities (please provide a description)
Operating bank accounts and/or investment accounts. Please provide the banks name and location.

Explain the type of assets or participation

Name of the bank: *

Bank Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Name of the bank: *

Bank Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

PEP Declaration

Are you or any member of your family a politically exposed person (PEP)?

Yes
No

If you answered yes to the question above, please provide the details below (public position held, length of service, and other relevant details): *

Main data

Name of beneficiary *

First

Last

Beneficiary percentage *

Telephone number *

Telephone number

E-mail *

E-mail

Nationality *

Residence address: * *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Fiscal residence (if different from the place of residence):

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Address for delivery of document(s) (if different from place of residence):

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Cedula and/or Passport *

Cédula
Passport

Cedula (front) *

Click or drag a file to this area to upload.

Cedula (back) *

Click or drag a file to this area to upload.

Passport *

Click or drag a file to this area to upload.

Selfie showing document next to your face *

Click or drag a file to this area to upload.

selfie

Utility bill with your address (water, electricity, gas) *

Click or drag a file to this area to upload.

Proof of income of the beneficiary *

Click or drag a file to this area to upload.

Proof of income can be: a copy of your income tax return, a certification letter from an accountant stating how much you earn per year, a bank account statement, a letter from work certifying the amount of your salary, a financial statement prepared by an accountant, a certificate of pension. ATTENTION that the data must match those expressed in the KYC.

Balance/accounting *

Click or drag files to this area to upload. You can upload up to 4 files.

Average annual income during the previous year: *

Tax ID number

What is your occupation ( job, profession, etc.) *

Name of company for which you are currently employed: (if applicable)

Activity of the company you work for: *

Civil status? *

Married
Single

Name of spouse: *

First

Last

Personal References (minimum two)

Reference 1

Please select *

Lawyer
Bank
Public Accountant
Commercial reference

Telephone *

Telephone

E-mail *

E-mail

Physical address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Reference 2

Please select *

Lawyer
Bank
Public Accountant
Commercial reference

Telephone *

Telephone

E-mail *

E-mail

Physical address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Note: -If there are more beneficiaries, they must complete a KYC for each one.

Layout

Share with additional beneficiary via Email

Share with additional beneficiary via WhatsApp

Digital signature:

Your first and last name *

Grab a sheet of paper, put your signature, take a selfie with the signed sheet next to your face and upload the photo here *. *

Click or drag a file to this area to upload.

selfie

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Email *

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