Become A Partner – Mobil Plus

KNOW YOUR CUSTOMER (KYC) FORM
STRICTLY CONFIDENTIAL

1. Full Name

2. Legal Status

Individual Company Partnership Others

3. Permanent Address

4. Business / Trading Address

5. ID No./CR No./Registration No.

6. Purpose and Nature of Transaction to be undertaken

7. In case of Individual

(i). Nationality

(ii). Occupation or Profession

(iii). Name of Establishment or Employer

(iv). Location of activity

(v). Is the Individual a Politically Important person (PEP)

Yes No

8. In case of Others

(i).City & Country of Incorporation

9. Date of Birth / Incorporation

10. What is the principal business/activity of the Customer?

11. Is the Customer acting on behalf of another Person ?

yes No

If yes,

(i). Name of Beneficial Owner

(ii). ID No./CR No./Registration No

(iii). Domicile Country

(iv). If Beneficial Owner is an Individual, then

(a). Nationality

(b). Is the Individual a Politically Important Person (PEP)?

Yes No

12. Regulatory Status

Independent Regulator Non-Independent Regulator Unregulated

13. Name of Regulator (if any)

14. Name of Stock Exchange(if Listed)

15. If a Holding company, name of any other subsidiaries/branches/associated companies

16. If not, Group Company (if any)

17. If business activities are conducted in more than one country, please indicate names of all countries

18. Bank Details

19. Contact Details Of Customer

(i) Contact Person

(ii) Tel & Fax

(iii) E-mail/Website

(iv) Contact details of Compliance Officer (if any)

20. Copies* of Customer Identification Documents

Please submit the documents and tick against the documents attached

(i) Individual

ID Card/Passport/Driving License(DL) Proof of Domicile Country**

(ii) Company

Company Registration (CR) List & Passport copies of Authorised Signatories List of Major Shareholders List & Proof of Domicile Country** of Directors

Major Shareholders:-Shareholders who, directly or indirectly, owns or controls more than5% of the shares or voting rights

(iii) Partnership

Certificate of Registration Partnership Deed List of Major Shareholders List & Passport copies of Authorised Signatories List & Proof of Domicile Country** of Partners

(iv) Trust

Certificate of Registration Trust Deed List & Passport copies of Settlor,Trustees,Protector List & Passport copies of Authorised Signatories List of Major Beneficiaries

Major Beneficiaries:-Beneficiary who is to receive atleast 25% of the funds of the Trust

(v) Any other Legal Person

Registration Document List & Passport copies of Authorised Signatories List of the Individuals/Entities who ultimately owns, or exercises effective control over such person

Declaration
I/We hereby confirm that the above information provided to you is true and correct to the best of our knowledge. I/We acknowledge that if the information provided is found to be false or misleading then the business relationship may be annulled anytime at your discretion. I/We hereby agree to provide any additional information/documentation that may be required.

Date

Signature of Authorized Signatory

*Certified copies of documents clearly signed, stamped and dated by any of the following: -
(1) A representative of an embassy, consulate or high commission of the country; or
(2) A lawyer or attorney; or
(3) A notary public or commissioner of oaths; or
(4) A chartered or certified accountant.
The date of signatory should not be older than 3 months. Copies of certified copies is not acceptable. **Any document to show the residential address like utility bill, tenancy agreement.

KNOW YOUR CUSTOMER (KYC) FORM
STRICTLY CONFIDENTIAL

1. Full Name

2. Legal Status

Individual Company Partnership Others

3. Permanent Address

4. Business / Trading Address

5. ID No./CR No./Registration No.

6. Purpose and Nature of Transaction to be undertaken

7. In case of Individual

(i). Nationality

(ii). Occupation or Profession

(iii). Name of Establishment or Employer

(iv). Location of activity

(v). Is the Individual a Politically Important person (PEP)

Yes No

8. In case of Others

(i).City & Country of Incorporation

9. Date of Birth / Incorporation

10. What is the principal business/activity of the Customer?

11. Is the Customer acting on behalf of another Person ?

yes No

If yes,

(i). Name of Beneficial Owner

(ii). ID No./CR No./Registration No

(iii). Domicile Country

(iv). If Beneficial Owner is an Individual, then

(a). Nationality

(b). Is the Individual a Politically Important Person (PEP)?

Yes No

12. Regulatory Status

Independent Regulator Non-Independent Regulator Unregulated

13. Name of Regulator (if any)

14. Name of Stock Exchange(if Listed)

15. If a Holding company, name of any other subsidiaries/branches/associated companies

16. If not, Group Company (if any)

17. If business activities are conducted in more than one country, please indicate names of all countries

18. Bank Details

19. Contact Details Of Customer

(i) Contact Person

(ii) Tel & Fax

(iii) E-mail/Website

(iv) Contact details of Compliance Officer (if any)

20. Copies* of Customer Identification Documents

Please submit the documents and tick against the documents attached

(i) Individual

ID Card/Passport/Driving License(DL) Proof of Domicile Country**

(ii) Company

Company Registration (CR) List & Passport copies of Authorised Signatories List of Major Shareholders List & Proof of Domicile Country** of Directors

Major Shareholders:-Shareholders who, directly or indirectly, owns or controls more than5% of the shares or voting rights

(iii) Partnership

Certificate of Registration Partnership Deed List of Major Shareholders List & Passport copies of Authorised Signatories List & Proof of Domicile Country** of Partners

(iv) Trust

Certificate of Registration Trust Deed List & Passport copies of Settlor,Trustees,Protector List & Passport copies of Authorised Signatories List of Major Beneficiaries

Major Beneficiaries:-Beneficiary who is to receive atleast 25% of the funds of the Trust

(v) Any other Legal Person

Registration Document List & Passport copies of Authorised Signatories List of the Individuals/Entities who ultimately owns, or exercises effective control over such person

Date

Signature of Authorized Signatory

Call us

Monday to Friday

E-mail us

KNOW YOUR CUSTOMER (KYC) FORM
STRICTLY CONFIDENTIAL

KNOW YOUR CUSTOMER (KYC) FORM
STRICTLY CONFIDENTIAL

Head Office

Canada

USA

UAE

KNOW YOUR CUSTOMER (KYC) FORM STRICTLY CONFIDENTIAL

KNOW YOUR CUSTOMER (KYC) FORM STRICTLY CONFIDENTIAL

DISCLAIMER

Select Your Region

Canada

USA

UAE

KNOW YOUR CUSTOMER (KYC) FORM
STRICTLY CONFIDENTIAL

KNOW YOUR CUSTOMER (KYC) FORM
STRICTLY CONFIDENTIAL