CURRENCY TRANSACTION
Know Your Client (KYC)
DO NOT USE THIS FILE TO REPLACE TYPE
USE THIS TO LOOK AT ONLY!
Date: Put in todays date 10-5-2015 (NOT IN RED, MUST BE BLACK)
“Note: Information must be typed – hand written KYC document will NOT be accepted” (MUST STAY RED, DO NOT REMOVE OR CHANGE THIS TO BLACK)
PERSONAL INFORMATION – ensure the ID used has NOT expired
Full Name : FIRST MIDDLE LAST
Current Home Address : 12345 STREET AVENUE
Primary Phone Number : 222-222-2222
Fax Number : 333-333-3333
Personal email Address :
Passport Number- Country : 123456789 USA
OR Driver License Number : 1234567 TX [DON’T LEAVE THIS BLANK, fill in or put N/A]
Date of Issue : It was issued on this date
Expiration Date : It expires on this date
Who Referred you : SOPC Stan Johnson
SS, SIN or other Number : 444-44-4444
Country Issued By : USA
Date of Birth : 12-12-1912
Place of Birth : DALLAS, TX
BUSINESS INFORMATION If Client (if using a registered Business)
Company Name : N/A (Fill in only if you have a business)
Company Address : N/A
Registration Number : N/A
Registered Office Address : N/A
Employer Identification Number (EIN): N/A
Company Telephone Number: N/A
Company Fax Number : N/A
Company Email Address : N/A
Company Website Address: N/A
BANKING INFORMATION – all fields are mandatory and must be filled in
Account Name : JANLEY E. STONSON (YOUR NAME)
Name of Bank : BANK OF THIS IS MY BANK
Bank Address : Credit Unions can be used
Bank Account Number : 123-456-7890
SWIFT Code : Call your LOCAL bank and ask them
ABA Routing Number : Call your LOCAL bank and ask them
IBAN Number : N/A (This is for international banks)
Transit & Bank Institution Numbers : 1234 (Bank number within this banking group)
Bank Officer Name and Title : WHOOPIE D. DOO - MANAGER
Bank Officer Phone Number : 123-45-6789
Bank Fax Number : 987-654-3210
Bank Officer Email Address :
Banks Special Wiring Instructions : N/A
BANKING INFORMATION for second bank – all fields are mandatory and must be filled in
Account Name : N/A (Probably no one will have this, it is a second bank)
Name of Bank : KEEP IN HONG KONG
Bank Address : N/A
Bank Account Number : N/A
SWIFT Code : N/A
ABA Routing Number : N/A
IBAN Number : N/A
Transit & Bank Institution Numbers : N/A
Bank Officer Name and Title : N/A
Bank Officer Phone Number : N/A
Bank Fax Number : N/A
Bank Officer Email Address : N/A
Banks Special Wiring Instructions : N/A
Personal Documentation Required
1. Notarized KYC).
2. Notarized Photo ID (passport or driver license) – must be color copy. If not available than 2 notarized government issued documents with photo.
ADDITIONAL documentation for company
1. Notarized KYC with notarized color photo ID for any and all directors/shareholders with 5% or greater ownership.
2. Article of Incorporation.
3. Certificate of Incorporation.
4. Certificate of Good Standing. From the Secretary of State of Company registration
5. Board Resolution.
By signing above, I hereby authorize an updated investigation into my background and records, to comply with Customer Identification Program (CIP), Anti-Money Laundering (AML), Know Your Customer (KYC) and other regulations. I understand that I will not be allowed to participate in this exchange transaction program should I refuse an updated investigation, or if the results of that investigation indicate that I do not meet suitable standards, as determined in the sole discretion of the Transaction Principals. I release all persons and entities involved in the background investigation, from any and all liability in relation to the information obtained and action taken. If denied participation, I understand and agree that my sole remedy is the return of product.
I hereby swear under penalty of perjury, that the information provided herein is accurate and true.
Client Signature: ______(Used in the .pdf phase ONLY)
Date: ______, 2015 (DON’T USE THIS FILE TO RE-TYPE OVER! PLEASE!)
This 3 page Client Information Sheet (KYC) document was signed before me on this day ______of ______, 2015.Notary Signature: ______
Notary Printed Name: ______
Notary expiration date: ______
Notary Seal
CURRENCY TRANSACTION - KYC – revised August 22, 2015 Page 4 of 4
Client Initials ______