Due Diligence Form DDF1 - Personal Accounts
1
Account Name
Please complete this section indicating how you wish to have the account registered/recorded for future reference
Account Name
2
Applicants Details
First Applicant
If there are more than the allocated number of applicants, then please submit on separate sheet
Existing Account No. (if known)
Second Applicant
Title
Title
Surname
Surname
Forename(s)
Forename(s)
Other/Former Names
Other/Former Names
Existing Account No. (if known)
Applicants must complete the following details with their permanent residential address. ‘Care Of’ & PO Box addresses are not acceptable.
Address
Address Post Code
Post Code
Contact Number
Contact Number
E-mail Address
E-mail Address
Date of Birth
D D
M M
Y Y Y Y
D D
Date of Birth
Place of Birth
Place of Birth
Nationality
Nationality
Passport No.
Passport No.
Tax Residence
Tax Residence
M M
Y Y Y Y
Applicants must complete the following details with their current occupation - if applicant has retired then please indicate this along with description of previous occupation.
Occupation
Occupation
Employer’s Name & Address
Employer’s Name & Address Post Code
Post Code
Preferred Method of Contact - Please delete as appropriate
3
Telephone / E-mail / Fax / Mail
Correspondence Address
Applicants may require correspondence sent to an alternative address. ‘Care Of’ & PO Box addresses are acceptable for this purpose only.
Address
Account Security & Access
4
When contacting Capital International Limited by telephone you may be asked to identify yourself. To assist us in this regard, please provide us with a codeword of your choice. In case you can not remember at the time of the 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
Bank/Building Society Account Details
Please complete this section with your 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 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.
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Please ensure all fields are completed to avoid delays in processing
© Capital International Limited 2011
7
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.
Please indicate who Delete as appropriate - Signing Together / Signing Alone _______________________________
Signing Authority
Signatures of ALL Applicants (YOU MUST SIGN HERE - Please ensure all relevant sections are completed as per the instructions on this form)
First Applicant - Signature
FIRST APPLICANT MUST SIGN HERE Date
D D
First Applicant - Print Name
M M
2 0 Y Y
M M
2 0 Y Y
Second Applicant - Signature
SECOND APPLICANT MUST SIGN HERE Date Second Applicant - Print Name
8
D D
Checklist
I/We have fully completed this application form I/We have signed the application form I/We have provided a certified copy of a valid piece of photographic ID per applicant, i.e. current passport or driving licence. I/We have provided a certified copy of a recent piece of residential address verification per applicant, i.e. bank statement or utility bill. This can be no more than six months old
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Please ensure all fields are completed to avoid delays in processing
Š Capital International Limited 2011
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 - Personal DDF1 - V1.01-09.11
Received Date: