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Jose de Jesus Lopez Gomez: Client Information Sheet For Paymaster Services

This document contains client information for Jose de Jesus Lopez Gomez, including his full name, nationality, passport information, date of birth, contact information, and a statement that the funds for the activity were lawfully earned through commercial enterprise of non-criminal origin. It is signed by Jose de Jesus Lopez Gomez and provides his passport information and date. The document notes it is classified and confidential.

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412 views3 pages

Jose de Jesus Lopez Gomez: Client Information Sheet For Paymaster Services

This document contains client information for Jose de Jesus Lopez Gomez, including his full name, nationality, passport information, date of birth, contact information, and a statement that the funds for the activity were lawfully earned through commercial enterprise of non-criminal origin. It is signed by Jose de Jesus Lopez Gomez and provides his passport information and date. The document notes it is classified and confidential.

Uploaded by

Max
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Jose de Jesus Lopez Gomez

CLIENT INFORMATION SHEET


FOR PAYMASTER SERVICES
DATE: March 30 , 2016
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
Nationality
Passport Number
Issued By
Issue Date
Expiration Date
Social Security Number (MEDICARE NO:)
if any
LICENCES HELD(IF ANY)
Phone No.

Jose de Jesus Lopez Gomez


Mexican
G14169957
United states of Mexico
March,
03 of 2014
March,
03 of 2017

E mail address

licjesuslopezg@gmail.com

Skype address
Date of Birth
Place of Birth

Jesuslopezgomez123
July 04
1985
Zacatecas - Mexico

Company Name
Registered Office
Registered Number
Business Telephone
Mailing Address
Email Address

N/A
N/A
N/A
N/A
N/A
N/A

N/A
N/A
+524921320434

Attorney ( if you have one)


Address
Telephone
Fax
Mobile
Email Address

Origin Of Funds re this activity

The FUNDS were lawfully earned, through


commercial enterprise of NON criminal origin.

CLASSIFIED AND CONFIDENTIAL


Initial: ___________

Page 3 of 3

Jose de Jesus Lopez Gomez


Are Funds Free and Clear

Yes

Brief Corporate Activity


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 placement
transaction that is exempt from the Securities Act and not intended for the general public but
for Private Use Only.

______________________________________________
SIGNATURE AND SEAL (electronic signature or original)
Signatory: Jose de Jesus Lopez Gomez
Company: N/A
Title: Individual
Passport:
G14169957
Country: Mexico
Date: March 03, 2017

CLASSIFIED AND CONFIDENTIAL


Initial: ___________

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Jose de Jesus Lopez Gomez

CLASSIFIED AND CONFIDENTIAL


Initial: ___________

Page 3 of 3

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