DESTINATION OF FUNDS DECLARATION
INSTRUCTIONS CSB has responsibilities under the laws of the Cook Islands in relation to the activities of Anti Money Laundering and the Suppression of Terrorism. For this reason, we require to know your responses to the following questions prior to our processing your request to transfer funds from your account. We thank you for your understanding and cooperation with this requirement.
ACCOUNT INFORMATION Account Name:
Account Number:
Date:
TRANSFER INFORMATION 1
Do you intend to transfer/transmit these funds out of the Cook Islands? Yes (please complete 2 and 3) No (please complete 2)
2 Please indicate the following: a.
The purpose for which these funds will be used:
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3
b.
The currency and amount of the transfer:
c.
The expected frequency of the transfer
If you intend to transfer/transmit these funds out of the Cook Islands, please indicate the following:
a.
The country to which the funds will be transferred to:
b.
The expected Recipient(s)/ Beneficiary(s)/Organization:
Form - DoF June 2016 CAPITAL SECURITY BANK LIMITED 1