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Due Diligence Form DDF3 - Company Accounts


1

Account Name

Please complete this section indicating how you wish to have the account registered/recorded for future reference

Account Name

2

Company Details

Directors of the Company must complete the following details with the registered address of the Trust. ‘Care Of’ & PO Box addresses are not acceptable

Name of Entity Trading Names Nature of Business Country of Incorporation

Date of Incorporation

If different

Place of Domicile

Incorporation Number

Registered Address Postcode

If different from registered address

Principal Place of Business

Postcode Contact Name

Telephone Number

E-mail Address

If applicable

Name of Regulator

3

Correspondence Address

Companies may have a requirement that correspondence be sent to an alternative address. ‘Care Of’ & PO Box addresses are acceptable for this purpose only.

Address

Regulator Ref No.

Account Security & Access

4

When you contact Capital International Limited by telephone you may be asked to identify yourself. To assist us in this regard, can you please provide us with a codeword of your choice. In case you can not remember it at the time of your call, we have provided space for a codeword prompt to help remind you, i.e. ‘What is your place of birth?’

Codeword prompt Post Code

5

Codeword

Beneficial Owner Details

To be completed by all persons holding more than 25% of shares, if necessary submit on separate sheet. Where the Beneficial Owners, Directors and/or Shareholders are corporate entities, please utilise the personal fields in Sections 5 & 6 to provide the corporate equivalent.

First Beneficial Owner

Title

Second Beneficial Owner

Title

Surname

Surname

Forename(s)

Forename(s)

Other/Former Names

Other/Former Names

Percentage of Shareholding

Percentage of Shareholding

‘Care Of’ & PO Box addresses are not acceptable

Address

Address Post Code

Date of Birth

D D

M M

Y Y Y Y

Post Code Date of Birth

Nationality

Nationality

Tax Residence

Tax Residence

Place of Birth

Place of Birth

Passport No.

Passport No.

D D

M M

Y Y Y Y

If the Beneficial Owners have retired then please indicate this along with description of previous occupation

Occupation

Occupation

Employer

Employer

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Please ensure all fields are completed to avoid delays in processing

© Capital International Limited 2011


6

Director Details

First Director

If there are more than the allocated number of Directors, then please submit on a separate sheet

Second Director

Title

Title

Surname

Surname

Forename(s)

Forename(s)

Other/Former Names

Other/Former Names

Percentage of Shareholding

Percentage of Shareholding

Directors of the Company must complete the following details with their permanent residential address. ‘Care Of’ & PO Box addresses are not acceptable

Address

Address Post Code

Post Code

H W M

Contact Number E-mail Address Date of Birth

H W M

Contact Number E-mail Address

D D

M M

Y Y Y Y

Date of Birth

Place of Birth

Place of Birth

Nationality

Nationality

Passport No.

Passport No.

D D

M M

Y Y Y Y

If the Directors have retired then please indicate this along with description of previous occupation

Occupation

Occupation

Employer

Employer

Third Director

Fourth Director

Title

Title

Surname

Surname

Forename(s)

Forename(s)

Other/Former Names

Other/Former Names

Percentage of Shareholding

Percentage of Shareholding

‘Care Of’ & PO Box addresses are not acceptable

Address

Address Post Code

E-mail Address Date of Birth

Post Code

H W M

Contact Number

H W M

Contact Number E-mail Address

D D

M M

Y Y Y Y

Date of Birth

Place of Birth

Place of Birth

Nationality

Nationality

Passport No.

Passport No.

D D

M M

Y Y Y Y

If the Directors have retired then please indicate this along with description of previous occupation

Occupation

Occupation

Employer

Employer

7

Company Bank/Building Society Account Details

Please complete this section with the company banking details. Not only will these be used to fulfil our regulatory requirements but distributions and withdrawals can be made directly to your bank or building society account.

Account Name Bank/Building Society Name Bank/Building Society Address Post Code Branch Sort Code

Account Currency

GBP/USD/EUR or other_____

Please delete as appropriate

Bank/Building Society Account Number or IBAN SWIFT/BIC Code The sort code and account number, SWIFT/BIC Code or IBAN can be obtained from your Bank or Building Society branch. Please ensure your account will accept direct credit payments through the Banks Automated Clearing System. Capital International Limited does not accept instructions for payments to be made to an account other than the client’s own personal account. Should the quotation of account numbers and sort code, or IBAN made by the applicant prove incorrect, Capital International Limited will not accept responsibility for any loss incurred by the applicant.

Page 3

Please ensure all fields are completed to avoid delays in processing

© Capital International Limited 2011


8

Declaration & Signature

You must sign and date the form below

I/We understand that the information I/we provide on this application form, and any additional information supplied, will be processed in accordance with Capital International Limited’s data protection statement. I/We declare that: I/We am/are 18 years of age or over. I/We understand that we are not obligated or bound by any contractual agreement - this application form is for account set-up and information purposes only. I/We agree that the information contained within this application form is true and accurate. Unless you were introduced by an Intermediary, Capital International Limited may use your personal information to tell you of other products and services, as well as others from within the Capital International Group of Companies, which they believe may be of interest to you. If you do not wish for your personal information to be used in this way, please put an X in this box.

Signatures of ALL Directors who have supplied details on this application form. (YOU MUST SIGN HERE - Please ensure all relevant sections are completed as per the instructions on this form)

First Authorised Signatory

FIRST AUTHORISED SIGNATORY MUST SIGN HERE Date

D D

Print Name

M M

2 0 Y Y

M M

2 0 Y Y

Second Authorised Signatory

SECOND AUTHORISED SIGNATORY MUST SIGN HERE Date

D D

Print Name

9

Checklist

We have fully completed this application form We have signed the application form We have provided a certified copy of the Certificate of Incorporation We have provided a certified copy of the Memorandum and Articles of Association We have provided a certified copy of the Board minutes authorising the opening of the account with Capital International Limited We have provided a certified copy of the Authorised Signatory List We have provided a certified copy of a valid piece of photographic ID per Director, Authorised Signatory and Beneficial Owner i.e. current passport or driving licence We have provided a certified copy of a valid piece of residential address verification per Director, Authorised Signatory and Beneficial Owner, i.e. bank statement or utility bill. This can not be more than six months old.

Internal Use Only D D

M M

Acknowledged By:

Application Processed:

2 0 Y Y

D D

M M

Acknowledged By:

2 0 Y Y

Client Notification Sent:

D D

M M

2 0 Y Y

Acknowledged By:

CIL - Company DDF1 - V1.01-09.11

Received Date:

CIL - DDF3 (Corporate) - V1.01-09.11  

Due Diligence Form DDF3 - Company Accounts

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