High Risk Non-Individual KYC - FIASERV eKYC

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High Risk Non-Individual - KYC Form

Fields marked * are mandatory.

Entity Information

Full Name of Customer (Entity) *

Entity Type *

Registration / Incorporation Number *

Date of Incorporation

Place of Incorporation

Country of Incorporation *

Place / Country of Business Operations

Industry *

Occupation *

Customer Type *

Head Office Address *

Directors / Shareholders / Trustees / Beneficiaries

Name	Role	ID Type	ID Number	Nationality

Customer Representative (Where Applicable)

This customer has an authorised representative

Source of Funds & Tax

Source of Funds *

Tax Status / TIN Number

Source of Funds - Details

Tax Compliance Notes

Source of Wealth

Source of Wealth *

Source of Wealth Document

Senior Management Sign-Off

Senior Management Approval Obtained *

Name of Approving Officer

Approval Date

Approval Notes / Justification

Senior Management Sign-Off Document

Supporting Documents

Certificate of Incorporation

CR6 (Directors Register)

CR2 (Shareholders Register)

Memorandum & Articles of Association

Trust Deed (If applicable)

Company Profile / Prospectus

Source of Funds Document

Tax Returns / Capital Gains Tax Document

Directors / Principals ID Documents

Representative Authorisation Document

Additional Notes

Notes