SECTION A: PERSONAL PARTICULARS
Full name:
Date of birth:
Identity card or passport number:
Nationality:
Residential address:
Telephone number:
Email address:
SECTION B: OCCUPATION / BUSINESS DETAILS
What is your occupation?
If you are a business owner, please
provide details of the industry and
business (e.g. products / services).
FOR OFFICE USE
Verification of client’s details
Verify each of the following details Document
obtained in Section A to the verified to:
original identity card or passport (or
other independent and
reliable identification document) that
bears a photograph of the Copy of
client: document Yes / No
- Full name retained:
- Identity card or passport (or other
identification
document) number
- Nationality
- Date of birth
- Residential address
Where the identity card or passport (or Document
other independent and verified to:
reliable identification document) does
not indicate the residential
address, verify to other independent and
reliable document Copy of
document Yes / No
containing the residential address of the retained:
individual (e.g., an
original bank statement or recent utility
bill).
The following details of the client: Yes / No
- Full name
- Identity card or passport (or other
identification
document) number
- Residential address
have been screened, as a minimum, to:
(a) The list of sanctioned individuals
(b) Any other similar lists and information
required of professional firms for
screening purposes stipulated by
relevant authorities.