Know Your Customer Form

CONTRACTING PARTNER
Name of individual/company:(required) Street address:(required)

Please, tick the appropriate box, A or B, and complete the form
A I, the Contracting Partner, declare that I am the Beneficial Owner.
INFORMATION ABOUT THE BENEFICIAL OWNER (“BO”)
B I, the Contracting Partner, declare that I am not the Beneficial Owner and that the Beneficial Owner is:
BO information address (if different than above) Name of individual/company: Street address:

OTHER INFORMATION
Mobile number:(required) Correspondence address:(required)

IDENTITY INFORMATION
Nationality:(required) Date of birth:(required)

FAMILY INFORMATION
Marital status: (required) Name of spouse: Date of birth of spouse: Occupation of spouse: Names of children:(Only those of legal age) Dates of birth of children:(Only those of legal age)

PROFESSIONAL INFORMATION
Description of current activity and position:(Required) Name and address of company:(Required) Activity of the company:(Required) Professional telephone:(Required) Professional email:(Required) Internet site of the company: Estimation of my global yearly income:(Required)

WEALTH
Description of how the BO acquired his/her wealth:(Required) Estimation of my global wealth:(Required)

FUNDS WITH AFRISWISS
Explanation about the origin of the funds transferred or invested with AfriSwiss:(Required) From where will the assets will be transferred:(Required) What is the purpose of using the services of AfriSwiss:(Required)

PUBLIC FUNCTION
Is the BO a PEP (Politically Exposed Person) or personally close to or a family member of a PEP?:(Required) Is the BO active in a sensitive sector (as armament, casinos, gambling establishments, tobacco etc..?(Required) Does the BO have a Mining or Precious metal Trading License? If so please provide copy. YesNo Mining or Precious metal Trading License: (pdf, file limit 2mb)

OTHER INFORMATION ABOUT THE BO
Please, give relevant complementary information if necessary:

ACKNOWLEDGEMENT

The BO, respectively the Contracting Partner, has been made aware that:
•If during the course of the business relationship, the circumstances of the BO changes to such an extent that an adjustment of the profile becomes necessary, AfriSwiss will have to be informed without delay.
•The BO authorizes AfriSwiss to conduct an inquiry through professional companies to confirm and complete the information given by the BO.
•All the information about the BO will kept totally secret, unless obliged to divulge information by an authority, as within the framework of a criminal investigation.
•The passport of the BO has to be photocopied by AfriSwiss or a certified copy of the passport to be remitted to AfriSwiss.
•The BO, respectively the Contracting Party, has been made aware that to intentionally complete this form in an erroneous manner constitutes creating a false document falling under the Uniform Commercial Code of the Kenyan penal code.
•The BO, when requested, will provide their fingerprints to AfriSwiss for security reasons.

Additional information required to complete the compliance package

1. Proof of address for the beneficial owner or the contracting partner i.e. electric bill, or telephone bill or bank statement.
Proof of address:(required)(pdf, file limit 2mb)
2. Certificate of company registration.
Certificate of company registration:(required)(pdf, file limit 2mb)
3. Two reference letters from a bank officer, lawyer, or accountant.
Reference letters:(required)(pdf, file limit 2mb)
Place and Date:(required)
Signature of the BO:(required)
Signature of the Contracting Partner: (if different than the BO)(jpg/png, file limit 1mb)